It is with great regret and a heavy heart that we must announce the suspension of a large part of our services for financial reasons.

As of Monday, September 5th, we must unfortunately suspend initial appointments for all new patients. We must also suspend our training activities for health professionals and patients. Therefore, all announced fall events are cancelled. We will however continue to ensure the renewal of medical cannabis authorizations for existing patients.

We want to assure you that we will be here for our current patients. Our phones and emails will be open, however, we will have fewer staff to support them. Your doctors are here to provide continued care. Follow-up appointments will be a little different, but we are fighting to bring back our full level of care.

Here are ways that you can help:

• Make a contribution to our cause

• Share our campaign with your friends and family, or share on social media

• Continue with us – Moving to the recreational cannabis stream hurts our cause

• Send us a testimonial that you would be willing to share in our public campaigns – Rest assured, we won’t disclose any identifying information. 

•  Be patient with us during this difficult time, we will need more time to return your calls and your emails, we’re here for you but we are under-resourced

You might be wondering how this happened- Santé Cannabis has been a mainstay of medical cannabis access in Quebec since 2014. 

We’ve been struggling with the same question. Medical cannabis is not a priority for our government, for our healthcare industry, and we’ve tried everything we can to maintain our service, but we’re at our breaking point.

We’ve been slammed by the COVID-19 pandemic and increasing costs. And we now operate in the shadow of a recreational cannabis market entirely disconnected from its roots in medicine and patient advocacy. We now lack the resources required to continue providing our essential medical service. The RAMQ billings and educational grants we receive do not cover the costs of the care that we provide, and we must restructure in order to survive. We also receive no additional public funding in a province that profited $65 Million from recreational cannabis sales last year.

To date, none of these public funds are earmarked for medical cannabis research or improving medical cannabis access in Quebec. Many people will wonder, why do we still need medical cannabis clinics now that cannabis is sold legally?

There are many, many reasons:

• Patients using cannabis for medical purposes require care and education that cannot be provided by cannabis store clerks
• Physicians, nurse practitioners and pharmacists identify potential risk factors and drug interactions that require monitoring
• Vulnerable populations require personalized professional support to ensure they use cannabis safely and appropriately
• Cannabis purchased on the recreational market cannot be declared as a medical expense on income tax
• Medical cannabis authorizations provide protection to individuals who depend on it to work, to live and to care for their families
• Children and young persons can only access cannabis for medical purposes, and require personalized professional support
• Some patients receive reimbursement for their medical cannabis purchases, such as through Veterans Affairs Canada, CSST, SAAQ, and health insurance spending accounts. 
• Patients who grow their own cannabis require medical authorization, especially in Quebec where home cultivation is otherwise prohibited
• Specific Higher potency products for medical use are not available at the SQDC and can only be accessed via medical authorization

Once more, here are the ways you can help:

We are about to launch a media campaign to let the public know of this situation. We’ve protected our patients from these financial difficulties until now and avoided voicing them publicly. We are now at a point where we can no longer stay silent. As patients, you can help shed light on the importance of patient access to reliable information, educated medical evaluations and proper follow-ups. If any of the reasons for medical cannabis clinics to exist apply to you and you want to share your experience, send us your testimonial at info@santecannabis.ca.

We have also launched a donation campaign that we invite you to share with your connexions. We believe in our mission. We hope this situation is temporary, and thank you for your patience and support.

– Dr. Dworkind

Donate here

*Please note that this blog dates back to 2022. We restarted initial appointments for new patients in November 2022 and are still taking new patients.

No one said recovering would be easy; they said it would be worth it.  

Whilst sitting here wondering how I am going to take nearly 12 years of chronic health struggles and formulate it into a short blog post, I reflect on a 16-year-old: scared, confused, immature and unprepared adolescent. I bring myself back to the day I got the call from the Montreal Children’s Hospital Gastroenterology (GI) department to give me my first appointment, initiating the testing process for inflammatory bowel disease. It seems like so long ago, yet it’s still so fresh in my memory.  

As a medical cannabis patient and medical cannabis clinic employee, I hope my story can help anyone to see a glimmer of light at the end of even the darkest of tunnels. I currently see my daily fight to maintain balance and good health as a blessing and a strength, but as a teenager just starting to experience life, it felt like an absolute curse and weakness.  

The summer I turned 16, I went to see my gynecologist for my usual 6-month follow-up. Even though I was on birth control, I was constantly spotting between periods. Given my family history of Inflammatory Bowel Disease and Irritable Bowel Syndrome, and an additional concern of constant diarrhea for the last 3 months, worry grew that I may be battling an autoimmune disease. My doctor put in a request for me to be seen by the Montreal children’s hospital’s GI department, where I was diagnosed with Crohn’s disease.  

Within a month of my diagnosis and commencing treatments, I experienced an adverse reaction to the medication my doctors had prescribed to control my disease. It left me with pancreatitis – this was the beginning of my living nightmare.  

Due to ongoing complications, I was hospitalized for months at a time, and I was given opioids to control my pain, benzodiazepines for anxiety, and corticosteroids for the inflammation my disease caused. As time passed each hospitalization got longer and my time at home in between got shorter.  

Over time, I started to notice a shift in my moods. I thought I was only mildly depressed because of the cards I had just been dealt. I figured it was normal considering everything I had gone through in a short amount of time. I was watching my adolescence being ripped away from me. I began to feel like a prisoner in my own body. I went from being an outgoing and sociable teenager to being a reserved and isolated young adult. I was terrified.   

Shortly after being told that my pain from multiple flare-ups left me with chronic nerve damage to my intestines and pancreas, I began to realize that the pain I had was both physical and psychological, which in turn brought on severe anxiety. I started to seek unhealthy coping mechanisms.  

Subconsciously, I turned to opioids that doctors prescribed for my physical pain to alleviate my mental pain as well. I did not want to feel anything, I wanted to be numb. From that point on, there was not a day that went by that I did not misuse morphine, Dilaudid, codeine, fentanyl, or Ativan to escape the fact I was chronically ill and depressed.   

I was being followed in cognitive behavioural therapy and talk therapy for 6 months after my Crohn’s diagnosis. I learned I could tell my therapist whatever she wanted to hear just so my specialists would be happy and leave me be. After each session, I would go home and drown my feelings in whatever opioid I had at my disposal.   

Sleeping and avoiding reality became easier than dealing with my issues.  I had lost everything dear to me: school, friends, romantic partners, self-confidence, and, most of all, self-worth. I was doing absolutely nothing to help myself. I had secretly set a goal to do everything in my power not to see my 25th birthday. At this point, I was chronically depressed and had become a danger to myself.   

My cannabis journey began roughly 2 months later. I went into the ER as usually, thinking I was having another flare-up, but the nausea, vomiting, irritability, cold sweats and increased pain that I was experiencing was not disease related; it was withdrawal. I was hospitalized again, but this time was different. The chronic pain doctors and my care team agreed that I was physically dependent on Dilaudid. They proposed a 20-day in –hospital detox. At 17, I felt like I was being treated like a severe drug addict – little did I know, that was exactly the road I was heading down.  

My older brother came to visit me one day and was appalled with the approach the hospital was taking. Yes, on the one hand, they were doing right by getting me off the opioid causing more harm than good; but on the other hand, I had nothing in the short-term to control the constant pain that I was in. He decided to bring me outside and shared a joint with me. After smoking, my pain diminished, and I was able to finally eat something without vomiting. Since I was a minor my doctors were legally unable to recommend me using cannabis, but if it meant that I would use less opioids, they were not completely opposed to it. The doctors found less habit-forming derivatives of opioids for me to use during pain flare-ups; but with the help of cannabis, I did not need to use as large of doses as I used to.   

After my bowel resection at 20 years old, I recall that my family doctor noticed I was very depressed and needed help. He referred me to the best psychiatrist I’ve ever met. For the first time since getting diagnosed, I felt like I could make considerable progress. I felt like I could open up and be vulnerable with this doctor. I felt like finally someone other than my gastroenterologist genuinely believed in me and did not think I was just a drug seeker, that there was more to my substance abuse than the desire to get high. Despite that, it still took me 6 months to actually let her into some of the deepest, darkest parts of me.     

During one of my countless hospitalizations, I was assigned to the family medicine unit. Dr. Jean Zigby was following me. He was aware that I was trying to reduce my intake of opioids and substitute them with cannabis, but I had no guidance, little cannabis knowledge, nor did I have a clue what was in the cannabis I was consuming. Dr. Zigby changed all that and at 22, I was introduced to Santé Cannabis  

From there, I was blessed with a structured, positive, and organized care team. Confidently, I was able to find healthy approaches to put into practice and regain some balance in my life. I was able to gradually reduce my opioid use for anything other than pain management during my Crohn’s flare-ups. I no longer needed my benzodiazepines, not even for severe anxiety attacks. I was finally taking care of myself, and things began to look up for me. The one thing I did not expect was for the “rollercoaster” I called my life to sporadically have such horrific lows.     

After 7 years of being sick, I had hit rock bottom, attempted to overdose, and to commit suicide multiple times. It took me countless hospitalizations, substance abuse issues and 6 different mental health professionals for me to take my mental and physical health disorders seriously. I had a romantic partner at the time who gave me an ultimatum: it was drugs or her – and clearly, I chose her. I have been on a constant journey of recovery since.   

Due to a long-term use of steroids, I was diagnosed at 23 with ankylosing spondylitis in my sacroiliac joint, as well as rheumatoid arthritis. I was constantly waking up with swollen joints and pain in my lower back, hands, and knees. After being in constant pain for months, I had gone to the emergency room where they had done scans and blood tests. And sure enough, I had a new chronic autoimmune disease that I needed to deal with.  

I was already sober and well into recovery at this point. My medical cannabis care team and I had found a proper THC-rich cannabis regime for my neuropathic pain. Unfortunately, following my care team’s suggestion to add a CBD oil regime to control my ongoing inflammation was too costly for me, as I did not have an income at the time. I had no choice but to start methotrexate, which is a disease-modifying anti-rheumatic drug (and a cancer treatment at higher doses) with debilitating side effects. However, I was able to control my arthritis with it, to a point where I could keep a steady employment.  

Eventually, I was able to afford CBD oil, which in turn helped control the inflammation caused by arthritis. It almost seemed too good to be true, but following a strict ratio of THC:CBD, ALL my chronic health conditions were now under control. I was able to stop 98% of the medications I was prescribed.   

However, with my life headed in the right direction, a part of me still felt unhappy. There was still that little voice in my head, determined to think that I was going to fail, reminding me about the promise I made to myself that I would not see my 25th birthday. I hated the person I saw in the mirror daily. The only emotion I was able to feel was self-hatred. I overthought everything and anything, and I developed chronic social anxiety – I could no longer be in large groups or crowds of people.  

Instead of using drugs, I was now using romantic relationships and close friends to fill the empty hole deep within where self-love used to lie. I simply transferred addictions. I had not completely dealt with my trauma of the last 9 years. I was barely functioning. I hurt people and got hurt. I always had a superhero complex, but by the time I was 24, it was out of control. I thought I could deal with my “baggage” once a week in therapy without applying therapy tools to my daily life. My days revolved around my career and my partner; I was living and breathing for two things and none of them was me. I ended up burning myself out and nearly relapsing.  

I was a week away from the 2-year mark of my sobriety, 4 months away from my 25th birthday and I was once again ready to end it all. I had to take a sick leave from work and broke up with my then-partner when everything was getting hard. I had a plan to end my misery and give up on myself. The day I planned it, to overdose and close my eyes for good, somehow, with my hand full of pills, reality hit me. I realized how far I had come and could see my worth for the very first time in my life. Instead of relapsing and giving up, I decided it was time to go to rehab.  

I finally focused on myself and was able to get back to work. I took therapy seriously and was able to find new ways to appreciate the life I fought so hard for. I surrounded myself with positive and supportive people. I got through the darkness and celebrated my 25th birthday in June 2019.   

By sharing my story, I wanted to show you that anything is possible with a positive support system, a proper care team, and an individualized treatment plan. You can be dealt the worst cards imaginable, but it is the approach you choose to take that can lead to success or failure. I ventured down both roads and believe me when I say: once you learn to love yourself and embrace everything about yourself, you can overcome any obstacle.   

I found the positive before it was too late. I found my purpose and found my place in the world. No matter how dark the road gets for me, I can always manage to find a way to bring a glimmer of hope to the obstacle I am facing. I grew tired of letting my illnesses, my disorders and my struggles define my life, and learned to live with them.  

When I concentrated on caring for myself and dealing with my trauma, I could prevail through the darkness. I could not find the light in my darkness, so I became the light.  

Author: Rebecca Fogel, Patient Care Coordinator, Santé Cannabis   

Rebecca Fogel has worn many hats for Santé Cannabis since October 2017. She works as a Medical Office Assistant, Patient care coordinator and Patient advocate. She leads patient events and support groups, is passionate about public speaking, and is dedicated to providing medical cannabis patients a place to speak freely and to be heard. 

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

I often get patients wondering in the same manner. There is still much reprehension about cannabis. Our society is unceasingly finding fault with it, no matter how its status has evolved. The public has yet to fully and intuitively confirm its moral direction. Cannabis perception is changing at a very slow pace. 

Even the method of administration is very much compatible to its malignant opinion. ‘’ I don’t want to smoke cannabis. I’m not a druggy.’’ one of our patients did say. The current terminology, slangs precisely, is still and probably throwing people off. Many of our patients do not want to be taking weed or puffing on a spliff. Our treatment plans are based on scientific data, and accordingly we make sure to use the appropriate terms to the purpose. 

Our esteemed doctors do not prescribe marijuana. They recommend inhaling dried cannabis for breakthrough pain. I would gently remind a patient when he or she uses such words as “pot” or “ganja”. The old proverbial ‘’to-may-to/to-mah-to’’ would ring out. So, what is the difference? Really? 

I believe words and how we understand them are very consequential moving forward. I remember back in the 1990’s, the semantics affecting the scope of the term ‘’death tax’’ eventually became the ‘’estate or inheritance tax’’ in the US? Basically, politicians and advocates tried to kill the bill by putting stress on how it harmed family farms and small businesses. They knowingly coined the term ‘’death tax’’ to get the public to consider their cause. Dying has more impact and meaning in the collective conscience. 

I think the transition toward a proper nomenclature in medical cannabis practice must be imposed, applied and supported by all parties involved. Indica dried cannabis, THC-rich, 3-4 inhalations at bedtime or as needed does serves as better example of a positive and trustworthy interpretation than 3-4 puffs of weed before going to bed. 

– Pheng Lim, LPN 

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

The Opioid Epidemic in North America

“Too many Canadians share the heartbreak of losing a loved one to a drug-related overdose…. Addiction and substance use is a health issue, not a moral one.”

The Honourable Patty Hajdu

Minister of Health

April 14, 2016 the British Columbia provincial health officer declared the opioid-related overdose deaths a public health emergency under the Public Health Act.  A count of days stays active on the Vancouver City page as many work tirelessly to end the state of emergency.

(1,959 days when taken from the site. The count continues here)

British Columbia and Alberta continue to be the most impacted regions of Canada, although rates are increasing in other regions including Ontario. “The COVID-19 outbreak is worsening the already deadly and ongoing public health crisis of opioid overdoses and death. It is having a tragic impact on people who use substances, their families, and communities across Canada.” (more references here and here)

Nationwide, Canada experienced 21,174 apparent opioid toxicity deaths between January 2016 and December 2020, with 6,214 of those deaths happening in 2020, (approximately 17 deaths per day), of which 96% were accidental (unintentional.)

Vancouver, one of the hardest-hit cities, has been trying to implement innovative solutions to the crisis, including: seeking to decriminalize simple possession of illicit drugs in Vancouver; approving the Four Pillars Drug Strategy – Harm Reduction, Prevention, Treatment and Enforcement based on successful programs in cities such as Geneva, Zurich Frankfurt and Sydney; and hosting North America’s first legal safe injection site and needle exchange.

Despite this crisis, opioids are still being prescribed on label every day by doctors primarily to treat pain. In places such as the USA, cannabis is still considered a schedule 1 drug, despite knowing that fatal overdoses are impossible with cannabis, while opioid overdoses are at the point of public health emergency. 

As opioids are used to treat pain, it follows that reducing the number of opioids being prescribed to pain patients could also decrease the number of people experiencing dependency on these substances.  The Federal government includes the Canadian Pain Task Force Report (CPTFR) March 2021 as a recent highlight of their actions on opioids: 

“Goal #2 – People have equitable and consistent access to a continuum of timely, evidence-informed, and person-centred pain care and supports across jurisdictions” includes “the development, dissemination, and evaluation of evidence-informed clinical guidance for health care professionals who authorize access to cannabis for medical purposes to treat and manage chronic pain while actively working to support more research into potential applications.”

Today on World Overdose Awareness Day, we are exploring some of the medical cannabis pain treatments that are being researched, also available at our clinic, and the associated outcomes. 

Opioids & Chronic Pain 

Opioids are a class of medication primarily used to treat pain. 

About 1 in 4 Canadian lives with chronic pain; it is an enormous global public health problem. 

Chronic pain is pain that lasts or reoccurs for more than 3 months. It is not limited to the painful experience and is not only physical; several other symptoms are associated with pain. Pain provokes an emotional response too, causing anxiety or stress, depression, etc. With unrelieved pain, life can become pain-centered.

Chronic pain is recognized as an enormous global public health problem. Despite highly variable data, the estimated prevalence of chronic pain in adults is 18.9% in Canada (Schopflocher et al., 2011). Management of pain includes pharmacological and non-pharmacological treatments, but opioid medications remain a mainstay despite significant safety concerns and risk of use disorder, estimated at 46.6% among opioid users (Marel et al., 2019). Opioid use disorder involves both prescribed opioids and illicitly manufactured opioids, such as heroin or highly potent street fentanyl.

Opioid Use Disorder Treatment

“Addiction is not a choice—it is a treatable medical condition that requires a broad range of care and treatment options.”

Opioid agonist therapy (OAT) is used to treat individuals with opioid use disorder. The therapy mainly consists of methadone, hydromorphone or buprenorphine/naloxone treatment. While this therapy may have an impact on opioid-related mortality, its effectiveness is still debatable with many individuals still using opioids while on therapy (Stone et al., 2018).

Several supervised injection sites make these drugs available for opioid users. 

The Centre for Addiction and Mental Health recently published a set of guidelines for treating Opioid Use Disorder with OAT (CAMH, 2021).

Cannabis as a Potential Adjunct Treatment for Chronic Non-Cancer Pain

To move patients from a pain-centred life, to a functional-centred life, we must empower patients to take control over their own health, to improve their functionality and their quality of life. Healthcare professionals at our practice help patients to help themselves.

In this context, the use of opioids in chronic pain management is a topic of significant debate and there is increased interest in alternative treatment options.

Opioids = not that effective, strong side effect, risk for dependency, overdose

CBM = somewhat effective, mild side effects, minimal risk for dependency, no overdose

Cannabinoid-based medicines (CBM) may offer a safe complementary therapeutic option to refractory pain and associated symptoms, due to their potential analgesic effects in chronic pain patients (Urits et al., 2019). Some observational studies have reported a reduction in opioid use for pain management after starting a CBM treatment (Boehnke et al., 2019; Safakish et al., 2020). ​​In a recent observational study, 28.1% of participants reported using opioids at baseline, decreasing at 11.3% at six-month following medical cannabis treatment (Lucas et al., 2021). 

A review by Okusanya and colleagues (2020) analyzed 9 studies (7222 participants) and showed “a 64–75% reduction in opioid dosage when used in combination with CBM and use of CBM for opioid substitution was reported by 32–59.3% of patients with non-cancer chronic pain”.

Cannabis-based Medicine Treatment for Chronic Pain at Santé Cannabis

“Chronic pain is an epidemic in North American society; treating it with opioids is leading to the crises with opiod overdoses. Medical cannabis has been proven to work for both malignant and non-malignant pain, and therefore can be enormously helpful as an individualized treatment with opioid sparing effects. 

Further, anxiety, depression and sleep disturbances are related to chronic pain, and all respond to some strains of medical cannabis.

A fatal overdose of medical cannabis is very unlikely (WHO, 2018), so on a whole, when we increase medical cannabis we can decrease opioids, which in turn will lead to a decrease in overdose deaths. With the correct supervision for patients, the correct dosage and strains, we hope to see a change in removing people from their long term opioid use.”

-Dr. Michael Dworkind, MD, Medical Director

Our most recent data shows that about 75% of our patients come to the clinic to examine CBM treatment for chronic non-cancer pain not alleviated by conventional treatments. After three months of treatment, pain severity and pain-related interference scores, measured with self-reported validated scales from 0 to 10, significantly decreased suggesting improvement in pain intensity.

Side effects are experienced by about 30% of patients and include drowsiness, dizziness, headache and fatigue. The majority of them are mild and transient. Our clinic staff is well trained on the monitoring of such side effects and strategies to mitigate those include decreasing the dose or adjusting the product formulation. Some of this data was presented at a recent scientific conference, you can find more information about this here.

Overall, cannabinoid-based medicines are generally recommended as adjunctive treatment for chronic non-cancer pain. When considering cannabinoid-based medicines, it is important that a discussion takes place between the healthcare provider and the patient in a shared decision-making process  (Chang et al., 2021). Indeed, cannabinoid efficacy, potential adverse effects, cost, and related stigma should be addressed so that patients are adequately informed.

Further, data collected at Santé Cannabis shows that medical cannabis can address pain and sleep disturbances.  Our healthcare team uses medical cannabis as a tool that can serve as an adjunct treatment for chronic pain. (Häuser, W., et al. 2018)

Consensus-Based Algorithm

A recent Canadian initiative produced a consensus-based algorithm on the safe introduction of cannabinoid-based medicines and opioids taper in chronic pain patients. According to this algorithm, cannabinoid-based medicines can be considered in patients with chronic pain taking opioids and not reaching treatment goals, having opioid-related adverse effects and/or at risk of opioid-related harm (Sihota et al., 2021). Notably, there is no age restriction in the algorithm, as there is no rationale to withhold cannabinoid-based medicines until a certain age if the patient already takes opioids.

Cannabis as a Potential Adjunct Treatment for Opioid Use Disorder 

We previously wrote about how CBM can help in substance use disorder (here). In this blog post, we focus on opioid use disorder. Population studies have recently identified reduction of opioids and opioid overdoses in states where medical cannabis has been legalized (Bachhuber et al., 2014; Bradford et al., 2018). Nevertheless, data is very limited in this area making conclusions hard to draw (McBrien et al., 2019). 

A recent paper examined the impact of cannabis and fentanyl use among people on OAT in Vancouver and found that participants using cannabis (with THC) were associated with a lower risk of exposure to fentanyl (Socias et al., 2021). 

Very few controlled studies on CBM and OUD exist. A double-blind randomized placebo-controlled study was conducted on the effect of CBD on cue-induced drug craving and anxiety in 42 drug-abstinent heroin users (Hurd et al.,2019). It assessed the effect of CBD (Epidiolex®) or placebo on behavioural, cognitive and physiological measures following oral intake of CBD (acute), then again after 3 consecutive days of treatment (short-term) and last 7 days after the last treatment (protracted). ​​Exposure to CBD resulted in a reduction in cue-induced anxiety and drug craving in heroin-abstinent persons starting as soon as 1 hour after ingestion and up to 1 week after the final administration. However, this effect was not observed on self-reported drug craving questionnaires, which could be explained by the different types of craving: home-general craving versus experimentally induced one. The same study also showed that CBD administration did not affect cognition but led to decreased cue-induced cortisol levels.

Research on CBM and OUD is still in its infancy and more controlled research similar to this one is needed to consolidate observational findings and clarify the potential effectiveness of cannabis as an adjunct treatment to OAT for OUD. 

Claims of the role of CBMs in the management of the opioid crisis are still preliminary, and in direct contrast with cannabis’s status in the US. Such findings require further validation in controlled settings to assess the opioid-sparing effect and the safety and effectiveness of long-term CBM use. The status quo sees no end to both opioid and chronic pain crises while cannabis use increases primarily without sufficient medical supervision.

Looking to End the State of Emergency

We look forward to the day where the opioid crisis is no longer considered a state of emergency. No one single strategy will solve this issue, projects from reducing stigma, preventing pain, providing rehabilitation centres, reduction of opioid use and more all need to work together to reduce the number of lives tragically lost.

At Santé Cannabis we are taking on one small part of the work that needs to be done, by providing people alternatives to opioids when treating chronic pain. We look forward to the day when medical cannabis is an option for more patients when seeking support for pain from their family doctors.  

For Quebec doctors and nurse practitioners interested in helping end the state of emergency, we offer the Prescriber Training Program to provide practical information about the clinical use of medical cannabis, and just published a new module on non-cancer pain and medical cannabis. Register for free here: 

Resources 

https://www.nature.com/articles/d41586-019-02686-2

https://pubmed.ncbi.nlm.nih.gov/32419434/

https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/maps

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

It would be difficult to deny the impact of the COVID-19 pandemic on anxiety and anxiety disorders in the population. Whether there are new anxiety symptoms or an exacerbation of existing ones, most of us know people who have been affected, if not ourselves. 

Reasons for increased anxiety in 2020/2021? 

Social isolation, monetary stress, sudden major changes, uncertainty about the future, sensation of losing control, fear of illness, etc. Some people have been in extremely close contact with COVID-19: people who have been infected, people who have lost loved ones or who have feared losing them, essential workers and, of course, healthcare professionals in many areas.

According to a  survey by Statistics Canada and the Public Health Agency of Canada conducted between September and December 2020 and published in March 2021, 7 out of 10 Canadians have been negatively affected by the pandemic and 2 out of 5 have experienced distress related to it. 

A survey was also conducted by the University of Sherbrooke on the psychosocial impacts of the pandemic: 

“What we see today is that levels of depression and anxiety in Quebec are currently considerably higher than what was observed pre-pandemic. These numbers are similar to the levels observed in the community of Fort McMurray, 6 months after the 2016 forest fires” (Dr Mélissa Généreux, septembre 2020 – Link available in french)

WHAT IS ANXIETY?

Anxiety is an emotion characterized by feelings of tension, worry and physical changes such as increased blood pressure.

Although this emotion can be useful to us, it sometimes takes on magnitudes that have a negative impact on our ability to function, our quality of life and on our interpersonal relationships. It can even have a significant impact on our long-term health. The effects that anxiety and anxiety disorders can have on a person are real, undeniable and deserve our attention.

According to Anxiety Canada, there are 11 categories of anxiety disorders in adults: Agoraphobia, Separation Anxiety, Health Anxiety, Body-Centred Repetitive Behaviours, Specific Phobia, Generalized Anxiety Disorder, Compulsive Hoarding Disorder, Social Anxiety Disorder, Post-Traumatic Stress Disorder, Obsessive Compulsive Disorder and Panic Disorder.

In addition to considering the impact of anxiety on a person, specialists also evaluate 4 broad categories of symptoms and their frequency: 

• Physical responses
• Thoughts
• Emotions
• Behaviors

If you think you may be suffering from anxiety, an anxiety disorder or any other psychological condition, it is important to talk to your doctor. You can also refer to several resources such as those offered by the Government of Canada on their website.

TREATMENTS AVAILABLE AT THIS TIME

• Pharmaceutical Treatments: The main pharmaceutical treatments for anxiety are usually antidepressants. Benzodiazepines may also be prescribed for acute symptoms and/or until the therapeutic effects of the antidepressant are achieved, as antidepressants can take several weeks to have an impact on mood-related symptoms.
• Psychotherapy: Several approaches in psychology are recommended for the management of anxiety, such as cognitive-behavioral therapy and psychodynamic therapy, and can be of great help. 
• Exercise: Experts agree that exercise has great benefits on anxiety. This is because physical activity activates the production of neurotransmitters in the brain. These neurotransmitters include those targeted by many antidepressants such as serotonin, which helps combat anxiety.
• Mindfulness techniques: Often associated with meditation, mindfulness is an approach, an attitude as well as a set of techniques including meditation. Many of these techniques can also be practiced in everyday life, for example, while eating, walking or exercising. These techniques allow you to better understand and identify what triggers anxiety. They allow you to take a step back from these stressors and make it easier to manage them. Moreover, as this approach can be very beneficial both mentally and physically, we have recently partnered with MindSpace to offer opportunities for our patients to practice mindfulness techniques. If you are interested, you can join the mindfulness-based stress reduction program this coming fall. Our patients are eligible to 20% off. You can ask our clinic staff for the promo code!
• Cannabinoids: The endocannabinoid system present in our body also plays a role in the mechanisms related to anxiety. This is why they are also used as an adjunctive therapy for anxiety symptoms.

A treatment that combines several options (e.g., pharmaceutical treatment and psychological therapy) is far more effective than each treatment option alone.

CANNABINOID-BASED TREATMENTS FOR ANXIETY

The human body has an endocannabinoid system that manages many functions, including emotional behavior. This system includes cannabinoids and enzymes produced by this system that bind to various receptors. Cannabis is a plant that includes more than 100 cannabinoids, the main ones being cannabidiol (CBD) and delta-9 tetrahydrocannabinol (THC). We also know that CBD interacts with many receptors/anxiety targets. Indeed, strong preclinical evidence supports the use of CBD as a short-term treatment for generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and post-traumatic disorder (Blessing et al., 2015). The promising effects demonstrated by CBD in the preclinical phase – certainly influencing the “CBD craze” – highlight the critical need for more clinical studies. We recently published an article on this craze, and you can read it here. 

However, it is important to note that, for now, only limited evidence supports the use of medical cannabis for anxiety disorders (Walsh et al., 2015). 

Nevertheless, Santé Cannabis has observed some success with medical cannabis for the treatment of anxiety. In addition, in reviewing our patient data, we have also seen positive results with medical cannabis in patients with unrelieved secondary symptoms of anxiety or depression (chronic pain being the most common primary condition) (Rapin et al., 2021).  

The place of medical cannabis in the treatment of anxiety

On May 5th 2021, Santé Cannabis held a large-scale Conference on Cannabinoid-Based medicine focused on International Research and Innovation. As part of this event, Dr. Howard Mitnick presented a workshop exploring the question regarding the place of medical cannabis in the treatment of anxiety and managed to make this interactive workshop both amusing and incredibly insightful. He delivered powerful arguments starting with stating that cannabis isn’t the only field where evidence-based medicine and it’s usual hierarchy is a challenge. Obstetric and breast-feeding medicine are examples among others and for various reasons. In his clinical practice, particularly in 2016, when many veterans were coming back from Afghanistan, Dr. Mitnick said he was impressed by the very significant impact cannabis had on patients that were struggling with PTSD-related anxiety, grasping at anything to just stop their brain. He humorously pointed out that “if this talk was about what evidence there is supporting the use of medical cannabis on anxiety, it would be a very short talk.” The question then becomes,  how can we, as clinicians and as a community, negotiate with this limited evidence, while clinicians see that medical cannabis helps many patients effectively manage their anxiety?

ANXIETY AT SANTÉ CANNABIS

As clinicians, we have seen first hand the improvement many patients are able to experience with medical cannabis treatment. However, we know that individual success stories are not enough to provide insight into how to prescribe this medicine on a large scale. Through the use of our real-world data, our clinic strives to provide better patient care by advancing science including data regarding the place of cannabis in the treatment of anxiety.

We also offer our patients support groups, presentations and tools including stress management and mindfulness.

The combination of formal training of healthcare professionals and high quality research is essential to increase the selection of anxiety treatments and provide the best care for patients. 

Join us in working to develop the highest quality treatments for people with anxiety.  

Santé Cannabis is committed to advancing knowledge about anxiety and cannabinoid-based treatments, and as such, we offer research services to companies and institutions interested in developing clinical studies. 

For clinicians currently treating people with anxiety who wish to include medical cannabis in their practice, our preceptorships are available to all local and international physicians. For prescribers in Quebec, we also offer a free training program on cannabinoid-based treatments and how to prescribe them.

Author

Andrée Charbonneau, Nurse Coordinator

With thanks to the Research Department

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This year we were thrilled to be selected out of the many applications for both an oral presentation and two posters highlighting the work from not just our research team, but our entire clinic. 

The Symposium

“The International Cannabinoid Research Society is a non-political, non-religious organization dedicated to scientific research in all fields of cannabinoids, with more than 650 international Members researching the endogenous, plant-derived and synthetic cannabinoids and related bioactive lipids.” https://new.icrs.co/ICRS2021/ICRS2021/

Every year, the society holds a symposium to present the latest on cannabinoid research. 

Due to the COVID-19 pandemic, the symposium was held virtually this year; it was nonetheless a success with over 70 oral presentations and 180 posters, bringing together top researchers and clinicians from the medical cannabis community. Our presentations  discussed the impact of medical cannabis on pain management (one poster) and the role of cannabidiol (CBD) in symptom management (one poster and one oral presentation). 

CBMs for Chronic Pain 

The poster on cannabinoid-based medicines (CBMs) for chronic pain investigated the overall effectiveness of CBMs and the impact of treatment and population-based factors including treatment formulation, method of administration and pain mechanism. This study on 198 patients with pain as a primary symptom provided preliminary indication that CBMs may be considered as an adjunct for the treatment of various pain conditions besides neuropathic pain. Results are both novel and require further investigation. In contrast with current literature, oral CBD-rich products were the preferred product and method of administration.

Click to view CBM_for_Chronic_Pain poster

The CBD Craze

The other poster talked about the current CBD craze. Many countries are now legalizing CBD-rich products, yet validation of the therapeutic expectations of CBD products has fallen behind, and requires further research. The study compared effectiveness of CBD-rich products and THC:CBD products in 1,095 patients on symptom burden. Findings showed a modest improvement in symptom management with CBD-rich treatments and the necessity of both CBD and THC-based medical cannabis treatments to improve treatment effectiveness, for specific symptoms. 

The oral presentation assessed CBD-rich treatments on overall symptom burden and the effect of transition from a CBD-rich to a THC:CBD combination in 279 patients. Our results show that CBD-rich products may be effective to treat multiple symptom expressions simultaneously. Precisely, this study indicates a more significant positive impact of initiation of CBD treatments in patients who present with a higher number of severe symptoms, regardless of the product used after the first follow-up visit. 

We are very excited to announce that a full manuscript relating to this dataset was recently published in the Journal of Cannabis Research. 

Click to view The_CBD_Craze poster

What does CBD-rich, THC:CBD and THC-rich products mean, really?

Cannabis products, including medical cannabis ones, contain over 100 cannabinoids, among which Δ9-tetrahydrocannabinol (THC), and cannabidiol (CBD) are found in significant but variable concentrations and have garnered the most attention. Products available in Canada are categorised depending on their THC and CBD concentration, expressed either in weight concentration proportion (% w/w) for dried flowers or in volume (milligrams/milliliters; mg/mL) for oil products. When we talk about CBD-rich, THC:CBD and THC-rich, we group the products based on their CBD and THC concentration. 

CBD-rich means the product contains a high concentration of CBD and hardly any THC. In the Canadian medical cannabis program, CBD-rich cannabis oils contain approximately 0.5-1 mg of THC/mL and 20-25 mg of CBD/mL depending on the product manufacturer. In Canada, CBD-rich products can come from both hemp plants and other varieties of cannabis plants (more about CBD regulations in Canada here). 

THC:CBD means the product contains somewhat equivalent concentrations of both CBD and THC. 

THC-rich means the product contains a high concentration of THC and hardly any CBD. THC concentration can go up to 30% in dried flower cannabis products available in Canada. 

CBD, while  structurally similar to THC, does not cause intoxication or euphoria. Because CBD produces few adverse effects (Chesney et al.,2020), both patients and clinicians generally prefer to start medical cannabis treatment with CBD-rich products in order to limit the use of THC and its inherent potential adverse events (Brown, 2020). THC may be gradually added later to improve treatment effectiveness on specific symptoms. 

Table 1: THC and CBD contents and associated THC:CBD ratio for three of the most common oil products from each category authorized at Sante Cannabis.

Table 2: THC and CBD contents in percentage weight per weight (% w/w) and associated THC:CBD ratio for three of the most common dried flower products from each category authorized at Sante Cannabis.

To learn more about specific dosage to recommend to your patients, visit our international training page to find out about our unique clinical learning programs and preceptorships. 

Conclusion

As usual, the symposium was a great opportunity to learn more about all the exciting cannabinoid research that is happening around the world. So many people are dedicated to advancing knowledge on medical cannabis to improve access for patients, and we are proud to be able to play a part in advancing the world’s knowledge base. We are already looking forward to next year’s event, hopefully in person this time. 

Thank you to all our patients who participated in our real-world data observational study. These presentations would not have been possible without your dedication to advancing cannabis research. 

To find out more about our research programs and to get involved, visit our Research Partners Page

Author

Lucile Rapin

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Veterans Affairs spokesperson Marc Lescoutre told the Globe and Mail on Friday that “consideration will be given to whether coverage should be extended,” as part of an effort to keep the marijuana program as “up to date” as possible.” Veterans Affairs has been reimbursing the cost of medical cannabis products in dried flower form for military veterans and former RCMP officers since 2008. More than 10,000 veterans submitted requests for the reimbursement of their medical cannabis over the last year. The ministry offers $8.50 for every gram of dried cannabis purchased.

Adult use of reusable and disposable cannabis vape pens was legalized across Canada in the fall of 2019, although provincial governments in Quebec and Newfoundland have banned their sale. Patients in Quebec and Newfoundland who have a medical authorization for cannabis however can still purchase them from Licensed Producers.

Click here to read the article on the Globe and Mail’s website.