How the Hippocratic Oath Drove This Doctor to Speak Up About Medical CannabisElianna LevFebruary 20, 2018
“We were taught that (cannabis) was a drug that had high potential for abuse,” says Dr. Verbora of medical school. “That’s really about it.”
Now the lead physician at a clinic that prescribes medicinal cannabis to Canadian patients, Verbora is baffled at his alma mater’s limited curriculum.
“We were taught that it was a drug that had high potential for abuse and that it could cause anxiety and addiction problems,” he tells Leafly. “That’s really about it. In psychiatry you learn about cannabis use disorder and how it can affect people’s mental health negatively.”
After finishing his training at the University of Toronto in 2013, Verbora learned about the Canabo Medical Corp., a chain of clinics that prescribe cannabis to patients referred by a family doctor. At the time, he was clueless that physicians could be the gatekeepers to this type of medicine. He signed up to be a resident at the Toronto Cannabinoid Medical Clinic, where he spent time shadowing another doctor, and soon realized there when it came to cannabis education, a lot was left out of his schooling.
Embracing What Was Not Taught
The first case Verbora heard involved a six-year-old boy who’d previously been prescribed about 10 different pharmaceuticals for chronic seizures. None of them worked. The child’s parents praised the effects of CBD oil, reporting that the compound, which Verbora knew nothing about, helped their son go from 100 seizures a month down to one.
The more time he spent in the clinic, the more stories he heard about the positive outcomes cannabis had on patients’ ailments.
“His parents told me he was walking, talking and doing things for the first time in his life,” says Verbora. “I was completely blown away, especially since no one had told me anything about cannabis.”
The more time he spent in the clinic, the more stories he heard about the positive outcomes cannabis had on patients’ ailments. Verbora decided to learn as much as he could from mentors at the clinic, online tutorials and textbooks. Soon, he was promoted to staff, which gave him the ability to start prescribing. He’s now the medical director of Canabo Medical Corp and physician lead at the Toronto Cannabinoid Medical Clinic.
After working in the space for a few years, Verbora felt it was crucial to share his knowledge and experiences with other doctors.
“It’s important for the medical field to embrace this as a medicine and objectively present the data that we have and understand why the observational, anecdotal stories we get from patients is what is it, which is, that is has such positive benefits,” he says.
His intentions, however, haven’t always been met with enthusiasm.
Stigma in the Academic Community
When Verbora approached universities, there didn’t appear to be any interest in the information he had to share.
“It feels like they’re not interested in looking at this from a medical perspective at this point in time,” he says. “I was told essentially I wasn’t allowed to teach residents or students in this field of medicine. They said they’d be discussing it in certain areas but they didn’t have a desire or want to bring further cannabis education to the curriculum.”
University representatives told Verbora that he was welcome to teach from his experience with family medicine, but they didn’t want to approve him to teach through the cannabis clinic. He found this puzzling, given the demand for information, especially as Canada moves towards legalization. About 30 students have come to the clinic in the past two years to shadow doctors and learn more about the uses of medicinal cannabis.
“Most of the students who come through (the cannabis clinic) are pretty amazed and curious as to why they’re not being taught this in a formal fashion.”
“Most of the students who come through are pretty amazed by what they see and most are curious as to why they’re not being taught this in a formal fashion and why it has to be what we call a ‘hidden curriculum,’” Verbora says. “At the front lines, you have doctors who are embracing this and new students who are interested in learning how to prescribe this for the right patients, and yet, it doesn’t seem like the academic community seems ready to provide the education to the students or faculty.”
Traditionally, medical students have to take the Hippocratic oath when they begin their studies, which vows to do no harm. Verbora feels the oath allows if not compels him to discuss the potential of cannabis, especially CBD oil, which the World Health Organization recently declared as posing no risk.
“It’s supposed to be ‘Do no harm’, but when people come and criticize cannabis they talk about the lack of evidence,” he says. “As a physician, my oath isn’t to ‘do best evidence,’ it’s to do no harm first. And that’s why I prescribe cannabis. I find, at least with CBD, the side effects are minimal and there’s zero potential for abuse or harm so far.”
Stigma in the Medical Community
The resistance to cannabis’ potential extends past medical school. Verbora says he regularly feels shunned by his peers. He’s had conference presentations derailed by doctors who attack his character, or the information he’s presenting.
“It’s challenging and frustrating to face my own physician peers who won’t listen to me or look at the data.”
“It’s challenging and frustrating to face my own physician peers who won’t listen to me or look at the data,” Verbora says. “I wanted to share my patients’ stories and information I’d been reading, but (my presentations) would be hijacked by doctors who would share their views, which were essentially a confirmation bias.”
Every year Canadian doctors are required to accumulate 50 credits by attending informational presentations at conferences. Verbora’s presentations have been denied academic credit by organizations in the medical community.
At a conference called Academic Pain Day, the College of Canadian Family Physicians (CCPF) told him that his information was biased, even though Verbora felt it presented a well-balanced meta-analysis from a large, reputable organization.
“They wanted me to change my slides to only focus on the harms, not the benefits, which in my opinion is not balanced,” he says. “They told me unless I change my slides, the people who were there wouldn’t receive credit.”
The CCPF did not respond to a request for comment.
Verbora is committed to presenting the best evidence available, while sharing his patients’ stories and encouraging more research in the field. He also acknowledges that there are different layers of evidence.
“Cannabis is very observational and anecdotal, but people have been using it for thousands of years, and we can’t just discredit all of these observations and anecdotes,” he says. “It is evidence—not the best evidence, but we also have to be cognizant on why we don’t have that. It’s hard to say there’s no evidence or research, because it’s impossible to do and there’s no incentive to do it.”
Predicting Growing Pains
Verbora suspects that once cannabis is legalized, there will be growing pains in how it’s received. He refers to American states that have legalized cannabis and specifically, the edible market, which has lead to problems amongst naïve or novice users, unclear on how much to take.
“I anticipate the media will be there to pick up on all this,” he says. “They’ll sensationalize anecdotes, whether good or bad, like they do anyways.”
He also anticipates positive change—patients will turn to cannabis instead of some more harmful substances, like tobacco or alcohol, which are the two legal drugs that kill the most people in North America. In some US states where recreational cannabis is legal, there’s been a decline in opioid deaths by as much as 25%.
“It’ll be interesting to see how data pans out in the long run,” Verbora says. “There will be some negatives, but I think the positives overall will outweigh them. I think we’ll have to get to five or 10 years to look back to recognize the positives.”
Verbora also anticipates legalization will foster progress in the medical community. He suspects there will be more research and eventually drug identification numbers for cannabis products, which will facilitate insurance coverage and the “pharmaceuticalization” of cannabis products, with researchers isolating cannabis ingredients and producing medicines out of them.
“You’re going to need physicians who have an interest and expertise in the next few years,” says Verbora.
In the past decade, Verbora has heard growing talk of “patient-centered” care, where patients engage in the decision-making process with their doctors and share their goals and targets for treatment. This approach could be key when it comes to prescribing cannabis.
“The patient in front of you isn’t the patient in the research study that the pharmaceutical company funded,” he says. “It’s always a different patient, so you have to look at that one patient and find what works for them. That’s the future of medicine, and cannabis is pushing us towards that and we need to embrace it and understand it.”