We asked Dr. Antonio Vigano, attending physician at the McGill University Health Centre’s Division of Supportive and Palliative Care, five questions about medical cannabis.
According to Health Canada, more than 300,000 Canadians use cannabis for medical reasons. Dr. Antonio Vigano has been interested in this complementary approach since 2016. Among other projects, he led the first cannabis research project in Canada, conducted between January and August 2018. He presented the project’s first findings at the Quebec Breast Cancer Foundation’s Forum on May 11, 2019.
Question: Why are you interested in medical cannabis as a cancer treatment?
Answer: As a doctor, my main objective is to improve my patients’ quality of life. Given its properties, cannabis can play a significant therapeutic role for patients suffering from pain and other symptoms that considerably affect their quality of life: loss of appetite, fatigue, etc. These are examples of symptoms that are not always completely relieved with conventional treatments. That’s why cannabis rounds out these traditional approaches.
Question: What types of patients can obtain a prescription for medical cannabis?
Answer: All types of patients can get a prescription. On one condition: the doctor must ensure that the therapeutic benefits for the patient’s health surpass the potential adverse effects and risks. No matter what stage the disease is in—whether the patient is in palliative care, in remission, suffering from the side effects of treatments—medical cannabis can provide benefits.
Some patients in chemotherapy experience peripheral neuropathy. This is a very common problem that is still not optimally managed by traditional medicine. Synthetic or natural cannabinoids are an option to consider for such patients. These types of products can also help patients who’ve received hormone therapy for several years and feel like their bodies have aged significantly. Their joints, bones and muscles all hurt terribly. It’s similar to fibromyalgia symptoms, another area that doesn’t have much to offer in terms of pain management.
The important thing is to be overseen by a doctor and a multidisciplinary team. It’s not enough to just write a prescription, the doctor has to monitor the effects of the treatment to optimize it.
Question: Can all doctors, regardless of their training or speciality, prescribe medical cannabis to their patients?
Answer: All doctors can prescribe medical cannabis. However, training in this area is highly recommended. It’s another type of medicine, a very personalized one, that needs to be learned. There are no given doses, specific strains or types of products that work the same on everyone. That’s why it’s important to have theoretical and practical training on using cannabis as complementary medicine. As research director at Santé Cannabis, I advise healthcare professionals to consult this organization to obtain specialized services concerning the use of medical cannabis. At the moment, the Access to Cannabis for Medical Purposes Regulations lets Quebec’s faculties of medicine decided whether to integrate such training.
Question: What are the dangers of using medical cannabis?
Answer: Patient safety must be our top priority. We have to be cautious. It’s the same with traditional medications. If they aren’t controlled, they can pose several risks.
First, the doctor has to be aware of the contraindications for using medical cannabis, including cardiovascular diseases, heart arrhythmia, uncontrolled hypertension, schizophrenia, pregnancy or nursing, bipolar disorder and major depression. It’s also not appropriate to prescribe cannabis for patients under 25 years of age, people with a risk or history of addiction or people suffering from kidney or liver failure (cirrhosis of the liver).
Finally, patients must be started on the lowest possible dose and gradually increased, with careful monitoring.
Question: What is your position on Canada’s legalization of cannabis on October 17, 2018?
Answer: Let’s look at the positive. Legalizing recreational cannabis helped quiet the anti-cannabis outcry, thus giving our patients easier access. However, I believe that cannabis can be dangerous when not used properly. The aims of recreational use are very distinct from medical use and often, there is confusion between the two. Some of the problems that can arise with recreational use (addiction, tolerance) are precisely those we want to avoid in medical use. It’s a completely different approach.