Hey there, time traveller!
This article was published 24/11/2017 – that’s before recreational cannabis was legal in Canada, so language and information in the article may be dated.
OTTAWA — Lana Thiesen got a second chance. She's among thousands of Canadians whose lives have been ravaged by opioids, but cannabis helped her regain normalcy and purpose.
"I was able to join the world of the living, basically," Thiesen said.
The federal government has promised to make recreational marijuana legal in July, a move advocates say could help wean opioid users off high-risk drugs. But they also fear Ottawa's plan to raise taxes on cannabis for medical purposes could push recovering addicts back to drugs such as heroin.
Thiesen's experience with opioids started in 2010 after she hurt her back. After surgery to fix shattered vertebrae and herniated discs, Thiesen’s doctor prescribed extremely high doses of oxycodone, along with other drugs.
"I was pretty much in bed all the time. I couldn't go anywhere. I couldn't do anything with my kids," said Thiesen.
Though she regularly took sleeping pills, Thiesen rarely slept. Her husband took time off to care for her, and they closed their family-run store near Edmonton. "I had absolutely no quality of life whatsoever."
"I was able to join the world of the living." -Lana Thiesen
Roughly two years ago, a pain-management specialist suggested Thiesen try cannabis. She initially refused, remembering the zonked-out feeling she experienced when she had tried pot as a teen. Her husband also disliked smoke. She also feared the stigma surrounding marijuana.Advertisement
But her pain got worse, and after a year, Thiesen reconsidered. "I'd reached the end of my rope and thought 'OK, I'll try anything.'"
Thiesen now runs a trucking company with her husband. She's gone from being obese to having a healthy weight. She still uses a low-dose butrans patch that has helped her come off opioids gradually, because doctors said abruptly stopping oxycodone would be risky.
Her experience is increasingly common.
Philippe Lucas said he started noticing a trend two decades ago while working with a British Columbia non-profit that provided cannabis to people suffering from diseases such as AIDS. He said many patients reported they'd stopped taking heroin and other opioids.
"At the time, that really flew in the face of what we were hearing from our government, and what had been long-standing orthodoxy on cannabis, which is that it was a gateway drug."
Lucas cited numerous peer-reviewed studies that suggest marijuana can help wean people off opioids, often unintentionally. He said researchers are debating how much of this is caused by brain chemistry or behavioural changes.
The research to which Lucas referred includes a 2014 study that compares parts of the U.S. that do and don't allow cannabis for medical purposes. It found a 24.8 per cent lower mean rate of opioid-related deaths from 1999 to 2010 in states that allow medical pot. The study found that rate didn't change when looking at unemployment rates.
A study of overdoses in Colorado from 2000 to 2015, published this month, found that recreational cannabis has likely saved eight lives each year in the state, despite an overall increase in opioid deaths.
Lucas said patients report that marijuana isn't as effective at numbing pain as opioids, but it also doesn't give them constipation or an out-of-body sensation.
"They prefer the cannabis, or cannabinoids, because it gives them a sense of distance from their pain. They can be higher-functioning," said Lucas, who three years ago joined Tilray, a federally licensed cannabis producer in B.C.
Some patients believe cannabis revs up the potency of heroin replacements such as suboxone and methadone, allowing addicts to use lower doses, and sometimes quit opioids altogether.
This month, Lucas kicked off a study of 500 patients using those drugs, to see whether taking cannabis makes them more effective.
Michael Verbora, medical director of Toronto-based Canabo Medical Corp., said he hopes such research will steer doctors towards smarter guidelines for pain treatment.
Currently, physicians are trained to give patients over-the-counter drugs such as Tylenol, then opioids, and then cannabis, despite opioids having a higher documented rate of addiction.
"Cannabis has evolved so quickly that it's not keeping pace with what we've seen on the frontlines," said Verbora. His company has 19 clinics that take pain referrals from family doctors and connect patients with legal cannabis producers.
"We are able to reduce or get patients off (opioids) completely."
He recently got approval from Acadia University to see how 1,000 patients cope with replacing morphine and similar drugs with cannabis derivatives. The study will look at how many re-enter the workforce, and how much governments spend and save as a result.
Verbora is aware of suggestions that cannabis can be a gateway drug to opioids. For example, a 2004 study that found teens who use marijuana may have altered dopamine receptors, leaving them more liable to take riskier drugs.
But Verbora said the vast majority of research points to the opposite of a stepping-stone effect. A poll two years ago found a fifth of Canadians had smoked pot within the previous 12 months, and Verbora said few of them went on to use opioids. "We're noticing, in our data, that it's an exit drug."
Canada’s top doctor said there’s not enough research to prove whether recreational cannabis will help or hinder the opioid crisis.
"From a public health perspective, we actually need more data," Theresa Tam, the chief public health officer, told The Leaf on Nov. 15.
"I do think that the reduction of the federal regulatory barriers in many sense will allow us to get at this information," she said. "We actually need to look more holistically at people who use different substances… and the interactions between each of these."
Health Minister Ginette Petitpas Taylor referred questions to Health Canada, which pointed to the American research. "This evidence, while promising, needs to be substantiated with additional studies," the agency wrote.
But advocates say they're facing a more immediate threat. Ottawa has proposed to tax all cannabis at the same rate, whether recreational or medicinal.
"We do not want the taxation levels to be an incentive for people to utilize (the medical) system inappropriately." -Bill Blair
"We do not want the taxation levels to be an incentive for people to utilize that system inappropriately," Liberal MP Bill Blair said Nov. 10 as he announced the proposal. It involves imposing GST and PST plus an excise tax of between $0.50 to $1 per gram, which would be shared with the provinces.
The government is taking responses until Dec. 7, before presenting the provinces with its plan a week later.
Thiesen said she's enraged by the proposed tax. She volunteers with Help Alberta, a support and advocacy group for people with chronic pain. She hears of doctors over-correcting, going from prescribing too many opioids to cutting patients off cold turkey, regardless of withdrawal symptoms.
Currently, Thiesen takes two syringes of CBD-THC oil per day, costing $168.58 every month or two. Under the proposal, she’ll pay $30 to $120 more each year, but she said she's worried about poor people.
So is Verbora, who said many of his patients survive on welfare and disability payments. Some spend $10 to $30 daily on cannabis.
Most insurance plans don't cover cannabis because the plant and most of its derivatives don’t have formal drug identification numbers the same way that pills do — meaning opioids are much more likely to be insured than pot.
"Adding this extra tax is throwing us to the wolves." -Lana Thiesen
Verbora said he's already seeing patients who stopped taking opioid drugs such as Percocet return to them due to cost. Recently, a patient in his 30s died, and the man's mother claimed he'd returned to prescription opioids after not being able to afford medicinal cannabis.
Though Verbora couldn't confirm what caused his patient’s death, research suggests that former opioid users are at highest risk of overdose when they return to such drugs. That's because their bodies have a lower tolerance for the drugs, and because street varieties are increasing in potency.
Thiesen said Ottawa risks squandering a chance to reverse the opioid crisis, by limiting the number of Canadians who can replicate her experience.
"Adding this extra tax is throwing us to the wolves."
With files from Solomon Israel