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How the Hippocratic Oath Drove This Doctor to Speak Up About Medical Cannabis

February 20, 2018
(Courtesy of Dr. Michael Verbora)
Dr. Michael Verbora spent six years in medical school, but in that time, only 30 minutes were devoted to learning about cannabis.

“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.

Related

Medical Cannabis Clearly Saves Lives, Federal Judge Declares

“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.

Related

Cannabinoids 101: What Makes Cannabis Medicine?

“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%.

Related

A Guide to Canada’s Medical Marijuana Program

“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.”

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Elianna Lev

Elianna Lev is a writer who splits her time between Toronto and Vancouver.

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  • Turner Kayston

    “As a physician, my oath isn’t to ‘do best evidence,’ it’s to do no harm first.”
    Amen! He should be the spokesman for all of Canada…

    I think that’s the first Doctor I’ve heard of, that actually understands the point of the “Hippocratic Oath”… Without this, I think no others should be entitled to their Doctor title. I think that many of the linear thinking Doctors of today, are terminally schooled and indoctrinated (trained solely in allopathy) and should NOT be entitled to have any say on Cannabis, whatsoever. We should leave Cannabis to be a specialty, in homeopathy, as it was before
    all the greedy capitalism.

    That’s not to say that some Doctors are not good at what they do, or not smart in their field, but they’re certainly not G_d nor authoritative over anyone’s body, other than their own – they’re just people like the rest of us after all.

    Rick Simpson during an interview once suggested looking up a Documentary, Rockefeller I think it was… After watching it, things started to make a lot more sense in why things are the way they are now. The more you dig, the more you see it all revolves around the mechanistic mindset, materialism, reductionism and capitalism… and others I won’t bother mentioning.

    Their mentality is usually “no, no, no… don’t eat that fruit… here, take this vitamin instead”

    • Réal Guy

      Salutations,

      I believe this guy working in Québec city may be connected to the following event which made the news in Ontario recently:

      https://uploads.disquscdn.com/images/e9d7e009842baff42c4ef7508bdf89e1b733af8a88abb9e56fc7d7e34b391644.png
      [ https://www.ctvnews.ca/canada/officers-wrongly-told-teens-that-pot-causes-enhanced-mammary-growth-in-men-1.3811696 ]
      CTV: Officers wrongly told teens that pot causes ‘enhanced mammary growth in men’ (2018-Feb-18)

      « …erroneous information was included in a presentation by officers for high school students last week. »

      « We’re no health experts, but we’re pretty sure getting high does not cause enhanced mammary growth in men. » (York Regional Police Service spokeswoman Const. Laura Nicolle)

      M’well, Québekers as myself who happen to recognize him from his 2014 appearance at Découverte may remember that Richard Bélanger declared – and i quote verbatim (hence in French):

      [ http://ici.radio-canada.ca/nouvelles/science/2014/11/07/001-cannabis-marijuana-effets-cerveau-adolescents-decouverte.shtml ]
      SRC: Quels sont les effets du cannabis sur le cerveau des adolescents? (2014-Nov-10)

      « En clinique c’est pas tant ces choses-là qui font, euh… qui font peur aux adolescents. C’que les jeunes ont l’plus peur c’est les choses qui les touchent directement là. Ça va aussi avec le comportement adolescent, donc… J’les vois allumer quand j’parle, euh… de… d’augmentation d’la masse mammaire chez les garçons, de savoir ça, qu’y a une suppression donc qu’ça peut amener une… une poussée des seins chez les garçons – ce qu’on appelle la gynécomastie – ou à la limite une diminution d’la quantité de spermatozoïdes qu’y produisent… C’est quelque chose d’intéressant à savoir, p’is chez les filles ça augmente la prolactine, donc ça peut amener des montées laiteuses mais surtout ça diminue, euh… la fertilité et l’ovulation. »

      Which i believe was the “science” source of those police officers in Ontario…

      Go figure if mister Richard Bélanger was the primary initiator or simply yet another conveyor, but the fact is that this was broadcasted A Mari Usque Ad Mare at premium time, in the Harper era.

      Sometimes it seems they don’t/can’t/won’t know when to stop, not even after they’re told the cost is just too high.

      Good day, have fun!!

      • Turner Kayston

        Interesting, and thanks for those links.

        Perhaps you’re already familiar with the channel, but if not, then there are some active videos (and audio) from parliament and the senate on YouTube, of Bill C-45 stuff. A profusion of ‘reefer madness’ rhetoric being promulgated into law; in my view, pseudo-science & sophism, unfortunately…

        Just thought that it may be of interest to you as well… 😉

        • Réal Guy

          Hi again Turner Kayston,

          TK > Perhaps you’re already familiar with the channel, but if not…
          TK > …
          TK > …Just thought that it may be of interest to you as well…

          There are so many communications i’d want to watch on the land of cap’tain Itnoc, but lets admit i no longer hope for unbiased/well-informed events on cannabis. Anyway i’ll keep it in mind, so thanks! But the thing is their propaganda drains me hard these days and i’m not resourceful enough to engage into activism.

          There was a time when the trickery seemed worth healthy criticism but this present article alone makes that almost trivial. For example, doesn’t 30 minutes of “science” teached in a matter of 6 years actually say a lot about the “credibility” of today’s “speciali$ts”/”expert$”, those same running medical schools in charge of providing more doctors/therapists, the primary source of all things with a “high potential for abuse”, all too often.

          Big Pharma and its prescription pills ain’t the fault of cannabis which they hate for consistently failing to fit a mono-molecule model, on the contrary!

          Just allow me to remind the reader about what happened when European “scientifics” working at Biotrial attempted
          to develop “BIA 10-2474”, which was based on a synthetic “designer” mono-molecule it seems:

          [ http://www.cnn.com/2016/01/18/health/france-drug-trial-participant-dies/index.html ]
          CNN: Drug trial participant dies, 5 others hospitalized in France (2016-Jan-18)

          « …designed to work on the body’s endogenous cannabinoid system… … …does not contain cannabis or cannabis extracts. »

          M’well, maybe nobody would have died if it had contained cannabis, after all: would have the test subject gone brain-dead if he could have benefited from USA’s patent on cannabinoids behaving as a “neuro-protectant” (US6630507)??

          Not to mention such valuable feature even got validated, eventually:

          [ http://www.nature.com/articles/srep16921 ]
          Nature: Prenatal exposure to recreational drugs affects global motion perception in preschool children (2016-Nov-9)

          « …global motion perception was improved… »
          « …marijuana reduced the negative effect of alcohol exposure… »

          Which means when in adverse health-threatening situations as that it’s better keep pro-cannabic consumption tools handy, just in case!…

          Now lets continue with CNN article, by refering to this other excerpt:

          « Biotrial International said it was “in close and regular contact with the Health Authorities and Ministry in France. »

          M’yep! That’s the point indeed: just like “science” as teached in North American medical schools.

          3 crucial dates come to my mind: 1890, 1923 and then the fatal hit: 1925 at the League of Nations, on February 19 of 1925, when a 1st treaty targetting cannabis was drawn which prompted the creation of a problem when there was none before. Based on the “science” of John Warnock, who required a translator to run an assylum in Cairo/Egypt, unable to communicate directly with his patients…

          Too bad for the bigots, “Stoner$”/”Droÿés” know better!

          We heard about sativa vs indica before, and now THC vs CBD, etc. No matter how many years are spent in a medical school, doctors persist in collecting contaminated “data” while fair play ain’t on the menu.

          Did THC-centric cannabis even exist before man-made distortion forces induced sufficient mercantile motivation to catch attention from all those prepared to make a dime on it – and i mean *all* of them.

          In Canada even LPs were caught spraying BANNED pesticides under Trudeau, while our H.-C. ministry remained contemplative, refusing to cause prejudice to LPs who plotted this! … Imagine: they broadcasted their actions right during the rejoicing season (…), effectively promoting more VILIFICATION nation-wide (LP or otherwise):

          [ http://www.theglobeandmail.com/news/national/canadians-not-told-about-banned-pesticide-found-in-medical-marijuana-supply/article33443887/ ]
          Globe & Mail: Canadians not told about banned pesticide found in medical pot supply (2016-Dec-29)

          « Myclobutanil… …found in product recently recalled by Mettrum Ltd… »
          « …known to emit hydrogen cyanide when heated. »
          « …pyrethrin was used by mistake… »
          « …neither Health Canada nor Mettrum announced the findings to the public. »
          « …dispensaries in Vancouver had sold products containing dodemorp… »

          Then some crunchy details were finally released which shead new light on the event:

          http://weedwire.ca/hydropothecary-expands-voluntary-recall/
          WW: Hydropothecary expands voluntary recall (2017-Jun-5)

          « The results of their internal testing show trace amounts of myclobutanil between 0.01 parts per million and 0.13 parts per million on the 19 recalled lots. »

          So, these days when we’re told by holier-than-you gurus about “anxiety” and “addiction” there are real chances multi-intoxication compounded to pesticides is systematically included… Yet myclobutanil was only 1 pesticide, i remember there were 200+ of those on the Washington list alone:

          http://washingtoncannabisinstitute.com/list-of-acceptable-pesticides-for-growing-marijuana-under-i-502/
          List of Acceptable Pesticides for Growing Marijuana under I-502

          « Only authorized pesticide products may be used. Using an unauthorized pesticide is a public safety license violation and can result in the cancellation of a producer’s license (see WAC 314-55-520). »

          But i figured it’s totally possible LPs dreamed of a “soup” of substances all undetectable individually.

          Back to the initial Leafly article.

          As for psychiatrists on cannabis use disorder i’m not gullible enough to expect serious scrutiny of the
          consumption method itself, specifically, and yet that and its associated substance are totally inert without each other…

          How about cannabis isolated from external factors, once in a while?

          In clear i’d argue all “science” is deeply contaminated by decades of toxic combustion smoke, nearly as many decades of THC-centric strain selection, banned pesticides and – last but not least: a poisonous cigarette/”joint” consumption method inherited from the mercantile 1880 patent of James Albert Bonsack.

          In other words: SELF-VILIFICATION passively promoted by contemplative bigots taking over our public institutions while overtaxing as predators ruling a “sin” industry.

          Unfortunately, if “saving” children truly were the bigot’s motivations then they’d have to put aside their socio-toxic ideology and start listening at those who know better: e.g. US!

          Knowing nothing about CBD cannabis is a clear admission of medical incompetence, nonetheless.

          It’s kind of some relief to read that at least some doctors will remain sufficiently attached to their “do no harm” oath to question the establishment when necessary. But does it work?

          Which somehow makes me vaguely recall that the “BIA 10-2474” mono-molecule represented a potential 100 billion $ market… Imagine the fights if it had succeeded: today’s schools might adopt anti-cannabic drugs as the norm, just like Ritalin before.

          In such cases “doing best evidence” (instead of “no harm”) revolves around the statiscially ellusive children of planet Itnoc, driven by an utopic ideology which only exists in sick/fake self-serving imaginations meant to captivate masses of voter$. Worse: now Canada pretends to educate its citizens!

          So, about videos of parliament and/or the senate via YouTube, i once commented (via YT) on Lucie “Nez-Rouge” Charlebois who’s a model of “reefer madness” but this was more an exception than a habit of mine, really:

          Vice: https://www.vice.com/en_ca/article/xwajv4/these-politicians-are-spreading-new-reefer-madness-myths
          These Politicians Are Spreading New ‘Reefer Madness’ Myths (2017-Nov-21)

          http://www.macleans.ca/news/canada/are-canadas-pot-fearing-politicians-raising-children-or-goats/
          Macleans: Are Canadians pot-fearing politicians raising children or goats? (2017-Nov-24)

          IMHO the rights protected by groups as Québec’s “Collège des Médecins” are those of its professional doctor/therapist members themselves! As for politicians they’ve learned to exploit every crack in the system, some to return favours to real criminals.

          There are those who feel like winners, then there’s the rest of us who must deal with reality.

          For example:

          https://montreal.ctvnews.ca/police-look-into-alcohol-as-possible-factor-in-laval-teen-s-death-1.3825064
          CTV: Police look into alcohol as possible factor in Laval teen’s death (2018-Mar-1)

          « Police are waiting on the full autopsy and toxicology reports to get a clearer picture of what was the exact cause of death. »

          Do we bet it’s going to end up burried & forgotten should alcohol have been found?!

          In The Name Of Children.

          https://uploads.disquscdn.com/images/c2c84f2f8879ea8bdfc6d7144244f709244c81c94e5fd1c7623cf22733da4a11.png

  • Juergen Meixner

    Cannabis is Medicine.

    Cannabis sativa L. – The Benign Herb

    The official Empirical Studies into actual use of pure cannabis conclude:
    1) use of pure Cannabis has no adverse effect upon mental or physical health: Cannabis is harmless;
    2) use of pure Cannabis does not cause any impairment to mental and physical abilities: Cannabis is safe;
    3) modern Medical Case Histories show pure Cannabis to have numerous beneficial results to health: Cannabis is benign.

    In short, the allegations of “harm” by which Cannabis has been prohibited are, by disinterested scientific scrutiny, not substantiated: the “harm” has been competently , comprehensively and consistently dismissed. The allegations are naught by figments. The unfounded “law” – quod erat demonstranduum – has always been false; the Prohibition is an ongoing fraud; all Cannabis related prosecutions of citizens are malicious.

    To do nothing to stop this abhorrent Prohibition is as shameful as instigating or enforcing it. These people’s acquiescence to Prohibition is flagitious and fatal. Dishounourable self-interest produces their duplicity. They evade the guilt of their position which encourages governments Prohibition, by which the Owners and politicians cause suffering, incarceration, deaths and ecological disasters. However, to consent to any measure is to share responsibility for its results. The “law” is not simply “wrong”; it is the subterfuge of criminals. People’s intentions , guilty or innocent, are tested by their stance: if individuals be selfish and dishonest, or money-motivated, predictably, they do not support Relegalisation; but the honest person supports RESTORATION.

    Facts:

    Currently, to use the term “drug” to describe cannabis is not simply untruthful, but worse, it is the premeditated adoption of an unconscionable Prohibitionist tactic of semantic abuse. This devious ploy deliberately associates mild, benign cannabis with potentially dangerous, addictive substances, drugs – of which alcohol is one such – to make cannabis appear to be something harmful, which the official empirical researches confirm is not.

    Regarding the oath:

    Denial of cannabis by Prohibition ‘law’ premeditatedly inflicts suffering, blindness, and, in many instances, death. Those who maintain any use of life-saving cannabis to be “illegal” should be regarded and treated as perpetrators of the gravest of crimes, and deemed unfit to hold any public office in a democratic society.

    The Report collates Empirical Evidence and the Findings of Fact of official clinical studies which exonerate cannabis and vindicate all cultivation, trade, possession and use. The Report establishes massive ulterior money-motive and prejury behind prohibition; and indicts government.

    The Report presents irrefutable Legal Grounds for Restoration: Relegalisation, Amnesty & Restitution.

    THE REPORT. CANNABIS: THE FACTS, HUMAN RIGHTS AND THE LAW ISBN 9781902848204.

    • Réal Guy

      Nicely said, that must be the inspiring effect from reading an article which we can read, understand and accept as coherent thought, mostly in harmony.

      Except i don’t subscribe to the desire to classify consumers as “criminal”, “medical”, “recreative”, etc., and soon “legal” – even if THC-centric and pesticide-laced… But that’s a rare type of reading anyway, lets toast to that!

      M’well…

      😉

      • Juergen Meixner

        Thirty years ago the endocannabinoid system was unknown.

        We knew much about the use over millennia of Cannabis plant preparations both as a medicine and as “a drug that takes away the mind” (as so-well stated in ancient Assyrian clay tablets, they hadn’t have the idea of the Jarisch-Herxheimer-Reaction). During the early part of the last century considerable progress was made on the chemistry and pharmacology of Cannabis, but it was only after the identification in 1964 of ∆ 9 -tetrahydrocannabinol (∆ 9 -THC) as the active constituent of the plant that this field caught the interest of many research groups and hundreds of papers on the chemistry, biochemistry, metabolism and clinical effects of this compound were published.

        However, its mechanism of action remained unknown for nearly two decades. In the mid-1980s the presence of a cannabinoid receptor in the brain was identified and shortly thereafter it was cloned.

        This was followed by the isolation of the major endogenous cannabinoids, anandamide and 2-arachidonoyl glycerol, and the clarification of their biosyntheses and degradations. These advances led to an avalanche of publications in a wide variety of fields. We are now in the midst of major advances in biochemistry/physiology associated with the actions of the endocannabinoids.

        M’well…

  • lovingc

    The really weird thing about this attitude is that cannabis tinctures were sold over the counter up until the 50’s. It was prescribed for a number of ailments by Doctors. The resistance from the schools is about fear, the fear should be about not informing new Doctors about possible drug interactions. This has got to stop. We have medical cannabis in 60% of he country. These schools have abrogated their responsibilities to their students and the public.