When Quebec’s CAQ Government announced that there would be a ban on all ingestible and topical forms of cannabis on July 26, outrage was heard from patients who felt as though they should have been consulted prior to the decision.
As cannabis is only available in combustible, vapable, capsule, and oil forms for patients, the proposed edibles and topicals ban would also restrict these products from patients interested in trying them.
But, according to Dr. Antonio Vigano, patients need to stick to their prescriptions if they’re actually looking for medical grade cannabis.Join the Leafly Canada CommunityVigiano is the attending physician and associate professor at McGill in oncology and palliative care at the MUHC, and director of the Cancer Rehabilitation Program and the McGill Nutrition and Performance Laboratory.
Also an expert on medical cannabis as appointed by the Court of Quebec, and the Research Director at Santé Cannabis, Vigiano is the principal investigator on the Quebec Cannabis Registry (QCR) Study, which will finally provide data on 3,000 patients using cannabis.
While the CAQ Health and Social Services Minister Lionel Carmant’s proposed ban on candies, cookies, gummies, and also topical creams was aimed at minimizing “harm to the public,” Vigiano said that there wasn’t enough oversight with these recreational products to begin with.
In a phone call with Leafly, Vigiano argued that there is a lot of confusion between both the recreational and medicinal markets, as well as what it can and can’t do for patients.
More Studies Needed
“There are inconvenient myths where cannabis is seen as an anti-cancer treatment and unfortunately, to date, we only have the clinical data on that.
“We have something studying animals in a petri dish where it seems to be extraordinary, but then we go to human trial and it fails. We still need to better also qualify [the] characteristic, the possibility, and the opportunity to date, that medical cannabis provides,” said Vigiano.
However, that doesn’t mean that cannabis is not being studied medicinally or used in a startling amount of cutting edge medical treatments.
Vigiano said that the vast majority of physicians have simply not been trained on how to prescribe cannabis.
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At that, lacking some of the data that the QCR will provide—a longitudinal surveillance study that involves more than 3,000 patients in Quebec—including real world information and population based data, physicians will get the key figures needed to help them prescribe and understand cannabis for more uses.
Candies and Confections ≠ Medicine
Vigiano said that Canada is the only country in the world that has quality control monitored by the government, so that physicians can best prescribe and titrate quantities for patients.
The fear is that a product that has not gone through this rigid inspection process could mean trouble for anyone, especially patients. What’s marked on the package may not be exactly what’s in the product, plus, a medical patient could be on another ten drugs simultaneously, making dosing even more important.
Dr. Vigiano cited edibles and topicals in general as being a problem, simply because they are not held up to the same standards as Health Canada.
“Many activists will say ‘I don’t see any difference, you go to the SQDC, and it is the same product.’ I am sorry but it is not the same product!” said Vigiano fervently.
As an example, Vigiano explained that he has had patients cross the border into Vermont and to buy gummy bears labeled as containing 300mg of CBD. He said that for that patient in particular, he would have only have recommended five mg of pharmaceutical grade CBD oil.
“First of all, I don’t know how much this gummy bear really has inside of it. It is sold by a pharmacy but there is no indication of whether this [is] pharmaceutical or medical grade. There are no licensed producers in the US. So you see the difference.
“Everybody says it’s five grams of something but who knows? It could be five or seven mg, or it could be fake,” said Vigiano. This is because across the border, cannabis products undergo the same scrutiny as natural supplements.
In the patient’s context, Dr. Vigiano said something ingestible would only be used to treat chronic pain. In other contexts he said that different sprays, turbuhalers, patches, and other modalities of treatment are being looked at for short and long acting cannabis applications, depending on patient need.
“Whatever can be useful to facilitate the intake of cannabis will be my favourite, but it has to have that pharmaceutical grade because otherwise we are not treating cannabis as a medication, we are treating it like a supplement or natural product,” said Vigiano.
Non Combustible Alternatives
What isn’t being talked about are the kinds of strides that cannabis is making when being used as an alternative to other forms of treatment for treating diseases like HIV/AIDS, various cancers, the treatment of malignant diabetic ulcers, and a wide range of other diseases that require the use of anti-inflammatory drugs.
When using cannabis as a complementary drug, instead of receiving a substance that is an immune-suppressant they get what he called an “immune motivator.”
“It facilitates and enhances the positive aspects of information. Information is the way that the body protects itself from everything. It will depress anything that is being over-expressed because of a pathological disease or condition. Most of the medications, such as steroids, being the prototype, they tend to suppress all kinds of information, making the patient immunodeficient and more prone to infection,” said Vigiano.
Instead of making patients immunodeficient, cannabis works at immune-modulation, and Vigiano said that on this end it can work at reestablishing and rebalancing the body too, in this sort of “homeostatic” or “homeostasic mechanism.”
Where other drugs would suppress what is being over-expressed, debilitating the patient, cannabis is still anti-inflammatory, but without causing further suppression.
Rebalancing the Body with Cannabis
“The endocannabinoid system is the one that would help again[st] the stress or stress related reaction of the central nervous system, and rebalance the one that has been suppressed, like in many instances where we have a balance between inflammatory and anti-inflammatory factors.
“The cannabis, in general, will balance this sort of equilibrium and that is very, very unique. This is the first time that I have seen something like this in my experience,” said Vigiano.
He gave the example of a patient going through leukemia and receiving a lifesaving bone marrow transplant. A frequent side effect, even in successful transplants, is that it carries a very high risk of the patient developing graft-versus-host-disease (GVHD).
GVHD happens when the cells that have been transplanted start to react against the body and the patient develops a “terrible syndrome” involving their skin, joints, and other problems.
While the patient may be cured from cancer, they are now dependent on steroids and therefore at risk to other “opportunistic infections,” because of the suppression that happens with them. Vigiano has been experimenting with using cannabis in this instance while reducing steroids and seeing positive outcomes.
While cannabis is proving to be miraculous at “filling those gaps,” Vigiano said more research and testing is required to implement these discoveries. This will be the next phase of research but it has not received a green light yet.