Dr. Ian Mitchell says that in an ideal world, physicians would learn about the medicinal properties of cannabis in medical school. Doctors would be trained about different extracts from marijuana plants, including cannabidiol, aka CBD, and tetrahydrocannabinol, aka THC.
But the Kamloops emergency-room physician tells the Georgia Straight by phone that the vast majority of doctors haven’t been educated in this area.
As a result, some are not aware that the CBD extract has proven useful in sharply reducing seizures in children with a rare condition called Dravet syndrome, as well as in other situations.
“It’s been tested in studies to be an effective antipsychotic,” Mitchell says. “It can be used as an anti-anxiety medication and it’s also anti-inflammatory. So it has great potential for inflammatory diseases like arthritis and Crohn’s disease.”
CBD and THC differences not well understood
Mitchell says knowledge of CBD and THC is essential in properly prescribing cannabis to patients suffering from pain linked to cancer, AIDS, arthritis, and multiple sclerosis. He points out that some people’s stomachs can’t tolerate traditional anti-inflammatory medications, which can cause gastrointestinal bleeding.
“I have a few little old ladies in my practice,” he reveals. “They have a cookie every night and say, ‘I don’t take my Percocet anymore.’ I would consider that a success because that’s a far less harmful way to treat their pain.”
Mitchell says that CBD is normally about one to two percent of a marijuana plant, whereas the psychoactive agent THC is over 10 percent and getting closer to 20 percent.
Drug prohibition has led to plants being grown with a higher THC percentage because that’s what buyers prefer. The downside, he says, is that plants with higher THC levels often have drastically lower levels of CBD.
“You don’t have the antipsychotic and anti-anxiety properties,” Mitchell explains. “So all of the sudden, you’re smoking this very intense stuff that in the U.K. they call skunk. That probably does make people a bit psychotic and probably does make people very anxious, but this is because of prohibition.
“That’s part of the argument for proper regulations—so that you could choose stuff to have cannabidiol,” he adds. “I consider that essential in a medical-cannabis situation. I want to know what my patients are getting as far as the THC and CBD content.”
Research planned into PTSD and cannabis
He's part of a team awaiting approval from UBC and Health Canada to launch a study into the effect of different preparations of cannabis on posttraumatic stress disorder. He points out that PTSD is taking a tremendous toll on military families in particular.
"This is a huge deal in America," Mitchell says. "Right now, there are 22 veterans a day who commit suicide."
Paxil is the only medication that's approved for treating PTSD, but according to Mitchell, it doesn't work for most people. He says that there is "very good preliminary evidence that cannabis can be effective".
"Some of the synthetic cannabinoids like nabilone have been shown effective for nightmares associated with PTSD," Mitchell states.
He reveals that in the pending research study—the first trial of its kind—one group of research subjects would receive cannabis with CBD but no THC. Another group would consume cannabis with CBD and THC. Another would get cannabis with THC but no CBD and others would receive a placebo.
"Even looking at the THC alone versus the THC and cannabidiol [offers] an the opportunity to test out the effect of this cannabidiol in a real-world situation," he said.
The researchers are hoping to recruit participants in the fall.
ReaLeaf offers advice to those seeking legal cannabis
Meanwhile, Mitchell is a consultant with ReaLeaf Wellness Centres, which counsels patients who want to obtain cannabis legally through the federal government’s Marihuana for Medical Purposes Regulations. After paying a fee, ReaLeaf clients obtain discounts from licensed producers. To buy marijuana legally, a patient requires a physician’s signature.
“The authorization document is similar to a prescription,” he says. “Generally, it contains the patient’s demographic information and the physician’s information.”
The document sets out how much cannabis can be used per day—the maximum is five grams—and the length of time the patient will be using it. The maximum is one year.
Mitchell says that licensed producers are only permitted to supply dried herbs from marijuana plants.
“You can’t order any edibles and you can’t order any oils,” he notes. “So you’re going to be smoking, vaporizing, or possibly cooking it.”
This has created a niche for dispensaries, which sell extracts, oils, and edibles. Dispensaries operate in a grey area since the Harper government required Canadians to buy medical cannabis from licensed suppliers.
"It just seems like right now, they have free rein to open up," Mitchell says. "You can go in and buy a cookie from them or buy one of these cannabinoid extracts. You can't do that from the licensed producers. That's the biggest difficulty that patients have right now in dealing with the licensed producers. They don't have that variety of product."