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Part of cannabis laws and regulations

Peter Blecher is the chief medical officer of Starseed Medicinal, a Canadian licensed producer of medical cannabis, an emergency room physician and a medical director for CPM Centres for Pain Management.

Two major milestones were reached in the past few days: Canada became the first G7 country to legalize cannabis for recreational use; and it was reported that a record number of Canadians – nearly 4,000 – died from opioid overdoses in 2017.

These two events do not seem to be connected, but they are.

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The legalization of cannabis is prompting employers across Canada to review their workplace policies, as concerns are raised about employees showing up to work high. New “cannabis in the workplace” guidelines are furiously being drafted as the scent of marijuana becomes increasingly familiar in parking lots and parks.

At the same time, we know that we have an overwhelming number of Canadians who suffer from chronic pain – totalling nearly one in five of all adults.

We also know that in most, if not all, of these cases, opioids are not the answer. In my time as a physician, I have seen firsthand the disastrous and even life-threatening effects of opioids, which have tenuous evidence for use beyond short-term, or traumatic pain.

What is the answer? In many cases, it may include medical cannabis.

I am a veteran of 25 years working as an ER doctor in busy urban emergency departments, and have practiced chronic pain management for the past 15 years. In that capacity, I prescribe cannabis to some of my patients.

My patients are lawyers, teachers, scientists, accountants, labourers and grandmothers, all suffering debilitating and chronic pain. They are not looking to get high. They are looking to get well.

The medical cannabis I prescribe is typically high CBD oil. The two most prevalent active components in cannabis are cannabidiol (CBD) and THC, which is the psychoactive component that is associated with “getting high.”

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CBD is not intoxicating, but has valuable therapeutic benefits to treat chronic pain and inflammation – among other conditions. It can help people control their pain and adds to their quality of life. It means they can go to the office. They work. They contribute to society.

I began prescribing medical cannabis after hearing about its benefits from my patients. Medical cannabis began as a patient-led movement. At a time when medical authorities, such as the Ontario Medical Association and the Canadian Medical Association, had approved guidelines for physicians to use long-acting opioids, I began hearing from my patients about the positive effects of cannabis.

In my practice, I saw that at times the opioids, the very drugs prescribed to lessen pain, were in fact heightening it. With medical cannabis, I saw results. More than that, patients were able to get off opioids, and avoid their deadly addictive qualities.

Medical cannabis, when used properly and responsibly, is very unlikely to be addictive. Unlike opioids, a person would have to consume an incredibly large amount to overdose on cannabis. This confusion should concern us all as it could lead to restrictions on the rights of medical cannabis patients in the workplace.

Through my pain management practice and experience with medical cannabis, I became involved with Starseed Medicinal given their core mandate of advocating for the safe and responsible use of medical cannabis in the workplace. At Starseed, I’ve worked to educate insurance providers, employers, and fellow health-care professionals about the opioid-sparing effects of medical cannabis.

This is what ultimately resonated with the Laborers’ International Union of North America (LiUNA), a major North American construction union, and was the primary reason they chose to establish an industry-first strategic partnership with Starseed. LiUNA represents about 120,000 construction workers across Canada – construction workers who traditionally over-index for chronic pain. Recognizing this, LiUNA’s leadership stepped up and supported medical cannabis as a safer alternative to opioids.

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The recent 2018 Sanofi Canada Healthcare Survey supports LiUNA’s move. It found 64 per cent of employees with workplace health plans agreed that medical cannabis, when authorized by a physician, should be covered by their health benefit plan.

Plan sponsors, however, were undecided: 34 per cent would like their plan to cover medical cannabis (including 8 per cent who say they already do); 34 per cent do not want it covered; and 32 per cent do not know or are unsure.

I am often asked by insurance companies and employers – what would I do if an employee comes to work high? My answer? Do exactly what you would do if any employee came to work intoxicated or impaired with any substance – legal or otherwise. Reprimand them. Medical cannabis is not recreational cannabis.

With the historic vote to legalize adult-use cannabis, it is now more important than ever to have an honest conversation about the medical use of cannabis. We need to stop conflating medical cannabis with recreational use. Maybe then, we can make progress in addressing the opioid crisis and save lives.

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