CORNWALL, Ontario – Dr. Dean Ducas, a local family physician, has been authorizing patients to use medical marijuana since 2014. He believes that he is the first Clinical Cannabinoid Consultant in Eastern ON.
According to Dr. Ducas, the Canadian Medical Association (CMA) recently released a controversial statement. The Association suggested that the medical stream of marijuana should be abolished because Canadians no longer need to see a doctor to have access to the drug. Dr. Ducas has already witnessed patients losing access to different medical strains.
“If you take away regulations, I believe you will have more harms,” said Dr. Ducas.
“Medical strains are different from recreational strains,” he added, maintaining that medical strains contain a higher concentration of Cannabidiol (CBD) than Tetrahydrocannabinol (THC).
Dr. Ducas said that statistically, only one in nine physicians in Canada are willing to authorize the use of cannabis.
“Doctors don’t feel comfortable authorizing for something that isn’t approved by Health Canada or the Food and Drug Administration (FDA),” he said.
Dr. Ducas acknowledges that there are exceptions, including Nabilone, a synthetic cannabinoid, and Sativex, a specific cannabinoid derivative, which have been approved.
“There’s a lack of knowledge, and not only that, a lack of evidence-based medicine — randomized controlled studies,” he added. “This is how drugs are developed through the pharmaceutical industry. You do years of research with hundreds or thousand of patients…that hasn’t happened with medical marijuana yet, primarily because of difficulties accessing it.”
Dr. Ducas said that most medical marijuana studies are conducted outside of the U.S., where marijuana is a schedule one drug. Thus, research is more uncommon as most drug studies are conducted in the U.S.
Since 2014, Dr. Ducas has hosted four presentations amongst doctors in the community discussing and educating about medical marijuana.
Over the past four years, Dr. Ducas has seen many cases of success amongst patients to whom he has prescribed medical marijuana.
“When it comes to pain management, I have observed a substitution effect,” he said, explaining that in certain cases patients have reduced or replaced opioid dosages with cannabis. He has also observed cases of improved sleeping habits, reduced anxiety and improvement of overall quality of life. Dr. Ducas screens patients for Cannabis Use Disorder before authorizing use, as well as potential drug interactions.
“But we have to go slow and observe as cannabis is not meant for everyone,” he said. In Dr. Ducas’ experience, every two of three patients referred to him are cannabis experienced, meaning they have tried the drug before, and thus have a greater success rate. Cannabis naïve patients, who have no prior experience with the drug, see approximately a 60 per cent success rate.
According to Dr. Ducas, for neuropathic pain, the Canadian Pain Society (CPS) has rated opioids as a ‘number two,’ second-line therapeutic pharmaceutical drug, while cannabis is felt to be a third-line drug.
“They only recommend (cannabis) as the last resort when standard pharmaceuticals fail,” he said.
Dr. Ducas doesn’t agree with this order of classification as he acknowledges that statically the Opioid Overdose Crisis claimed approximately 4,000 Canadian lives in 2017 and 65,000 American lives in 2016. A report published by Canada’s Chief Public Health Officer on Oct. 23 suggested that the Opioid Crisis may be causing a drop in the life expectancy of Canadians.
“I personally feel there should be a flip…I feel that there are more harms with opioids than there are with cannabinoids,” said Dr. Ducas.
Dr. Ducas understands the paradox that individuals as young as 19 have access to recreational marijuana, whereas medical marijuana patients are recommended to be over the age of 25. Dr. Ducas said that health professionals have cited a number of studies that suggest early use of cannabis alters individuals’ brain chemistry, hence the recommended age of 25.
Despite marijuana being legalized in Canada on Oct. 17, regulations to access marijuana for medical purposes were created in July of 2001.
