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BC’s Mental Health and Journal Visions Vol. 5 No. 4 | 2009

Cannabis experiences background perspectives& 3 Editor’s Message Sarah Hamid-Balma 14 From Thrills to Ills: Why pot is risky business Geoffrey Griffiths 4 What Do We Know About ? Philippe Lucas 16 Cannabis and My Road to Healing Kerry Porth 6 Cannabis Glossary 17 Cannabis and Me: A cautionary tale... 7 Cannabis Background Anita Smith

8 Cannabis and Psychosis 19 Alternatives: Miracle Alasdair Barr, Ric Procyshyn & Heidi Boyda Michelle Rainey

9 Why People Use Cannabis Rielle Capler 20 Marijuana: Help or hassle? Emily Smith

11 Cannabis, and Use in 22 Should We Have Been More Aware? How Canada Gerald Thomas & Chris Davis cannabis changed my life Matt 12 The Legal History and Cultural Experience of Cannabis Andrew Hathaway

web-only articles available at www.heretohelp.bc.ca/publications/visions

Should We Have Been More Aware? Epilogue: Mom’s View Gina

Cannabis: A mental challenge Mark Ware

bc partners visions

Seven provincial mental health and addictions non-profit Published quarterly, Visions is a nationally award-winning agencies are working together as the BC Partners for Men- journal which provides a forum for the voices of people tal Health and Addictions Information. We represent Anxiety living with a mental disorder or substance use problem, BC, British Columbia Schizophrenia Society, Canadian Men- their family and friends, and service providers in BC. tal Health Association’s BC Division, Centre for Addictions Visions is written by and for people who have used mental Research of BC, FORCE Society for Kids’ Mental Health, health or addictions services (also known as consumers), Jessie’s Hope Society and the Mood Disorders Associa- family and friends, mental health and addictions service tion of BC. By working together we have a greater ability providers, providers from various other sectors, and leaders to provide useful, accurate and good quality information on and decision-makers in the field. It creates a place where mental health, mental illness, substance use, and addictions many perspectives on mental health and addictions issues including how to prevent, recognize, treat and manage these can be heard. To that end, we invite readers’ comments and issues. Our goal is to help people feel empowered and im- concerns regarding the articles and opinions expressed in prove quality of life. this journal. The BC Partners are grateful to BC Mental Health and Services, an agency of the Provincial Health Services Authority, for providing financial support for the production of Visions

 Visions Journal | Vol. 5 No. 4 | 2009 editor’s message

fter our Visions issues on alcohol and tobacco, I’d been hoping for some time to round out the trilogy with cannabis. Cannabis is un- doubtedly a hot issue and even thought Visions is a substance use alternatives Ajournal in its own right, we were pretty sure we’d have—like in Alcohol and approaches& Tobacco—a lot of crossovers into mental health. We were right on all counts. In researching this issue and trying to find contributors, a quick stroll 24 When Help is Not at Hand: Teens turning to around the Internet reveals a lot of very strong pro-cannabis and anti-can- marijuana for emotional problems nabis advocates. We don’t want this issue to be either. We wanted it to be Joan Bottorff, Barbara Moffat based on credible research so we could set myths aside, but also grounded in & Joy Johnson real experiences and context. Because the context of use is so important. The more I’ve personally learned about cannabis, the more I knew that we didn’t 25 Tips for Cutting Back Rielle Capler want to paint it just in black and white, just the extremes. We want to fill in 27 The Health Effects of Medical Marijuana the middle. Project (HEMMP) Linda Balneaves, Joan Bottorff, H. Bindy Our Vision at the BC Partners—the group that brings you Visions Journal, Kang, Rielle Capler and the HEMMP the HeretoHelp website and many other resources—is to help provide good research team quality information to help you feel empowered to make more informed choic- es about your health. Each author speaks for themselves and/or their agency 28 Vaporizers: Safe alternatives to smoking? only. More than any other issue, I encourage you to read many articles in this Mridula Morgan issue, even ones that don’t fit your current opinion of cannabis. I want you to think about what your attitudes and assumptions are, suspend them for a lit- tle while, and listen to the various perspectives in this issue. Be curious. Ask questions. Talk to other people. Look up the research that’s brought up in many articles. Share this copy of Visions with others. And make up your own mind. If an article excites or angers you—or just makes you think—tell us about it. Be part of the conversation.

Visions is no stranger to controversy. Our sexuality issue back in 1999 ran- web-only articles regional kled some readers and we’ll be looking at that topic again with our GLBT issue available at www.heretohelp.bc.ca/publications/visions programs in the Fall. We want to pick themes that are timely and that add to important conversations—or even help fill gaps in knowledge. So whether you smoke 30 Compassion Clubs: weed or not, I think you’ll find this issue fascinating. You are bound to, as I did, Working for health and liberty Kailey Willetts learn something new. Sarah Hamid-Balma

Sarah is Visions Editor and Director of Public Education and Communications at the Canadian Mental Health Association’s BC Division. She also has personal experience with mental illness

subscriptions and contact us Tel: 1-800-661-2121 or 604-669-7600 advertising Mail: Visions Editor Fax: 604-688-3236 c/o 1200 - 1111 Melville Street Email: [email protected] Vancouver, BC V6E 3V6 Web: www.heretohelp.bc.ca If you have personal experience with mental health or sub- stance use problems as a consumer of services or as a family member, or provide mental health or addictions serv- editorial board | Representatives from each BC Partners The opinions expressed in ices in the public or voluntary sector, and you reside in member agency this journal are those of BC, you are entitled to receive Visions free of charge (one editor | Sarah Hamid-Balma the writers and do not free copy per agency address). You may also be receiving structural editor | Vicki McCullough necessarily reflect the Visions as a member of one of the seven provincial agencies views of the member that make up the BC Partners. For all others, subscriptions editorial assistants | Megan Dumas, Stephanie Wilson agencies of the BC are $25 (Cdn.) for four issues. Back issues are $7 for hard design/layout | Kailey Willetts Partners for Mental copies, or are freely available from our website. Contact us issn | 1490-2494 to inquire about receiving, writing for, or advertising in the Health and Addictions journal. Advertising rates and deadlines are also online. See Information or any of www.heretohelp.bc.ca/publications/visions. their branch offices

Visions Journal | Vol. 5 No. 4 | 2009  guest editorial

What Do We Know About Cannabis?

arihuana is not an approved therapeutic “Mproduct and the provision of this information What does the scientific should not be interpreted as an endorsement of the community know about cannabis? use of this product, or marihuana generally, by Health We know that: Canada. • Cannabis isn’t nearly as physically dangerous or ad- Since this marihuana product has not been author- dictive as either alcohol or tobacco.3 ized through the Health Canada approval process, • It doesn’t lead to violent or criminal behaviour, or its safety and efficacy have not been established. The decrease motivation.3 use of this product involves risks to health, some of • It’s highly unlikely that smoking cannabis leads to which may not be known or fully understood.”1 upper respiratory or lung cancer. Evidence suggests that it could actually have a protective effect on the Philippe Lucas What do we know about lungs.4 marijuana (cannabis), its therapeutic • It appears to be associated with the potential devel- Philippe is the founder (healing) potential and its side effects? opment of psychosis and schizophrenia in people and Executive Director According to the Health Canada quote above, it may seem with a predisposition for these conditions, but this of the Vancouver Island like we don’t know much at all. And yet, a search for “mari- is still a highly debated issue with new evidence Compassion Society, a juana” or “cannabis” on Google Scholar turns up a total of emerging every day.5 Additionally, I believe there is non-profit medical 563,000 hits. evidence to sug- cannabis research and The same gest that this may distribution centre search on have as much to (www.thevics.com). He’s PubMed (a data- Recent polls show that over do with high lev- also a Graduate Research base of scientific els of ammonia Fellow with the Centre for publications) 50% of Canadians support resulting from ni- Addictions Research of BC, turns up 25,976 trogen-based a Victoria city councillor published sci- the legalization of cannabis fertilizers used and a federally authorized entific articles to grow the can- patient on marijuana and/or nabis as it does from the cannabis. plant itself.6-7 Cannabis is one of • About 10% of regular users the most studied herbs develop a mild psychologi- in the history of man- cal or physical dependence kind. However, as a re- on cannabis, but it doesn’t sult of the international lead to the use of other illic- prohibition on canna- it substances.3 In fact, can- bis, government-funded research has largely examined nabis is often used as a treatment (or “exit drug”) harms and side effects rather than its potential as a for addiction to both legal and illegal substances like medicine. ,8 crack,9 alcohol10 and opiates.11 (This area Recent developments and discoveries, though, of research is the basis for my master’s thesis in the have changed this landscape considerably. In 2005, University of Victoria’s Studies in Policy and Practice Health Canada approved Sativex,® a cannabis-based program.) oral spray developed by UK company GW Pharmaceu- ticals, for treatment of pain in multiple sclerosis.2 And What about the social as you read this, most major pharmaceutical compa- consequences of cannabis use? footnotes nies in the world are studying cannabis and cannabi- In terms of its impact on the Canadian criminal justice visit heretohelp.bc.ca/ noids. They all hope to come up with the next treat- system and limited police resources, we know that can- publications/visions ment for chronic pain, depression, addiction, move- nabis prohibition results in more drug arrests than all for Philippe’s complete ment disorders, appetite loss, schizophrenia, diabetes, other illegal substances combined, costing taxpayers footnotes or contact us obesity and Alzheimer’s disease. Many scientists are over $384 million per year.3 There are more than 50,000 by phone, fax or e-mail even looking at this plant and its compounds as a po- cannabis-related arrests made each year in Canada,3 and (see page 3) tential cure for cancer. over one million Canadians now have criminal records

 Visions Journal | Vol. 5 No. 4 | 2009 • letters for cannabis-related offences.12 We also know that over I’m a Visions reader formerly from BC and now in the Czech Republic. I read 70% of these arrests are for personal possession, rather your Workplaces issue with interest. Factual information on human rights and than for trafficking or cultivation.3 disability accommodation in the workplace is particularly useful in the context of And, despite the legalization of medical cannabis new anti-discrimination legislation in the Czech Republic. What works in Canada in Canada, most medical users are not protected from could be applied to the Czech Republic too for the mutual benefit of people with arrest and prosecution by our federal program. Accord- disabilities and the general public. This issue will be an inspiration for a similar ing to government-funded research, there are currently publication of the Czech Association for Mental Health. about one million Canadians using cannabis for medical purposes,13 but fewer than 3,000 patients are currently Pavlina Vagnerova, Prague, Czech Republic protected through Health Canada’s Marihuana Medical Access Division (MMAD).14 MMAD has been found un- constitutional five times in as many years when courts I am a new Visions reader and was so pleased to see all the practical and help- in Ontario, Alberta and BC ruled that it created unnec- ful information included in the Workplaces issue. I found Jennifer Lynch’s article, essary obstacles to legally accessing medical marijua- Human Rights and Employer Responsibility to Accommodate Disability in the Workplace, na.15 As a result, dozens of critically and chronically one of the most informative. I was unaware of the legal rights and responsibili- ill Canadians—people living with HIV/AIDS, hepatitis C, ties discussed in the article. I think a knowledge of their rights and the duty to cancer, MS and other serious conditions—are arrested accommodate is important for all workers, and I am very happy to be able to find and forced to defend their medical use in court every so much information about a single topic like Workplaces in one spot. year. Marie Willetts, North Vancouver Where do we go from here? As the articles in this issue of Visions will show, there may still be much to learn about cannabis. But through we want your feedback! the hard work of world-class researchers, front-line If you have a comment about something you’ve read in Visions that you’d like service providers, patients and recreational users like to share, please email us at [email protected] with ‘Visions Letter’ those in the following pages, we are slowly understand- in the subject line. Or fax us at 604-688-3236. Or mail your letter to the ad- ing more and more about both potential harms and dress on page 3. Letters should be no longer than 300 words and may be edited benefits of cannabis. for length and/or clarity. Please include your name and city of residence. All Substance use, however, is a very complex and letters are read. Your likelihood of being published will depend on the number emotional issue. It has been influenced by years of often of submissions we receive. misguided or misinformed anti-drug campaigns. Even amongst the many contributors to this issue, there is some disagreement about how best to regulate access Photography disclaimer: Please note that photographs used in the print issue of Visions and online at HeretoHelp.bc.ca are stock photographs only for illustrative purposes. Unless clearly to this plant. Although this social debate will likely con- captioned with a descriptive sentence, they are not intended to depict the writer of an article or any tinue for some time, it’s clear that criminalizing other- other individual in the article. The only regular exception is the guest editor’s photo on page 4. wise law-abiding and responsible adults isn’t supported by the available evidence, nor is it reducing rates of use Footnotes Reminder: If you see a superscripted number in an article, that means there is or potential harms to vulnerable populations.16 In fact, a footnote attached to that point. Sometimes the footnote is more explanation. In most cases, this is a cannabis prohibition may actually be making use more bibliographic reference. To see the complete footnotes for all the articles, see the online version of each dangerous by driving its production, distribution and article at www.heretohelp.bc.ca/publications/visions. If you don’t have access to the internet, please contact us for the footnotes by phone, fax or mail using the contact information on page 3. use underground and surrendering control and profits to the black market. Additionally, we are missing op- portunities to make cannabis use safer through quality control measures, age-restricted access, and evidence- based drug education focused on public health, and human rights. And that leads me to one final thing that we know about cannabis: it has been used at least once by over Get Visions Delivered to Your Inbox 44% of Canadians.13 In fact, Canada’s cannabis poli- cies have a very unique distinction: they are the only federal laws that don’t enjoy the majority support of citizens. Recent polls show that over 50% of Canadians Sign up for e-Visions at heretohelp.bc.ca to support the legalization of cannabis,17 and that over have summaries of Visions’ articles with links 90% support medical access.18 Ultimately, Canadians want and deserve drug poli- to the full text delivered to your e-mail inbox cies based on science and compassion, and not fear before Visions is even off the press! and misinformation; that much we know for certain about cannabis.

Visions Journal | Vol. 5 No. 4 | 2009  background

Disclaimer These definitions are adapted from trustworthy sources. We hope they will help readers to better understand some of the special terms used in this issue. They are purposely brief and in plain language. As such, these definitions may not include all nuances or variations of a term, and alternate or expanded definitions may be used by some organizations. These have been developed by editorial staff and may not be definitions in use by members of the BC Partners or its funder.

Substances added to marijuana, usually to enhance the experience. Additives like herbs or tobacco may simply change the taste or aroma of the marijuana. like cocaine, Additives salvia or PCP may be added to produce a different high. When other drugs are added to marijuana, it is also called laced marijuana. A smoking device similar to a . Smoke is drawn through water to cool and filter it. Bong Also known as a water pipe. Inhaling smoke from a bong may be referred to as taking a bong rip or a haul. A group of chemical compounds found in marijuana. It generally includes substances related to (THC) and substances that bind to cannabinoid receptors. Extracts from the plant, usually in the form of an oil. Tinctures, which use Cannabis derivative alcohol to extract substances from plants, are also common. Derivatives can be natural or synthetic (man-made). In general, five forms of cannabis are consumed: the flowers of the female plant, (a resin created by heating and pressing glandular trichomes from the plant), Cannabis forms (glandular trichomes from the cannabis plant), (an essential oil extracted using a ) and resin (a tar-like byproduct of heating the cannabis plant). The scientific name for the marijuana plant. The genus isCannabis and the species is C. Cannabis sativa sativa.

A water pipe commonly used to smoke tobacco or herbal blends. Plant material may be

cannabis glossary Hookah heated directly or indirectly, and the smoke is drawn through water to cool and humidify it. are also known as Shishas.

Joint Popular slang for a marijuana cigarette. An alternate spelling of “marijuana,” most common in the early 1900s. “Marihuana” appears in Canada’s Controlled Drugs and Substances Act. As a result, Health Canada Marihuana uses “marihuana” in legal documents related to the Act, such as Marihuana Medical Access Regulations. Canadian government regulations that allow approved and licensed patients to possess Marihuana Medical Access and use marijuana to treat specific medical illnesses or conditions. To read the Marihuana Regulations (MMAR) Medical Access Regulations online, visit: http://laws.justice.gc.ca/PDF/Regulation/S/SOR-2001-227.pdf. Marihuana Medical Access A division of Health Canada that administers the Marihuana Medical Access Regulations. Division (MMAD) Medicinal marijuana Marijuana that is used to treat medical conditions or to lessen the symptoms of medical (or medical cannabis) conditions. A smoking device. Material is placed in a bowl and lit. Smoke is then drawn through a Pipe stem and mouthpiece. A pipe used to smoke marijuana is often called a bowl. Breeds of Cannabis that have been manipulated (such as through selective breeding) or Strains cloned to enhance certain properties or to increase market . A device to heat plant material until the active ingredients are released as vapour. Vaporizer

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Cannabis Background

hat is cannabis? are more than 60 types of , but the Cannabis is the scientific name for best known is commonly called THC (delta-9-tet- Wthe plant. The hemp plant has rahydrocannabinol). It has the most signifi- roots, a stalk, leaves, flowers and seeds. There are cant psychoactive effect. three species of the hemp plant: Cannabis sativa, Concentrations of THC and . may range widely from Cannabis stalks are fibrous and are used to plant to plant, but most make clothing, paper, textiles and fuel. Cannabis contain 2–5% THC. Resin seeds contain essential fatty acids and are used products typically contain for nutritional purposes. Cannabis leaves and 8–14% THC. flowers are used for medical and psychoactive Cannabinoids fit into (mind-altering) purposes. the body’s cannabinoid Cannabis is commonly called marijuana, a receptor sites found in the slang word that originated in Mexico and refers brain and other parts of only to the leaves and flowers of the hemp plant. the body, particularly in the Hemp typically refers to plants grown for fiber nervous and immune sys- and seed. tems. For example, cannabinoids bind to recep- The earliest record of cannabis use comes tors on the pain centre of the brain and provide from Taiwan over 10,000 years ago. Today can- temporary relief. They suppress hormones nor- nabis grows wild and is cultivated in many parts mally produced in response to stress. They also of the world. Breeders have developed hundreds stimulate an increase of dopamine in the brain. of different strains of cannabis. Dopamine is a naturally occurring chemical (neu- Cannabis is consumed in several forms, rotransmitter) which activates the brain’s “pleas- including: ure pathway.” • dried flowers or ‘buds’ (marijuana) When cannabis is inhaled, cannabinoids are • pressed resin from flowers and leaves (hashish absorbed through the lungs and into the blood- or hash) stream. The effects are felt within minutes and • loose resin (kief) generally last a few hours. When swallowed, can- • concentrated resin extracted with a solvent nabinoids are absorbed through the stomach and (hash oil) travel through the body. The effects take longer to Cannabis in these forms can be smoked in a be felt, are stronger and last much longer. or through a pipe or bong (water pipe). It can also Cannabis has different effects on different be vapourized to produce a vapour instead of people. It can make one person feel calm and re- smoke. Sometimes cannabis is mixed with other laxed. It can make another person feel energized herbs and smoked. Cannabis can be swallowed and stimulated. And it can make yet another per- when added to cake, cookies and other foods or son feel anxious and paranoid. The effects de- brewed into a or other beverage. It can be ex- pend on many factors, including: tracted into alcohol as a tincture and absorbed • dosage through the mucous membranes in the mouth. • strain of cannabis And it can be applied to the skin in a salve. • setting or environment • person’s history of use How does cannabis work? • person’s biochemistry Cannabis leaves and flowers have a resin contain- • person’s mood or mindset ing unique chemicals called cannabinoids. There • person’s diet

To see the full 2009. Excerpted from Learn about cannabis fact sheet developed the Centre for Addictions Research of BC for the BC Partners for fact sheet, go to : Mental Health and Addictions Information. www.heretohelp.bc.ca

Visions Journal | Vol. 5 No. 4 | 2009  background

Cannabis and Psychosis

Alasdair M. Barr, PhD hat is cannabis and how bis is less addictive than , does it affect the brain? and it doesn’t have any serious Alasdair is an WCannabis is a flowering herb, origi- withdrawal effects compared to a Assistant Professor nally from Asia. It has been used drug like alcohol. in the Department for thousands of years for a variety A large number of scientific of Anesthesiology, of purposes, including drug use. studies have used techniques like Pharmacology & Cannabis is now the world’s most magnetic resonance imaging (MRI) Therapeutics at the popular recreational drug. In BC, to study the brain in living people University of British more people have used cannabis who have previously used large Columbia (UBC). He is than anywhere else in Canada.1 amounts of cannabis. Those stud- also a Senior Scientist There are many different chem- ies have found very little evidence with the BC Mental icals in cannabis that can affect the for major brain damage in people Health and Addictions brain. The most powerful of these who use cannabis on a regular ba- recent studies, researchers have Research Institute is a compound called delta-9-tet- sis.3 For many, the major health started to question whether can- rahydrocannabinol (THC). Once hazards of cannabis use are those nabis use itself can actually cause THC has entered the bloodstream related to smoking the drug—such psychosis.6 Ric M. Procyshyn, through smoking cannabis or in- as lung damage—rather than the PharmD, PhD gesting it (e.g., eating brownies), it effects of THC on the brain.4 What is the link between can rapidly enter the brain. This is cannabis and psychosis? Ric is a Clinical Associate where it produces its main effects. So why is there so much It is commonly known that smok- Professor in Psychiatry Like many other drug factors concern about cannabis ing cannabis can produce a number and an Adjunct Professor that are derived from plants, the and mental illness? of effects in the average person that in Pharmaceutical THC molecule is able to interact di- A major concern is that ongoing use resemble some of the symptoms of Sciences at UBC. He is also rectly with nerve cells in the brain. of cannabis by people who have psychosis. These include anxiety, a senior scientist By chance, the THC molecule close- developed psychosis (i.e., a loss of paranoia and delusional beliefs. with the BC Mental ly resembles several naturally oc- contact with reality, commonly as- Generally, these effects are fairly Health and Addictions curring chemicals in the brain (en- sociated with hallucinations and short-lasting, and there are no re- Research Institute docannabinoids) that allow nerve delusions) results in a poorer future maining problems after the drugs cells to communicate with each outcome. Relapses and hospitaliza- have worn off. other. The THC is therefore able to tion are more common. This is now Researchers are now concerned Heidi N. Boyda, BSc bind to a part of these nerve cells well-established.5 that there may be a small propor- known as the CB1 receptor, simi- At the BC Mental Health and tion of the general population who Heidi is a doctoral lar to the way a key fits into a lock. Addictions Research Institute, are much more vulnerable to the graduate student in These receptors are present on we’ve recently completed a study . With enough Alasdair and Ric’s many different nerve cells, spread of first-episode psychosis patients use of the drug, these people may research laboratory widely throughout the brain.2 THC in the south region of the Fraser develop long-lasting or even per- is much more effective at binding Health Authority. (Lead investiga- manent psychosis. Their research interests to the CB1 receptors and affecting tor is Dr. G.W. MacEwan; results are There have been several ma- include understanding the nerve cells than the natural en- currently being prepared for sub- jor international studies that fol- thecauses of mental docannabinoids are. This is why mission to a scientific journal.) We lowed a large number of healthy illness and addiction, you feel “high” or “stoned” after examined the links between can- young people, mostly in their from the molecular level consuming cannabis. nabis use and psychosis. Cannabis teens, over a period of 10 or more through to clinical trials use in this group of patients was years.7-8 These studies found that with patients What are the harmful notably more common than in the people who were heavy canna- effects of cannabis? general population. Importantly, bis users were more likely to de- Cannabis is generally known as a we observed that the patients who velop psychotic disorders, such as “soft” drug. This means that it is used cannabis had an earlier onset schizophrenia, as they got older considered less harmful to the gen- of psychosis than the patients who than were people who didn’t use eral population than “hard” drugs didn’t use cannabis. the drug. However, this may be a such as cocaine or . Canna- Based on this study and other fairly subtle effect: a review of the

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literature found that using canna- bis increased the risk of developing schizophrenia two-fold.9 While this may sound dramatic, remember that only 1% of the general popula- Why People Use Cannabis tion ever develops schizophrenia.10 What researchers have learned annabis users are often portrayed as unmotivated, Rielle Capler, MHA from these studies is that cannabis lazy “stoners.” But research into why people use can potentially cause psychosis, but cannabis paints a different picture. It shows that Rielle worked eight years only in a select group of people who Cmost people use cannabis as a rational choice to enhance as a Policy Analyst and are naturally vulnerable. their quality of life.1-2 Research Coordinator Cannabis affects people in different ways. It depends with the BC Compassion What makes you vulnerable to on the person, the situation, the type and quality of can- Club Society. She was a the effects of cannabis? nabis, and the method of use. Research shows most people Research Associate at We’re not sure yet what makes peo- who use cannabis use it moderately. Since cannabis has a the Centre for Addictions ple vulnerable to the effects of can- low risk for physical addiction,3-5 most people are not com- Research of BC (CARBC) nabis. As with most forms of illness, pelled to continue to use it. Instead, people use cannabis and is currently an there is a complex mix of genetic when they perceive its effects are beneficial. People all over Associate Researcher at factors and effects of the environ- the world have used cannabis for thousands of years—for the Centre for Applied ment you are surrounded by. social, medical and spiritual reasons. Sometimes these rea- Research in Mental We have some pretty good ide- sons are distinct, but often they overlap. Health and Addiction as, though. What we know is that at SFU people who have a stronger predis- Social Use position to psychosis are at greater The social use of cannabis includes its use for recreation, risk. They may have a family his- socializing and generally improving quality of life. Most tory of psychosis or may have had people who use cannabis today do so for these reasons. previous brief psychotic experienc- Historical records also point to the social uses of canna- es. Age is an important factor: teen- bis. Ancient in India were against the use of alcohol, agers are more at risk than adults. but accepted social cannabis use. In ancient Rome, wealthy Scientists have even identified a people finished banquets with a cannabis-seed dessert that gene, known as catechol-O-methyl- was known for the good feeling it caused. At ancient Indian transferase, which may make a per- weddings, cannabis () was served for good luck and son more vulnerable to the effects as a sign of hospitality.6 of cannabis. That is, they may have Today, people often use cannabis for specific activi- an up to five-fold greater risk after ties and occasions. When used properly, it helps some to cannabis use in adolescence of ex- relax and concentrate, making many activities more enjoy- hibiting psychosis and developing able. Eating, listening to , socializing, watching mov- schizophreniform disorder (like ies, playing sports, having sex and being creative are some schizophrenia, but lasting no longer things people say cannabis helps them to enjoy more. Some- than six months).11 times people also use it to make mundane tasks like chores more fun.1 Summary Cannabis, used socially, often becomes part of a per- Cannabis is a common recrea- son’s daily routine without negative health, social, tional drug. The majority of people legal or economic consequences.7 Most peo- who use cannabis are unlikely to ple use it responsibly to improve the quality of develop any lasting mental illness their lives, similar to the way others use alcohol as a result of its use. However, con- or .1 tinued cannabis use may result The World Health Organization Constitution in a poorer long-term outcome in defines health as “a state of complete physical, those with an existing psychotic mental and social well-being, and not merely disorder. Cannabis use may in- the absence of disease or infirmity.”13 Therefore, crease the chances of developing the social uses of cannabis sometimes coincide psychosis. Its use may also cause with, or complement, its medical uses. psychosis to begin at an earlier age in those who are at a greater Medical Use risk for psychosis than the general Like people who use cannabis for social rea- population. sons, people who use cannabis for medical

Visions Journal | Vol. 5 No. 4 | 2009  background

reasons also use it to im- and muscle spasms. These symptoms are often part On stigma: prove their quality of life. of physical or mental conditions. Arthritis, cancer, HIV/ “Lots of people know me, know I do pot, and Medical use is linked to AIDS, multiple sclerosis, epilepsy, Parkinson’s disease, they think that I’m a pothead. But really, the managing physical and ADHD and post-traumatic stress disorder are some thing they don’t realize is that I have a reason mental problems and to conditions cannabis can help treat. 15 for it.” preserving health. Sometimes cannabis is more effective than phar- Cannabis has been maceutical drugs and has fewer negative side effects. On social use: used medically for thou- Some people use cannabis to help them cope with the “Just about any activity is enhanced while under sands of years. In 2700 side effects of, or to replace, these medications. Others the influence of cannabis. I like hiking, cycling BCE, Shen Neng, Chinese use cannabis to deal with withdrawal symptoms from and dancing when I’m stoned or high and... I Emperor and father of other legal or illegal drugs. enjoy art, music, philosophy and meditation Chinese medicine, used while intoxicated. Going to a museum is one of cannabis as a remedy. Spiritual Use 1 my favourite activities under [the] influence.” The Ebers Papyrus, an Spiritual well-being is widely accepted as an impor- ancient Egyptian medical tant part of overall health. Spiritual use of cannabis “In my humble opinion, weed is not a drug; it’s text, also mentions can- relates to seeking a sense of meaning, enlightenment a seasoning... like salt for your life. So, just the nabis. It was written in and connection. same as a person would use salt to enhance a 1500 BCE and is one of Cannabis has a rich history of spiritual use. It is bland soup or what have you, smoking weed the oldest pharmaceutical listed as one of the five holy plants in theAtharvaveda , 1 can make things more intense and enjoyable...” works known.6,8 a sacred Indian text from the second millennium BCE. In Canada, cannabis The Scythians, who lived in what is now Eastern Eu- On medical use: was used as a medicine rope, used cannabis at funerals to pay respect to de- “Those persons in our lives that we met until it was added to a list parted leaders. Ancient Chinese texts say that canna- that think it’s all about getting high often of controlled substances bis can lighten a person’s body and allow them to com- misunderstand that that high often relieves us in 1923.9 In 2000, pa- municate with spirits. The Persian prophet Zoroaster of the tears, of hurt, of stress, of living with a tients won the right to (7 BCE) relied on the intoxicating effects of bhanga, a terminal illness and a lot of other things in our again use cannabis le- cannabis drink, to bridge heaven and earth. Some re- 16 daily lives.” gally as a medicine. The searchers believe that kannabosm, a plant mentioned court ruled that people in the Old Testament as an ingredient in the sacred “It relieves the nausea from the meds and allows should not have to choose anointing oil, was an ancient name for cannabis.6 me to have an appetite and to stick to the between their liberty and Today, some people use cannabis in their spiritual regimen of taking pills. And certain strains work their health because both practice. Rastafarians and some Hindus and use 16 better for the pain.” are protected in the con- cannabis in religious ceremonies. Other people use it stitution. In July 2001, in in ways they consider spiritual, such as for reflection, On spiritual use: response to the court’s contemplation or personal growth. The relaxing effects “Marijuana actually, what it does to me decision, Health Canada of cannabis help some people gain a different perspec- beyond all other social aspects of it, it actually introduced the Marihua- tive when trying to understand difficult life situations.1 really combines me with nature. A lot of my na Medical Access Regula- Some believe that cannabis, as a plant, has something religious experiences have actually come tions (MMAR).10 Under the to teach them.14 through marijuana. It is just that connection, an MMAR program, people Cannabis is used by some to increase an apprecia- awareness of yourself, I think, and that you are can apply for a licence to tion for and connection with nature.1,14 People also use 1 part of nature...” legally possess and grow cannabis to bond with each other. These feelings of con- cannabis for medical use. nectedness contribute to an overall sense of “oneness.”1 “When you ingest plants that have psychoactive Currently, there are effects, it’s sort of like the consciousness of the many barriers to the *** plant expresses itself vicariously through your Health Canada program. body and your mind... I like to use it for learning For example, some physi- Despite the criminal laws in Canada surrounding can- and to gain knowledge on how to treat people cians don’t want to partic- nabis, about 50% of Canadians have tried cannabis at 14 and how to live...” ipate. Also, the options for some point in their lives. About 14% of Canadians are a legal supply of cannabis current users.11 People who don’t use cannabis may are limited. As a result, only about 3,000 people have not understand why others do use it. The same is true footnotes licences at this time. However, about 4% of Canadians for those who have tried it and didn’t see any benefit. 11 visit heretohelp bc.ca/ (1.2 million people) use cannabis medicinally. In BC, However, with a better understanding of the reasons publications/visions about 200,000 people report using cannabis as medi- people use cannabis, we can look past the stigma and 12 for Rielle’s complete cine. assumptions. From here, it will be easier to find ways footnotes or contact us Cannabis is used to treat many medical conditions to enhance the benefits and reduce potential harms to by phone, fax or e-mail and symptoms. It is effective in treating nausea, loss individual cannabis users and the wider population. (see page 3) of appetite, pain, anxiety, insomnia, inflammation

10 Visions Journal | Vol. 5 No. 4 | 2009 background

Cannabis, Tobacco and Alcohol Use in Canada Comparing risks of harm and costs to society

hen we study the no more than 14 drinks per week. least once in the previous year:2-3 Gerald Thomas harmful impact of Use at this level carries few risks • 14% used cannabis substances in Canada, of health or social harm. High-risk • 20% used tobacco Gerald is a Senior Policy W Analyst with the Centre cannabis, tobacco and alcohol are drinking, on the other hand, is de- • 80% used alcohol often the focus. This is because fined as regularly drinking five or for Addictions Research of many more people use these drugs more drinks on a single occasion The patterns of use for the three BC (CARBC). He has been than drugs like heroin and ecstasy. for men. This type of “binge drink- substances also varied greatly, as with CARBC since May All substance use brings some ing” has been shown to greatly in- shown in Figure 1. 2007 risk of harm. The harms from sub- crease the risk of short-term harms Alcohol is used by a very large stance use can be divided into those due to intoxication.2 number of people with the vast related to intoxication, such as car In order to compare the harms majority of these using in low- or Chris Davis accidents due to drinking and driv- of various substances across Ca- moderate-risk ways. Conversely, ing, and those related to long-term nadian society, we need to take a cannabis and tobacco are used by Chris is a Senior Research use, such as lung cancer from life- Analyst with the Canadian Fig. 1 Distribution of the risk for cannabis, tobacco and alcohol, Centre on Substance time smoking. Some harms are Canada, past-year users age 15+, 2004 relatively minor, such as missing Abuse and a Professor in work due to a hangover, and some 12,501,339 Psychology at Carleton are very severe, such as contracting 12 - University in Ottawa HIV from sharing dirty needles. 10 - 9,028,493 There are several major cat- 8 - egories of harms, including health harms to individuals, social harms 6 - to families, and economic harms 3,890,000 4 - to businesses (i.e., lost productiv- 2,469,913 ity due to absenteeism, disability or 2 - 1,300,000 2,200,525 0 48,430 death). And there are even societal 895,949 harms such as social costs related Number of Users (in millions) 0 - low risk moderate risk high risk to providing health care and enforc- ing laws related to substance use. Cannabis Tobacco Alcohol For example, in 2002 an estimated

$1.2 billion was spent treating peo- Sources: Adlaf et al. 2005; Health Canada n.d.; Davis et al. 2009.2-4 ple with substance use problems in Canada.1 We all pay these costs number of different factors into far fewer people. The majority of through our taxes, so they are a account. These include the overall cannabis use is low- and moderate- form of social harm to society. number of users in society, their risk, however, while the majority of The notion of risk relates both patterns of use, the environmental tobacco use is high-risk. to the severity of consequences of and social contexts under which Understanding patterns of risk substance use and the likelihood this use occurs, the physical effects in society is important. A large that they will occur. Risk of harm of substances, and more. Due to the number of people engaging in low- from substance use varies accord- various factors involved, directly or moderate-risk use can account ing to the type of substance, the comparing the harmful effects of for a large share of overall harm.5 amount being used, the ways it is cannabis, tobacco and alcohol is This is the situation with alcohol. used, where it is used, and so on. quite complex. In Canada, there are many (over Substance use can be low-risk, 21 million) low- and moderate- moderate-risk or high-risk. For ex- A look at patterns of use and risk risk drinkers. These drinkers ac- ample, low-risk drinking for men is These 2004 statistics show the per- count for 40% to 60% of alcohol- normally defined as no more than centage of Canadians who used related health and social harms.2 two drinks on a single occasion and cannabis, tobacco or alcohol at Continued on page 13 >>

Visions Journal | Vol. 5 No. 4 | 2009 11 background

The Legal History and Cultural Experience of Cannabis Andrew D. Hathaway, he legal history of cannabis (marijuana) in Can- Enforcing a law that was increasingly disregarded PhD ada is a tale of ban, or prohibition of ‘the drug.’ became a problem. So, a government inquiry was TFor much of the past century, its use, for any commissioned to examine the issue and put forward Andy is a sociologist reason, has been considered criminal under the law. a solution. The Le Dain Commission of Inquiry did who teaches in the Yet this is a plant that can be grown and prepared for extensive research, consulted experts and held public area of crime and criminal use at home, with little risk or threat—apart from its hearings across the country over a three-year period. A justice at the University of illegal status. report was published in 1972.4 Guelph. His research on Our country’s drug laws have created a hugely The Le Dain Commission recommended removing cannabis, spanning more profitable ‘black market,’ inviting criminal involve- criminal penalties for cannabis possession. However, than a decade, ment in selling cannabis. Social problems such as vio- despite the drug’s low toxicity and low potential for examines use patterns, lence, unsafe street drugs and a declining respect for abuse, the commission did not propose that it be legal- benefits, problems government and the police have also been linked to ized. They still preferred measures that would discour- and their implications prohibition. age young people from taking up the habit. for social policy A recent survey of Canadians over age 14 found A common form of ‘’ now prac- development that 44% reported using cannabis at least once in their tised in some countries, such as the US, Australia and lifetime.1 Despite these high rates of use and growing Europe, is using fines to punish users. This retains the public recognition of the many problems with the law, presumed advantage of withholding state approval, marijuana users are considered unconventional and while reducing social costs and the legal consequences looked upon as criminal or deviant. Whether we our- of criminal convictions. selves are ‘users’ or whether we’ve never smoked it, In Canada, the government rejected the Le Dain our relationship to cannabis is shaped by its status as proposal to remove criminal penalties for cannabis a banned substance. possession. And, in the post-Le Dain years, there have been ongoing calls for law reform and growing popular When the law is the problem support for relaxing penalties for cannabis possession. In 1923, when cannabis was outlawed in Canada, few These appeals have also been rejected and neglected.3 people in this country had ever seen or heard of mari- juana. and cocaine had been outlawed some Recent reform suggestions stalemated years before, and no further debate was needed to in- Three decades after Le Dain, the pressure to change clude cannabis among the banned . But near- the legal status resulted in Parliament striking two com- ly 10 years passed before the first arrests for cannabis mittees to study the problem of illicit drugs in Canada. possession were reported. Thus, this early legislation In 2002, the House of Commons Special Committee has been called by some observers: “the making of a on Non-medical Use of Drugs and the Senate Special law without a problem.”2 Committee on Illegal Drug Use both released reports. Until the 1960s, marijuana use was rarely en- And both committees recommended reforming laws countered in the mainstream population. But then its on cannabis possession and supply.5-6 popularity and use began to increase among educated, In the spirit of Le Dain, the House Committee rec- white youth of higher means and social status. ommended decriminalizing the possession and culti- The law itself began vation of small amounts (up to 30 grams) of marijuana. to pose a problem. In the The Senate went much further, suggesting that canna- ’60s, the maximum pen- bis be legalized in Canada. The Senate recommended alty for possessing small that the production and sale of marijuana be licensed, amounts of cannabis was while keeping criminal penalties for export, trafficking six months in prison and and other activities outside the regulations. a $1,000 fine for a first The Senate’s view departs from that of the Le Dain offence.3 Criminal convic- and the House committees. The Senate recognizes tion was a serious con- both the social harms of prohibition and the violation sequence for otherwise of the user’s rights. That is, the law should not be used conforming, law-abiding to restrict behaviours that do no harm to other people, young Canadians. as is the case with .

12 Visions Journal | Vol. 5 No. 4 | 2009 background

Neither Parliament committee had the mandate to been granted (approximately 3,000), when there are do more than research, consult and recommend solu- several hundred thousand Canadians who self-medi- tions to ‘the problem.’ And so the legislative stalemate cate with cannabis. And for many people who apply on the issue continues unresolved. Opportunity for re- for exemption, the application process has been on- form has been denied, and cannabis use still has crimi- erous, confusing and not supported by physicians, nal consequences in Canada. and the program has failed to guarantee a safe, af- fordable supply.8-9 Marijuana as medicine—well, maybe... The most significant new-century development may The future? be the federal government’s begrudging recognition The legal history of cannabis over the next 100 years footnotes of the value of using cannabis for medical conditions. is a tale yet to be written in Canadian experience. But, visit heretohelp.bc.ca/ Since 2001, legal access has been granted to people without question, the experience of marijuana users publications/visions with HIV/AIDS and other serious illness under the Medi- needs to be acknowledged and respected. Actual and for Andy’s complete 7 cal Marihuana Access Regulations. meaningful reform of harmful drug laws must be based footnotes or contact us The government’s commitment to this program, on both scientific knowledge and concern for human by phone, fax or e-mail though, is suspect. Few medical exemptions have rights, democracy and justice. (see page 3)

Cannabis, Tobacco and Alcohol Use in Canada | continued from p. 11

The situation with tobacco is very highest at $328 Fig. 2: Direct health and enforcement costs for cannabis, tobacco and alcohol, different. (In fact, tobacco use is per user—94% Canada 2002 never considered low risk, thus of social costs Estimated Past-Year Users: Enforcement (millions) zero low-risk users). Here we have for cannabis are Cannabis 3,560,391 about four million users who ac- linked to enforce- 12000 Health Care (millions) Tobacco 5,302,710 Alcohol 20,024,043 10000 count for a large proportion of the ment. Enforce- Health Costs / User: overall harms. In the case of can- ment costs per 8000 Cannabis $20.50 nabis, we have much fewer people user for alcohol Tobacco $822.26 6000 Alcohol $165.11 overall using the substance across are about half 4000 Enforcement Costs / User: all levels of risk. those for canna- Cannabis $328.00 bis ($153), while 2000 Tobacco $0.00 0 Alcohol $153.43 Social costs of substance use e n f o r c e m e n t Cannabisa Tobacco b Alcohol Total While it is difficult to directly com- costs for tobacco a. 1) Cannabis health care costs: $73 M, enforcement costs: $1,167.8 M. pare the harms of cannabis, alcohol are very low. 2) The cannabis-related enforcement costs reported are estimated by assigning 50% of all illicit drug and tobacco, harms can be indi- enforcement costs in Canada to cannabis. This figure is reasonable given that around 60% of illicit drug offenses reported by police involve cannabis. rectly compared by measuring the Conclusion b. There are enforcement costs to do with illegally importing and selling tobacco and with enforcing laws social costs connected to each of The harms, risks against seeling tobacco to minors, but these are likely very minor and weren’t included in the source study the substances (Figure 2). and social costs

In terms of social costs, the of alcohol, can- 3,1 Sources: Health Canada. n.d.; Rehm et al. 2006. vast majority of the social costs of nabis and tobac- cannabis are enforcement-related co vary greatly. while the vast majority of tobacco A lot has to do with how the sub- about further efforts to deal with costs are health-related. The social stances are handled legally. Alcohol the use of these three substances costs of alcohol are about evenly and tobacco are legal substances, in Canada. Efforts to reduce social distributed between health care which explain their low enforce- costs related to cannabis, for ex- and enforcement. ment costs relative to cannabis. On ample, will likely involve shifting footnotes In terms of costs per user: the other hand, the health costs its legal status by decriminalizing visit heretohelp.bc.ca/ tobacco-related health costs are per user of tobacco and alcohol casual use, to reduce the high en- publications/visions for over $800 per user, alcohol-re- are much higher than for cannabis. forcement costs. Such a shift may the article’s complete lated health costs are much lower This may indicate that cannabis use be warranted given the apparent footnotes or contact us at $165 per user, and cannabis-re- involves fewer health risks than al- lower health risk associated with by phone, fax or e-mail lated health costs are the lowest at cohol or tobacco. These variations most cannabis use. (see page 3) $20 per user. On the enforcement in risk, harms and costs need to side, costs for cannabis are the be taken into account as we think

Visions Journal | Vol. 5 No. 4 | 2009 13 experiences and perspectives

From Thrills to Ills Why smoking pot is risky business

Geoffrey Griffiths started smoking pot when Fun was a weekend of parties. lucky we were to be alive. Appar- I was 13. I was not a happy A party wasn’t considered good un- ently there’d been many fatalities Geoff is a 55-year-old I camper as a kid. School was less the police had broken it up. We at this location. information technology misery right from the start. I had also spent a great deal of time in Buying pot can be a very risky worker. When he lost great difficulty learning to read and cars just driving around. Occasion- business. The dealer could be sell- his job due to company write—and failed grade one. I had ally, the police would pull us over ing to support his hard drug habit. downsizing, the greatest no sympathy or support from my to check IDs. On many of these oc- Cocaine was the popular drug, and adventure of his life teachers. In fact, I was frequently casions we narrowly escaped being people who used it heavily were began—self discovery. bullied and physically abused by caught in possession of drugs. usually very paranoid and aggres- What Geoff thought was several elementary school teach- sive, thinking they were under po- burnout from constant ers—interestingly, two of them fe- lice surveillance. Someone I knew stress turned out to be male, both redheads. One beat me had his arm broken by a dealer post-traumatic stress up—punching, kicking and scream- because he didn’t pay up when re- disorder. Geoff now works ing at me. Shame (from feeling stu- quired to. part-time as Strategic pid), anxiety, low self-esteem and One house I walked into to buy Office Support sleep issues escalated. I didn’t want pot reeked of ether (a chemical used for AnxietyBC to fall asleep—it would just bring the for “freebasing”1 cocaine so it can next school day, and more trouble. be smoked for an immediate high). And a recurring dream of a wom- People were slumped in chairs smok- an’s looming, glaring face would jar ing cigarettes dipped in the freebase me awake, terrified. solution. All I could think about was Smoking pot was new and fun. how, if the police showed up, being It introduced me to a social scene caught here could jeopardize my fu- that was an exciting mix of parties, ture. Cocaine possession is a federal drug deals, fast cars and readily Once we tried to cross the US offence, and although I wouldn’t go available drugs. One of the most ex- border while we were stoned and to jail for a first-time offence, the citing aspects of this scene was the carrying joints. The American bor- record can limit job opportunities thrill of ‘not getting caught.’ This der guard pulled us out of line, and travel. I left without scoring and was risky behaviour for the ‘excite- calling us “farmers” after finding never went back. ment’ of it. cannabis seeds in the car seats. He Another risk was that you Until I was 23, I smoked pot or sent us through US customs and couldn’t tell how safe the pot you hash regularly—two or three joints immigration, where they searched were buying was. At the time, as on weekdays; more like a few ‘nick- us for drugs, but found none. Nev- part of the USA’s , el’ bags on weekends. The more ertheless, we were refused entry to paraquat (a herbicide, toxic to hu- stoned I got, the less other parts of the US of A. We thought this was mans when ingested) was regularly my life existed. quite a joke and had lots of laughs. sprayed on illegal crops to kill the My friends and I drove every- plants. The marijuana growers soon Flying high—laughing it up where as fast as we could, stoned learned that if they harvested the without a safety net or sober. One dark and foggy night, crop immediately, they could still My pals and I were deeply involved we were driving out to Mission along sell it.2 The people involved in this in the ‘’ of pot smoking. the Dewdney Trunk Road, smoking illegal trade were more interested When I was 15, I had a hookah up as we went. We were climbing in profit than in the ethics of selling (a water pipe) in my room in the a hill when the driver was blinded a tainted product. basement and a variety of smok- by oncoming headlights. Because Then there are the ‘special ad- ing pipes and papers. My hair was he was driving too fast—and he ditives’ that promise a different or halfway down my back, and I wore was too high—we found ourselves even more enhanced high. One ‘hippy clothes’—headbands, pais- plummeting into a wooded ravine. night a friend and I dropped LSD ley shirts, bell-bottom pants, beads We thought this was a joke too, (lysergic acid diethylamide, a power- and leather vests. It was 1967. until the RCMP officers told us how ful hallucinogenic drug; also known

14 Visions Journal | Vol. 5 No. 4 | 2009 experiences and perspectives as “acid”), then smoked some pot company over my accident. I was arts in grade one was because of a laced with “angel dust.” This was having a difficult relationship with learning disability. like nothing I’d ever experienced my girlfriend. I’d been burning the I’m now using CBT (cognitive- before. Dropping acid had always candle at both ends—staying up behavioural therapy) to manage my been a mild shift in reality: colours late smoking pot with my friends, anxieties. For example, when I have were brighter, sounds clearer, eve- then getting up early to go to a an anxiety attack at my local Star- rything old seemed new again. But labouring job. Paranoia and anxi- bucks, I now know that it’s because with the angel dust pot I had vivid ety were increasing. One day, in a of the red-haired, female barista. I auditory and visual hallucinations. I friend’s car, we had two collisions understand that my breathlessness, saw cartoon characters in the mist, within minutes of each other— trembling and instant loss of concen- and my french fries turned into a looking at a map rather than the tration is a PTSD-triggered event and wriggling mass I’m better prepared to of snakes. Later handle it. in life, I found My friends only cared I consider the out that angel “ about the pot-smoking me; greatest harm from dust was PCP, a they didn’t care about me using drugs to be dangerous drug the illusion they give that can cause you—that you have harm if used regularly.3 road. Stoned. Then the car quit greater” control over your life. If I Another additive I tried in pot because the radiator had been hadn’t been stoned all the time, I’d (and hash) was opium. This was damaged. I started crying. I real- have felt my real feelings—anger, a smooth, forget-all-your-worries ized that smoking pot didn’t make rage and fear of intimate relation- high. I could sit or lie for hours in anything better. ships. I may have made better deci- the middle of bedlam and not be Right after that pivotal day, I de- sions. bothered. It was a good thing that veloped a liver and spleen infection. Cognitive-behavioural therapy product was rarely available, be- I was in bed for a month recovering; techniques give me much more con- cause it’s highly addictive. all I could do was sleep. And it was trol over my life than recreational then I realized that my friends only drugs ever did. Cannabis was escape; Coming down cared about the pot-smoking me; CBT is confidence and clarity. As tends to happen in life, my luck they didn’t care about me. started to run out. When I was I wanted to have a future. When I 22, I rolled my car. This certainly recovered from the infection, I moved wasn’t my first car accident; I’d out of the house I was sharing to live had numerous near misses as both on my own. I stopped taking drugs, a driver and a passenger. But for went back to school and earned a tel- a year after this one, I’d awake to ecommunications certificate. flashbacks of the accident. Some of my friends were involved in se- All things in moderation? rious accidents as well. One lost I’m sure that pot smoking is safe if control driving around a curve be- done moderately. As you can see, cause he was looking for a lit joint though, there was nothing moder- he’d dropped. ate about my use. The future wasn’t looking very Later in life I realized that in my good. Friends got arrested for pot early teens I was using pot to cope. possession. Others were getting It allowed me to suppress symp- more involved in using and selling toms of a developing post-traumatic harder drugs. Having a drug con- stress disorder (PTSD). It wasn’t un- viction for small amounts of pot in til my 30s that I sought help. I was Canada is not taken very seriously. at a social gathering where about Other countries, however, have 50% of the people present were very different attitudes. One of my teachers, and such an overwhelm- friends with a possession record ing and irrational rage welled up in had to change honeymoon plans me that I knew I needed help. for Hawaii because he couldn’t A counsellor encouraged me to travel to the US. get testing around my school fear For me, the final wake-up call issues. I discovered that I’m a high- came when I was 23. I had no car functioning dyslexic and not at all and was fighting the insurance stupid. My struggle with language

Visions Journal | Vol. 5 No. 4 | 2009 15 experiences and perspectives

Cannabis and My Road to Healing

Kerry Porth was one of those children who simply “fell un- I decided to go on to ease my transition der the radar”—no one knew I was unwell. I off of heroin, but found that the symptoms of my PTSD Kerry is 44 years old and I was sexually abused as a child and have suf- returned to plague me. I was becoming frustrated with was born in Vancouver. fered from post-traumatic stress disorder (PTSD) since my recovery and fearful that I’d relapse if I couldn’t She is married, with two I was about 11 years old. Despite a suicide attempt at find something to alleviate my symptoms. I absolutely children, and runs a small 17, I was never given the help I desperately needed. refused to consider psychiatric medications again. non-profit organization in A friend suggested that I get in touch with the Com- the Downtown Eastside of Full circle passion Club* and try smoking pot again. I was now 40 Vancouver, which provides I smoked pot in my teens—it was easy to get because years old and hadn’t smoked cannabis since I was 17. assistance to sex trade I knew someone who sold it. But I stopped at the age I was very nervous about this idea; I was afraid that workers of 17 after making myself ill by smoking too much on I’d simply be exchanging an addiction to heroin for an several occasions. I didn’t addiction to cannabis. By drink much because it was this time, in the spring of too hard to get a hold of 2005, I had made some * See the article the alcohol. amazing new friends about compassion In my first year of uni- while attending support clubs on page 30 versity, though, I started groups for sex trade drinking a lot of alcohol. I workers at two agen- was experiencing insom- cies in the Downtown nia and night terrors, and Eastside. All were re- drinking helped me get a covering addicts—some few hours of sleep. I did were practising harm re- stop drinking when I was duction and some were 25, but unfortunately my practising abstinence. I PTSD symptoms kicked also connected with an up a notch. Intrusive amazing therapist, thoughts and memo- also a recovering ries, flashbacks, per- My friends, my therapist and doctor addict, who I still sistent nightmares felt that cannabis represented real see today. I talked and difficulty sleeping “ it over with my made life intolerable. possibilities for me. I agreed to try it. friends, my thera- So, I spent five pist and the doctor years in my late twenties trying various psychiatric medi- who was supervising my methadone.” All of them felt cations (and staying sober), but was overwhelmed by side that cannabis represented real possibilities for me. effects. These included uncontrollable stuttering. I isolat- I agreed to try it. ed myself because I was so embarrassed by my inability to speak clearly. These drugs turned me into a zombie The Compassion Club and who could barely stay awake to care for my young son. cannabis—worked for me Eventually, at the age of 29, my pain and frustration The employees of the Compassion Club were extreme- led me to use heroin and . Over the next ly knowledgeable about the varieties and strains of 10 years, my life spiralled out of control. I contracted cannabis. They worked with me to find the type that hepatitis C from sharing needles. I supported myself as was best for me. a sex trade worker for five years—then found myself at During the first year, I smoked pot to help me rock bottom and homeless in the fall of 2004. to calm down and sleep at night. Pot also stimulated Just when my life had become absolutely intoler- my appetite, which was suffering due to the hepati- able and my ninth attempt at detox had failed, a close tis C. After years of barely eating or sleeping, I put friend offered me a different life. I needed to remove on weight and was able to consistently sleep through myself from the environment and people with whom the night. A healthy diet and lots of sleep is the best I used. With his loving support, I moved from the sub- treatment for hep C in its early stages. Within nine urbs of Metro Vancouver to his home in East Vancou- months, my liver enzymes had returned to normal ver to start on my road to healing. and I no longer needed to smoke pot to help with eat-

16 Visions Journal | Vol. 5 No. 4 | 2009 experiences and perspectives ing, though I continue to use it to help with anxiety And I definitely don’t want the side effects of psychiat- and sleep. ric medications. Cannabis has eliminated the harms I Cannabis also helped me stop taking methadone— experienced from these other substances. I got through a withdrawal process that took 30 days. I I have since married that dear friend who took a haven’t touched heroin or cocaine in nearly four years year off work to hold my hand through my first year of and I’ve been off methadone for three years. recovery. My son and I are closer than ever, and I am now blessed with a lovely stepdaughter as well. I’ve Cannabis = harm reduction = a blessed life found incredibly meaningful work as the coordinator I am so grateful to have found a harm reduction plan of a Downtown Eastside non-profit agency that helps that works for me. Smoking cannabis means that I can sex trade workers. In my work, my past experiences, live the life I want to live without being enslaved to an dark and horrible as they were, have daily meaning addiction or suffering side effects that limit my free- and value. I’m proud to model a harm reduction life- dom. I never wanted to be medicated 24 hours a day, style for the women that I work with every day. I lead seven days a week with alcohol, heroin and cocaine. an authentic life and am loved for the person I am.

Cannabis and Me A cautionary tale...

n January 1998, when I was 27, grasp, and I don’t know if I’ve come students; that’s where I was intro- Anita Smith I began hearing voices. The first to terms yet with that diagnosis. duced to weed. I started smoking it Ivoices I heard told me they were But I do realize now that I’d casually with friends—no big deal. Anita is a writer and going to kill me. I literally ran out of been delusional and very sick for at But I can remember even then that artist. She volunteers at the warehouse studio I was living in least two years before that first ter- I felt people could see me when I the Canadian Mental and into the street. I was petrified. I rifying episode. was in my bedroom, even if I closed Health Association, rode the buses all the curtain and door. Burnaby Branch night, trying to es- It felt as though I no Volunteers in Partnership cape the voices— I was slipping into another longer had privacy, program, takes writing but they followed world and pot made it so that my life was ‘on classes and enjoys me. I couldn’t fig- record.’ walking the Granville ure out how these pleasurable, like a waking dream After two Island seawall. Anita voices could ob- years of smoking has written screenplays serve me, hear pot casually, my and poetry, and in the me, know me. I decided they used Weed—very bad for me use increased and became a chron- fall will be a member ‘mind technology’ to do this. The In the summer of 1995, at my ic thing. I think it was because I was of Vancouver Coastal voices had names and histories— film school graduation ceremony, I getting sick; I found I was slipping Health’s Art Studios some of them were intriguing, oth- thought a helicopter overhead was into another world and pot made it ers terrifying. tracing my whereabouts and that so pleasurable, like a waking dream. After four days of this assault, my life was on display. But that de- I smoked pot every day during the one voice, which identified himself lusion was mild compared to what week (I managed to straighten up as Noah, seemed to be rescuing me followed once the voices arrived. for a weekend care aide job). I from the voices that threatened to The summer of ’95 was the smoked first thing in the morning, harm me. So when Noah told me first time I’d ever smoked marijua- right before bed and anytime in be- to go to the hospital, I did what he na. Before that I’d been a straight- tween that I could—probably nine said. I went to St. Paul’s Emergency arrow, hard-working kid—a tree times a day. and had myself checked into the planter, finance clerk in the- Ca My life started to deteriorate. psych ward. nadian Army reserves, university I decided to live in a van for the After a six and a half week student and now film school grad. summer and then moved into a stay, I was diagnosed with paranoid But that summer my life changed. warehouse space in the Downtown schizophrenia. This was painful to I was living in a house with other Eastside that had no kitchen or

Visions Journal | Vol. 5 No. 4 | 2009 17 experiences and perspectives

The seductive world of of sleep. In the more conscious weed and psychosis moments, I could feel the baby Smoking marijuana got kicking—I was now eight months me into a terrible state: pregnant. I still thought I was dy- I was in and out of the ing—not realizing that antipsychot- hospital system 11 times ics weren’t an effective suicide over the next 12 years. choice. When I awoke, I was full of When I smoked the remorse, shame and guilt. voices and hallucina- I decided that I was unfit to be tions were amplified and a mother; that my child needed took on a life of their to be raised in a healthy family. own. I believed what the I returned to my home province, voices were saying to where I found, through my per- me. Increasingly, I gave sonal networks, a wonderful fam- up on ‘ordinary’ life, ily for my daughter. I gave her would stay at home, up for an open adoption, which When I was diagnosed, smoke weed and re- means that I and my family are treat into this ‘theatre’ part of her life. no one told me marijuana of fun and drama. could cause psychosis Late night talk show I quit the weed—and life is good host Conan O’Brien I no longer smoke marijuana wanted to marry (though continue faithfully with me (eromatic delu- antipsychotic medication). I was bathroom. I proudly called myself sion).2 Famed film director/produc- sick of the psychosis—even hospi- a “starving artist”—but, in fact, I er George Lucas wanted to men- tal no longer offered refuge—that was losing touch with reality. And tor me. My days came to revolve in May 2008 I stopped. I’d never the stressful street scene in that around the delusions and voices, as have escaped the pull of the voices neighbourhood really upped my I went deeper and deeper into my if I hadn’t. paranoia. psychotic world. Giving up marijuana did create a void that I needed to fill. I find Interlude: still, I wonder... An awakening of sorts other ways to keep myself happy. I I often wonder whether I’d even Five years ago, I got pregnant. Be- write, volunteer and take classes. have schizophrenia today if I hadn’t cause of the pregnancy, my psychi- For some people, cannabis can been smoking a lot of marijuana atrist recommended that I stop all be harmless stuff. But it took me back then. I’ve been doing some medication. I was still smoking pot, away from everything life had to of- research, and there is information however. The delusions were grow- fer and made me focus only on what out there that says marijuana may ing stronger and stronger, and the was inside my head—and cause psychotic illness.1 voices were now with me 24 hours that was a pretty scary place. You’d think that after being di- a day, seven days a week. They Since giving up smoking pot, agnosed with schizophrenia I’d lay threatened to kill my unborn child my symptoms have been reduced off the pot. But smoking pot was part and me. by at least 50%, which is a life of my lifestyle. It was how I social- I travelled to a homeless shel- saver. I’m no longer suicidal, and ized, relaxed, had fun and related ter in another province, trying to the terror and fear I used to feel is to the world. I would play records, outrun the voices that ravaged gone. I’m enjoying mental well-be- write screenplays and daydream my mind—20 voices speaking all ing. And I’m able to enjoy seeing about making it in show business at once, non-stop. The wild visual my daughter grow up. Giving up as a Canadian screenwriter. hallucinations—like the fancy din- marijuana was the best thing that When I was diagnosed, no one ner parties where secret societies ever happened to me! told me marijuana could cause used mind technology to ‘own’ psychosis.1 Or that someone with people—were unbearable. These a mental illness shouldn’t use pot voices were going to ‘own’ me and footnotes because it makes the symptoms my child. This was life? I decided to 1 visit heretohelp.bc.ca/ worse and recovery more difficult. kill myself, to prevent all the future publications/visions for Although, I don’t know if I’d have pain my child and I would suffer, to the article’s complete listened even if they had told me. I make sure we would die together. footnotes or contact us was given antipsychotics and anti- In June 2004 I took an over- by phone, fax or e-mail —and I continued to dose of antipsychotic drugs—and (see page 3) toke up whenever I had a chance. for three days drifted in and out

18 Visions Journal | Vol. 5 No. 4 | 2009 experiences and perspectives

Alternatives: Miracle Marijuana

t the tender age of 15 I started to experience stigma of being caught by neighbours or family. Far Michelle Rainey severe stomach pain, nausea, cramping and from getting high; I was getting well—my nausea sub- diarrhea; a cycle that, I didn’t know then, sided and my intestinal spasms, along with the still per- Michelle is a cannabis wouldA repeat my whole life. Nobody seemed to know sistent diarrhea, were much less painful. My appetite patients advocate, Vice- what it was or how to treat it, and my symptoms per- increased, eating became healthy again, rather than President and Financial sisted with no relief for over two years. After many damaging, and my overall energy levels increased. I Agent of the BC Marijuana uncomfortable and painful tests, I was eventually diag- had none of the side effects I’d experienced with phar- Party, Director of Treating nosed with Crohn’s disease by my gastroenterologist, maceuticals (which I had quit at that time). I’d found Yourself magazine and who specializes in diseases of the bowel. There is no a miracle! the producer of Michelle’s known cause or cure for Crohn’s disease, also known Medicinal Marijuana as inflammatory bowel disease. Illegal “miracle”? on YouTube. Visit

Technically speaking, Crohn’s is a wasting disease; Acquiring marijuana was not easy—or legal. I risked www.michellerainey.com the body is depleted of nutrients that are vitally im- the possible consequences of using cannabis because I for more information portant for survival. Treatment includes a whole list of needed the relief I got from smoking pot. But finding a medications that have side effects that are each miles trustworthy dope dealer with a reliable supply “ of a quality long, including prednisone (a steroid), anti-inflamma- product at a rational price is virtually impossible. And the tory pills and painkillers. In severe cases, like mine, sur- expense—I paid $80 for a quarter-ounce and that wasn’t gery may be enough to last a required. The Far from getting high; I was getting week for my delayed diag- well—my nausea subsided and my medical needs. nosis caused intestinal spasms were much less painful. Finally, in me further I’d found a miracle! the late ’90s, damage, and i n f o r m a t i o n I needed immediate surgery. In 1989 the doctors re- started to trickle to the surface about the benefits of moved a small“ portion of my small intestine and ap- medicinal marijuana, even though it has been used pendix. Unfortunately for me, surgery was not the for its therapeutic value for centuries. And in 2001, the solution and the disease continued, maintaining its federal government’s Marihuana Medical Access Regula- destructive course. tions (MMAR) came into effect. Under the MMAR, Health I started a full-time bank career when I was 18 and Canada started a program for individuals suffering from just out of high school, all the while dealing with pain- certain diseases and life-threatening illness. People who ful spells of uncontrollable diarrhea and constant nau- were eligible could apply for a licence to legally access sea. The prescribed medications were costly and didn’t marijuana for medical use in Canada. really alleviate any of the symptoms of my illness, but Even though Crohn’s is considered an autoimmune helped enough that I could continue working at the disease and other autoimmune diseases such as AIDS bank. Then my weight ballooned up over 20 pounds were eligible, it wasn’t until 2005 that Crohn’s disease due to the prednisone. Food became my enemy. At any was included in the list of eligible conditions. moment the disease could flare up and the cycle would The MMAR application process was overwhelming. repeat itself. Over and over again. I was on a merry- There are 33 pages of paperwork; a doctor’s approval go-round with, seemingly, no way off. I began to seek and/or specialist acknowledgement is required and alternative treatment. much, much more. (I never had to fill out forms for the pharmaceutical drugs that were actually causing Wonder weed me harm!) A friend, who saw my terrible suffering, suggested that I wasn’t able to convince my family doctor of 34 I experiment with marijuana. He had done an extensive years to sign the Health Canada MMAR application. My research report in college on cannabis and its broad- doctor was completely supportive—and still is sup- range medicinal benefits. I had smoked marijuana a few portive, because he has documented how cannabis has times, recreationally, during my high school days, but helped me. However, there is still anti-cannabis propa- hadn’t been a regular user. In 1993, at his suggestion, I ganda in the medical field and a stigma that doctors tried it—and the results were immediate and amazing. who sign have to contend with. The College of Family I began self-medicating with marijuana—hiding in Physicians of Canada has, to date, not stated an official my bathroom with my vent-fan on high to avoid the Continued on page 20 >>

Visions Journal | Vol. 5 No. 4 | 2009 19 experiences and perspectives

Marijuana: Help or Hassle?

Emily Smith* ’ve been a nurse for a very As I near the end of my career, Cannabis—new uses long time, in acute and long- I want to speak out for an important for an old medicine Emily is a nurse who has term care, public health and freedom that is being threatened: the Many people with specific mental worked in a variety of Ihealth education for professionals freedom of choice in health care. health disorders and/or severe ad- clinical and community and non-professionals of all ages. Health professionals are dictions find marijuana, or “pot,” settings. For the past 20 Over the years, I’ve noted that some trained—no, it’s drilled into them— to be a more effective medication years, she has been a people benefit greatly from alterna- to respect patients’ rights to self-de- than any other substance available clinician in the mental tive medicines. But in some cases, termination and choice. Care is cli- to them, legally or illegally. Mental health field. Emily’s article patients are restricted from pursu- ent-centred, based on the specific health consumers of all ages know is based on her clinical ing health alternatives. Cannabis, or needs of the individual, and our that quality of life is linked to symp- observations as well as her marijuana, is a good case in point. practice decisions are made with tom management. And they make research on the topic of The controversy about the clients and families, we have been sincere attempts to improve their medicinal marijuana use medical use of marijuana has al- told over and over. quality of life in ways that are effec- ways interested me. I’ve worked When our patients seek con- tive for them, including the use of with health care professionals who, troversial treatment, we constant- cannabis products in various forms. * pseudonyms flat-out, say that cannabis is bad for ly struggle with our loyalty to our I’ve seen people in dire circum- all people. It’s easy to get along in clients’ wishes—because health stances—homeless, isolated, afraid the health field if you agree with professionals have legal and ethi- and suicidal—show clear improve- this opinion, or if you avoid the cal responsibilities to consider. But ments when marijuana was used topic altogether. But, as a nurse and those health care providers who to reduce anxiety levels in social mental health clinician, I’ve had ex- have rigid views that exclude offer- situations. I’ve noticed that many periences that give me a different ing treatment alternatives such as middle-aged clients (who may view from those who disdain mari- marijuana may be missing this im- have used pot at some other time juana’s medicinal use. portant element of patient choice. in their life) and crystal meth-ad-

Alternatives: Miracle Marijuana | continued from previous page

position on cannabis’ therapeutic value. The Canadian second-guessed by users. For these and many, many Medical Association has officially been opposed to the other reasons, I’ve chosen to grow my own medicine. MMAR, and Health Canada hasn’t assigned cannabis a It’s grown under my quality control and with my love DIN (drug identification number). Thankfully, my gas- and care—naturally as well as organically. By grow- troenterologist was willing to sign my application and ing my own medicine, I can cultivate the strains that now I can legally possess and use cannabis. work best for my illness and can also maintain a certain high standard for curing it and using it. Beyond a licence to use—taking Marijuana saved my life many times. I encourage control of your own health care everyone to inves- After a three-month wait, a few tense phone calls and tigate and research a few faxes, I was finally approved for a Health Canada alternative medi- licence in 2005. Health Canada has had a contract with cines. Taking con- a producer that grows only one strain of marijuana. trol and being re- That strain of isn’t suitable for my disease: I tried it and sponsible for your wasn’t impressed. own health can Compassion clubs, which still operate under a grey only benefit you zone legally, sell to Health Canada–licensed users and and your family. to some unlicensed users. But the compassions clubs purchase their marijuana from underground grow- ers who can’t be identified, questioned, inspected or

20 Visions Journal | Vol. 5 No. 4 | 2009 experiences and perspectives dicted youth respond particularly house and get involved in the com- assumed that well when marijuana is combined munity more often. He felt that his smoking mari- with life skills education and coun- quality of life was much better. juana use would selling. I’ve also seen marijuana aid Now, almost two years later, Joe have the same the management of serious drug or is still free of cocaine, has stopped effects on the medication withdrawal symptoms, drinking alcohol and has reduced his body. But there which is essential for successful re- marijuana intake to a rare event. At is a better way covery and improved quality of life. last report, he was off all his psychiat- to use cannabis ric medications and has developed a in terms of both Joe* more balanced lifestyle that includes health risks and Joe was just turning 50 when I met both paid and volunteer work. effectiveness: him. He was very lonely and his ad- vaporization,2 where the user in- diction to alcohol had already cost Ray* hales vapour rather than smoke.** him his job, his friends and his fam- Another case I clearly recall is that Clients who do use marijuana ily. After his marriage broke down, of a youth, just turning 19, who had for medical purposes also risk legal Joe had a hard time controlling his been fighting the effects of early problems—unless they get federal **For more information, intense feelings of sorrow and an- psychosis and schizophrenia since government approval. To get this see the article on ger. He had no self-esteem, no fam- childhood. His mother had report- approval, they must undergo an vaporizers, page 28. ily, no job and “no hope,” as he told ed how Ray had changed from a exhausting amount of paper work. me several times. happy, carefree youngster to a sus- The application isn’t easy for cli- Joe was using alcohol danger- picious, delusional youth who iso- ents with serious mental health and ously—and then he found cocaine. lated himself from everything and addictions problems to understand, His cocaine addiction began, ironi- everybody. let alone complete. Doctors who cally, when he sought help at an When I met Ray, he was drug- don’t agree with marijuana use may Alcoholics Anonymous meeting free, but had significant and dis- agree to fill out the forms, but the and was introduced to it by a group turbing psychotic symptoms. He application can lack the necessary member. He liked it a lot. And, after refused antipsychotic medication emphasis on need, and so may be years of social isolation, Joe bonded and, instead, found reasonable re- unsuccessful. quickly with the cocaine lifestyle lief from smoking marijuana. Ray and the people using it. It was his used pot to “ground” himself, he Clients not given a escape from reality and responsi- told me. When he wasn’t smoking choice—or a chance bility. He soon found, however, that pot, Ray was very agitated and Many clients aren’t even given a the escape was short, and reality paranoid. When he used pot, even chance to choose marijuana treat- was inescapable. in small amounts, he was able to ment. This is because some doc- Joe finally agreed to go to a work and share the responsibili- tors aren’t willing to make the sug- residential cocaine treatment pro- ties of home maintenance with gestion due to their own biases. gram after several unsuccessful at- his brother. He could work, eat, But marijuana can be beneficial for tempts to quit on his own. When sleep and play like everyone else. some clients in the same ways that he returned home, he found it al- He fit in like never before. I saw it conventional treatments can be ben- most impossible to manage his happen. eficial (or perhaps not so beneficial, drug cravings and his re-entry into in some cases). Each case must be the community without relapsing. It’s about risk assessment assessed separately and a variety of So Joe started using a small amount There are risks to weigh against treatment strategies must be made of marijuana to control his social the beneficial effects when choos- available, without judgment. footnotes anxiety and to manage the cravings ing to use marijuana—just as there Marijuana should be a ready visit heretohelp.bc.ca/ for cocaine that he was still experi- is with any medication, prescribed option—within all the necessary publications/visions encing. He told me he’d used pot or otherwise. government health guidelines and for Emily’s complete in his “wild youth,” but not as an I do want to acknowledge the warnings about its use—for those footnotes or contact us adult. He hadn’t even considered health risks associated with smok- who would like to test its relief po- by phone, fax or e-mail using it again until he became over- ing in general,1 since smoking is tential for themselves. (see page 3) whelmed by the effects of his de- the most common way that mari- pression and anxiety as well as the juana is used. Smoking tobacco is “call of cocaine.” known to cause As I worked with Joe in his re- several respirato- McManis, S. (2009, May 24). US CA: Pro-, anti-marijuana covery, I noticed that he presented ry illnesses such related forces cite their studies. The Press Democrat. Media in a calmer manner and had bet- as asthma, bron- resource Awareness Project: ter emotional control when he used chitis and lung www.mapinc.org/drugnews/v09/n559/a05.html pot. He was able to get out of the cancer, and it’s

Visions Journal | Vol. 5 No. 4 | 2009 21 experiences and perspectives

Should We Have Been More Aware? How cannabis changed my life

Matt t started in the summer before high school. I the computer.) I became skilled at rolling joints, without mysteriously developed strange vibrations in being tempted to smoke them. I knew all about the par- Matt* is a 17-year-old my neck and head that caused pain and head- aphernalia (items used for smoking cannabis, such as youth. He loves people, Iaches—and fear. It was a turbulent summer in many pipes, papers, etc.) and how to grow cannabis. I learned animals, nature and cars. ways: parents breaking up, a bad plane ride, general the names of hundreds of strains and how to tell good Currently, Matt is exploring angst about the coming school year. I felt an increasing weed from bad. I also read people’s testimonies that an interest in computer need to protect my neck and my pot offered relief from anxiety coding and programming, brain. I stopped doing anything and muscle pain—and I’d been plus he’s trying to get his that required me to move my having neck pain for a few years first car ready for the road neck and head. Anything that vi- by this time (at least partially due brated or had frequencies—elec- to immobility). *pseudonym tronic stuff like computers, TVs, So, in July 2008, after a few microwaves, for instance—made months of being off my meds, I me anxious and I avoided them. decided to try smoking marijua- When I began school in Sep- na. My friend and I each had our tember 2005, my symptoms and own (a hollowed-out cigaril- behaviours worsened. I spent lo that you fill with marijuana more and more of my time on rit- instead of the tobacco it comes uals and coping with fears around with). My first marijuana expe- mind contamination by electro- rience met all my expectations. magnetic frequencies (EMFs). Two My anxiety was toned down, my months later I was diagnosed with obsessive-compul- neck pain was relieved for the first time in years, and sive disorder (OCD). I had a good time. It was such a positive experience In December I wound up in the hospital Emergen- that I started thinking about a day trip to Vancouver to cy, and agreed to go on medication for the first time. I check out the compassion club. didn’t like being on the medication—it affects the very I was excited, thinking that a couple of puffs a day thing I was trying to protect: my mind. It’s ironic, this could make my life easier, and decided to experiment OCD, because my whole modus operandi has been further. Not only was I looking for reduced neck pain to preserve my mental health. So, over the next few and relief from my anxiety, but I also wanted to be like years, my meds were off and on. everyone else. I wanted to experience the things I had School and my social life were basically off and just been observing for a long time. on too, depending how I was doing. But I did notice A month later, I did marijuana with a bong—I had that the people who seemed to be enjoying high school waited to acquire some pot from a trustworthy friend most were those using substances. who knew a grower: I was wary of mainstream dealers. Occasionally I’d try to hang out with some of my But this time was not as enjoyable. I was a little tripped buddies, who were by then into experimenting with mar- out and it was scary. Friends said it was normal to get ijuana. I tried smoking tobacco, but avoided cannabis dizzy and out of it, but I didn’t like it. Not long after, I and alcohol because of the antidepressant medication I smoked a bong again... was taking for the OCD. I’d go to parties without being intoxicated. The friends I chose were aware of my mental A terrifying trip health issues and that I was on meds, so they didn’t pres- It was August 2008. I was hanging out on a friend’s sure me. But sometimes it was hard being the only one patio and looking forward to a really chill evening with straight in a large group of high and drunk kids. my buddies. But one large bong rip was all it took to ruin everything. Fascinated by cannabis culture Everything around me lost meaning. My entire For over two years, starting July 2006, I read about mari- grasp of reality slipped away. Every few seconds, just juana on the Internet. (Yeah. We got low-radiation flat- as I’d begin to get my thoughts organized, I’d slip away screen monitors at home, so I could handle being on again. I felt a terror deeper than fear for my life. And

22 Visions Journal | Vol. 5 No. 4 | 2009 experiences and perspectives it felt like it would never end. I didn’t know who and stasy or some other where I was. But somehow I made it home to my bed substance. If one of Read Matt’s Mom’s Story... and eventually fell asleep. their friends came When I woke up the next morning, the effect was over, I’d go into panic still there, though different. I had a basic grip on reality, mode. Epilogue—Mom’s View but felt like I was in a dream. Everything was foreign and uncomfortable. Everyone felt like strangers, even A cannabis ‘high’? my mom and my sister and brother. Nothing mattered. Or psychosis? Available Online at: I didn’t really exist in my own reality. On the Internet I www.heretohelp.bc.ca/publications/visions learned that many Cannabis aftermath kids have their first psychotic break when they’re us- I never regained the grip on reality I once had. That ing drugs. I realized that might be what had happened single cannabis experience turned the best thing go- to me. ing—the positive cannabis experience—into my big- This spring, I agreed to try antipsychotic medica- gest nightmare. tion. Now that I’ve used recreational drugs, I worry that In my mind, recreational drugs had become the it’s even worse on my brain to take the meds. But I do ‘enemy’—they terrified me. All traces from the days want to get better, so I agreed with my psychiatrist’s when I was fanatically interested in cannabis—the suggestion to add this new drug (risperidone) to my magazines, papers, bong, little dime bags—all of that treatment. It has taken the edge off my irrational fear had to go. My worry became excessive, and I spent my of drugs and has given me the energy to start living a days depersonalized—I still don’t feel like I’m in my bit more. I’m washing my hands less and I’m swim- body, on this Earth. ming, biking and seeing my friends. Whenever thoughts of my awful experience crept I still worry continuously about drugs, and I’m dis- into my mind, I’d block these out by playing video appointed with my impaired grasp of reality—I don’t games. (I wasn’t worried about electromagnetic fre- expect my mind will ever work quite the way it did quencies any more; that fear had been replaced.) When before my cannabis experience. But I’m working every gaming, my overwhelming world was condensed to a day to recover. In addition to taking medication, I’ve smaller one where I was able to find comfort. Unfortu- had five sessions with a therapist who is “awesome.” nately, the crash back to the real world felt even worse I believe that we shape our own reality. I’ve got after hours of being absorbed in my virtual reality. In some work to do before I’ll be comfortable in mine. conscious moments, I was stressed out about possible encounters with drugs. I tried grade 11 in September. Within two days, I had dropped two of my four classes. One class had “stoners” (heavy dope smokers) who I couldn’t imag- ine surviving a semester around for fear of contami- nation. Keyboards, desks—all the surfaces that kids Are you an immigrant or refugee who may have smoked dope between classes would come in contact with were a threat. Just being in the with a mental health or substance building could send me into panic. I believed that any contact, however small, would cause me to have the use story to share? same experience. Logically, I knew that a trace expo- sure couldn’t do that, but I couldn’t defeat this fear. BC Partners for Mental Health and Public school was no longer feasible. Addictions Information I tried two home-study courses, but was too preoc- Our Winter issue of Visions will deal with cupied with fears and rituals to keep up with the work. mental health and substance use issues and I went back on antidepressant meds in December at experiences of seniors who Visions my mom’s urging (medications that are prescribed are are immigrants and refugees not the enemy, though I don’t like taking them), but and their families. still lost most of the school year. I can’t begin to go into all the ways my life was impacted on a daily basis. I would wash my hands If you have a story idea, hundreds of times a day, to the point that my hands please contact us at: got raw; this was about drug traces contamination, not [email protected] germs. No friends could come to my home; I couldn’t or call 1-800-661-2121 go to their homes or any public places. My brother, who is 15, and my sister (14) couldn’t have their friends come here, especially if I knew the friend had done ec-

Visions Journal | Vol. 5 No. 4 | 2009 23 alternatives and approaches

When Help Is Not at Hand Teens turning to marijuana for emotional problems Joan L. Bottorff, n British Columbia, close to 15% of children and had teased her about her designer pants. PhD, RN, FCAHS youth suffer from a range of mental health issues: Amanda felt she had no one to talk to about how 6.5% experience anxiety and 2% suffer depres- she was feeling. She felt distant from her mother, dis- I 1 Joan is a Professor in the sion. One in seven children and youth experience liked her mother’s boyfriend and wasn’t comfortable Faculty of Health and mental health problems serious enough to cause sig- talking to the school counsellors. Amanda confided in Social Development and nificant distress and impair their functioning at home, an older friend who lived with depression. This friend the Director of the Institute at school, with their peers and in the community.2 introduced Amanda to marijuana because “it helped.” of Healthy Living and So, we wanted to know what happens when youth, Amanda said: “I use marijuana to battle my de- Chronic Disease Prevention ages 13 to 18, have no one to turn to for help with pression, so I don’t have to feel anything. If I start to at UBC Okanagan their emotional challenges. According to the Canadian feel like I’m going into a low or am feeling really bad Community Health Survey, youth are the least likely and need a quick pick-me-up, I’ll get my bong from of all age groups to seek assistance for mental health the closet and smoke a few bowls. When you’re in a Barbara M. Moffat, problems.3 depression, you seriously believe it, so you need to get MSN, RN out of it. It’s like a pot that you’re boiling. You know, The TRACE project you put the lid on it and the water is boiling and it Barbara is Project Director The TRACE (Teens Report on Adolescent Cannabis Ex- eventually starts boiling over.” for the TRACE (Teens periences) research project at the University of British For Amanda, smoking marijuana was a way to Report on Adolescent Columbia is aimed at understanding the context and relieve the intensity of her depression. Although she Cannabis Experiences) culture of frequent marijuana use. In 2006, we began found it was “usually” helpful, it didn’t always work project of the Centre data in communities in three regions of Brit- to help her feel better about herself. She also started for Nursing and Health ish Columbia (Vancouver Island, the Kootenays and to worry that she had become addicted to marijuana. Behaviour Research at Vancouver). During in-depth one-on-one interviews, During the interview, Amanda described how on her the UBC a total of 77 teens have shared their experiences and own initiative, she decided to see a psychologist at a perspectives on marijuana use. health clinic to begin to explore her depression. Although there have been a number of interesting Joy L. Johnson, findings from the TRACE study reported thus far,4-6 we Dylan’s* story PhD, RN, FCAHS were particularly struck by the number of teens who Two years prior to participating in the TRACE interview, turned to marijuana to address uncomfortable feelings Dylan discovered that smoking marijuana helped him Joy is a Professor at the like depression and anxiety.7 We also found that youth calm down when he felt anxious. He was always nerv- UBC School of Nursing. often didn’t know of resources or support that could ous meeting new people. Last September, his family She is also Scientific help them address their emotional problems. As a re- moved across town, and he started attending a new Director at the Institute sult, several described how they would isolate them- school where he had few friends. Up until four months of Gender and Health, a selves and smoke marijuana in the confines of their before he was interviewed, Dylan spent most of his time branch of the Canadian bedrooms. At times, when teens shared their concerns with his girlfriend. She had recently broken up with him, Institutes for Health with the adults they lived with, their concerns were however, because of his regular marijuana use. Research (CIHR), the not taken seriously. As a result, some turned to mari- At home, he often felt annoyed and aggravated. Canadian government’s juana to find relief from their uncomfortable feelings. His relationship with his mother was strained, he agency responsible for Teens often noted how they preferred marijuana over didn’t get along with his stepfather, and he had regular health research funding alcohol, believing it to be a healthier and safer option. arguments with his older brother. He was concerned However, many teens recognized that this was not the about his grades and worried that he’d have to repeat solution they were looking for. his school year or change schools again because of his academic performance. Amanda’s* story Dylan reported that he didn’t smoke marijuana to For over a year, Amanda noticed that she was feeling get high, but to manage his nervousness, to “feel nor- increasingly sad and depressed. At 16 years of age, she mal” and to calm down before sleeping. Dylan said: moved with her mom from a large urban setting to a “I’m nervous talking to people. So it’s better when I * pseudonyms; these are small community. Amanda had difficulty settling into smoke marijuana, because I’m not as nervous. I don’t constructed stories using her new school, felt lonely and missed her best friend. usually smoke just to get high. Instead, I feel normal real data She reported that just a week earlier, a girl in her class when I’m smoking marijuana.”

24 Visions Journal | Vol. 5 No. 4 | 2009 alternatives and approaches

Dylan was concerned about having to rely on students to access support in times of need. For marijuana in this way. He was aware that his mari- example, Vancouver’s SACY (School Age Chil- juana use was a temporary solution that “helped at dren and Youth) prevention the moment.” But he also recognized that he wasn’t program has piloted an alternative suspension really addressing his problems. Two of his friends program for students caught drunk or stoned. were attending weekly meetings at his school. The Suspended students work with a helping adult friends described the meetings as opportunities to at a central location to do a substance use self- talk about some of the “stuff” going on in students’ assessment and develop a plan to re-enter their lives, and there was free pizza. At the time of our school, substance free. The plan includes iden- interview with Dylan, he had decided to attend to tifying an adult ally at their school who they see if this might help. can approach for support.10 Other community-based programs are also New approaches needed to help available. One example, the Freedom Quest Re- teens with mental health concerns gional Youth Services in the Kootenays, offers There are health risks for youth that use marijuana, in- counselling and advocacy while focusing on re- cluding dependence to marijuana. Withdrawal symp- ducing risks associated with substance use (web- toms and cravings are signs of dependence among site: www.freedomquestonline.ca). some youth who smoke marijuana regularly.8 Research Some of the youth interested in finding better suggests that dependence on marijuana affects one in ways to manage their uncomfortable feelings were six to seven youth who use marijuana, and that those able to connect with programs like this in their school who are dependent are at risk for symptoms of depres- or community. They found turning to others instead sion and psychosis.9 This evidence, together with - of marijuana helpful. Several TRACE participants, at lished findings from the TRACE project,7 indicates that the end of the interview, talked about the benefits of new approaches to addressing teens’ mental health being able to talk about marijuana and what is going concerns are needed. By linking teens with supportive on in their lives. They made the point that the TRACE footnotes community resources and appropriate health care pro- interview was the first time they had been able to visit heretohelp.bc.ca/ viders, fewer teens may choose to rely on marijuana talk to someone about their problems. publications/visions for for relief from their emotional problems. Paying attention to youth with emotional problems the article’s complete School staff are well positioned to recognize like depression and anxiety, taking their concerns seri- footnotes or contact us changes in students’ academic performance and emo- ously and connecting them with the resources they need by phone, fax or e-mail tional well-being. And schools are the logical place for is essential for promoting youth mental health. (see page 3)

Tips for Cutting Back

eople develop patterns of can- There are differ- Rielle Capler, MHA nabis use that fit their needs. ent reasons why peo- PAs their needs change, people ple decide to change Rielle worked eight years tend to change their patterns of their pattern of use. as a Policy Analyst and use. For some this means stopping Some people may Research Coordinator the use of cannabis completely. For stop using cannabis with the BC Compassion others it means stopping temporar- temporarily to reduce Club Society. She was a ily or cutting back. their tolerance level. Research Associate at Often, patterns of use change This means that they the Centre for Addictions quite naturally. For example, many can use less cannabis Research of BC (CARBC) people who use cannabis in their to get the effect they and is currently an youth stop using it when they get want. Associate Researcher at older. Some use cannabis for medi- By cutting down Outline how you’ll the Centre for Applied cal purposes that may be tempo- on the amount used, deal“ with any withdrawl Research in Mental Health rary or change over time. Others they can maintain and Addiction at SFU use cannabis throughout their lives, the benefits, but symptoms and cravings with periods of non-use or less use. minimize possible you may get ” Visions Journal | Vol. 5 No. 4 | 2009 25 alternatives and approaches

harms (e.g., respiratory problems such as bronchitis which can accom- to changing your pany heavy, long-term use). For other people, it may be a matter of cutting current cannabis back on costs. Still others may be 6 steps use patterns concerned about the potential legal consequences. And for some, their cannabis use may be a problem—due to misuse, stigma or legal status—for Think about your current patterns of use the people they care about. 1 Think about how much, how often and when you use can- Most people who want to cut nabis in a day, week or month. This will help you understand down on or quit cannabis are able your cannabis use and will help you monitor your progress as to do so easily. The way cannabis you cut down. molecules work in the body typi- Think about why you use cannabis cally leads to controlled use of low 2If you’re using cannabis regularly, chances are there are doses, rather than the compulsive reasons why. Does it relax you? Does it help you sleep? Does it use sometimes seen with drugs relieve physical pain or help you cope with difficult emotions? that are considered addictive. Make a list of reasons why you want to cut down Cannabis has a low risk for 3Think about why you want to change your current pattern of physical dependence. However, use. Is it negatively affecting your health? Are you worried about when someone uses cannabis the costs? Are you worried about legal consequences? a lot over a long period of time, Be aware and prepare they may develop a psychologi- It’s important to know that, for some people, this change cal or emotional dependence. This 4 may be difficult to create and sustain. You can prepare by jotting means they may have come to rely down the things you think may be difficult and noting resources on the effects of cannabis and may for support, such as counselling or relaxation techniques. have trouble functioning with less cannabis. People who do develop Make a step-by-step plan to make change happen mild physical or psychological de- 5First, decide which day you’re going to begin making the pendence may experience minor change. Then, write down what the change will look like and the withdrawal symptoms. These can things you can do on the first few days. Next, outline how you’ll include irritability, anxiety, loss of deal with any withdrawal symptoms and cravings you may get. Fi- appetite and disturbed sleep. These nally, think about what you can do to make a healthy transition.* symptoms are usually slight and Stay positive and stay active last for about a week. 6Give yourself credit for the positive changes you make and If you’ve decided to cut down fill your time with meaningful activities and healthy relationships on or quit using cannabis, consider in which your desired level of cannabis use is respected. the following guidelines and tips.

Tips to help you cut of cannabis, but not to another to get the effects you want. down on the amount of strain. Instead of always using • Avoid adding tobacco cannabis you use the same strain continually, alter- Tobacco contains , which • Take a break nate between different strains. can quickly create nicotine depend- * See the Problem You may have found that you need • Practise self-management ency. Rolling tobacco and canna- Substance Use Workbook to use an increasing amount of can- Instead of smoking a whole joint bis together in a joint may make it at www.heretohelp.bc.ca nabis to get the desired effects. This or taking a puff every time a joint harder for you to cut down on using for more information is called tolerance. If you want to comes around, take a puff or two cannabis. reduce tolerance, stop using canna- and then wait a few minutes. You • Buy less, so you smoke less bis for a week may find that a smaller amount is Buying cannabis in bulk is cheaper, or two, or take enough. but you may end up smoking more longer breaks • Use higher potency cannabis than you want to just because it’s than usual be- Instead of smoking a lot of a weak available. tween use. strain of cannabis, smoke less of a For more information about • Use a variety more potent one. cannabis and other substances, of strains • Use a vaporizer visit www.heretohelp.bc.ca or You may build Because of the way they are de- www.carbc.ca. up tolerance signed, a good quality vaporizer to one strain will allow you to use less cannabis

26 Visions Journal | Vol. 5 No. 4 | 2009 alternatives and approaches

The Health Effects of Medical Marijuana Project (HEMMP) growing number of people with chronic illness- undertook a research study: the Health Effects of Medi- Lynda G. Balneaves es use marijuana to help them cope with their cal Marijuana Project (HEMMP). Dr. Balneaves is an symptoms. In fact, it is estimated that up to The objectives of the project are to 1) understand Associate Professor with A the School of Nursing at one million Canadians use marijuana for its medicinal the health and social effects for individuals who use effects.1 There are a limited number of clinical trials marijuana for medical purposes, and 2) examine how the University of British supporting the effectiveness and safety of marijuana. the social and political context around marijuana in- Columbia, as well as a However, observational studies2-5 and other personal fluences people’s decisions to use it. This includes ex- Lead Investigator with the observations suggest that marijuana helps people cope ploring issues such as the stigma around marijuana NEXUS research unit. with a number of symptoms, including pain, nausea, use and its continued illegal status beyond the Health She holds a CIHR New muscle spasms, depression and anxiety. In addition, Canada program. Investigator award marijuana may improve sleep and appetite. Since 2007, the HEMMP study has interviewed 25 Today, there is access to people who obtained mari- Joan L. Bottorff marijuana for medical purposes juana for medical use as Dr. Bottorff is a Professor through Health Canada’s Mari- members of a compassion and Director of the huana Medical Access Division club or as holders of MMAD Institute of Healthy (MMAD). MMAD is the govern- authorization. The sample Living and Chronic ment office that approves ac- includes men, women and Disease Prevention at cess to medical marijuana for transgendered individuals the University of British people who are eligible under ranging in age from 20 to Columbia Okanagan the Marihuana Medical Access 69. This study includes peo- Regulations (MMAR). People ple living with a wide range H. Bindy K. Kang living with specified chronic of debilitating illnesses, in- Bindy is a Project diseases no longer need to fear cluding HIV/AIDS, cancer, Director with the School legal penalties associated with hepatitis C and irritable of Nursing’s Centre for marijuana use, if they are ap- bowel syndrome. Fourteen Nursing & Research proved by MMAD. Those who of our participants also re- Behaviour Unit at the are approved can purchase ported using marijuana for University of British marijuana grown for MMAD. mental health issues, includ- Columbia and a Cross They may also be allowed to grow a limited number of ing anxiety disorders and depression. Cultural Mental Health plants for their own use (depending on their daily dose The stories of people taking part in the study re- Worker with Vancouver requirements),6 or they can designate another person flect the importance of marijuana use in the lives of Coastal Health to grow marijuana for them. ordinary people as they deal with a complex range of To date, only 2,812 Canadians are registered through symptoms. For many, marijuana was a last resort after Rielle Capler MMAD.7 Community-based compassion clubs also pro- other prescription drugs and therapies proved unsuc- Reille worked eight years vide non-legal marijuana to thousands of Canadians cessful. Marijuana helped individuals take part in eve- as a Policy Analyst and with or without a MMAD licence. Although, MMAD’s ryday activities, such as going to work, shopping or Research Coordinator authorizations to possess marijuana have steadily in- simply getting out of bed, and it provided them with a with the BC Compassion creased from 2003, the onerous 33-page application way to feel normal. Club Society. She was a and the reluctance of the Canadian medical community Research Associate at to support the therapeutic use of marijuana continue to Alia’s story the Centre for Addictions serve as barriers for compassionate access.8 Alia is a woman in her 50s living with arthritis and Research of BC) and is chronic pain. She doesn’t sleep well and lacks the en- currently an Associate Understanding the health effects ergy she needs to carry out normal everyday activities. Researcher at the Centre from the point of view of users Over the years, she tried various medications and sup- for Applied Research More people are turning to marijuana for medical pur- plements to deal with her sleep problems and pain, in Mental Health and poses. This has created a need to develop better re- but found nothing really helped. Addiction at SFU sources to provide information about the health ben- She started using marijuana at the suggestion of a efits and risks of marijuana use. In order to develop a friend. She found that one particular strain of marijuana, And the HEMMP toolkit for better practices, the UBC School of Nursing available through a local compassion club, improved her Research Team

Visions Journal | Vol. 5 No. 4 | 2009 27 alternatives and approaches

sleep immensely and decreased her pain. Alia smokes Marijuana as a lifeline marijuana once a day in the evening. She has been Alia and John are like many of our participants who using marijuana for 14 years. For her, the health and found prescribed drugs and other medical therapies to social risks of marijuana use are few and hold little im- be largely ineffective. Many of our participants believe portance when compared to the benefits she receives. that marijuana is a “lifeline” for them and that they “It reduces the pain enough that I can get through couldn’t function without it. the next few hours without worrying about how I’m go- Almost all of our participants shared concerns ing to do what I’m doing. So I don’t have to make so about using marijuana. As an illegal substance, mari- many concessions... and that’s a really big plus. Because juana continues to be identified as a potentially dan- then I can get three or four hours worth of stuff done gerous product that there should be limited access to. and not worry about how tired or sore I’m going to be Many of our participants shared concerns about dis- afterwards...” closing their medical use to work colleagues, neigh- bours, acquaintances, healthcare professionals, law John’s story enforcement staff, family and friends. They worried John, a 38-year old man, has been living with multi- about consequences of disclosure such as losing their ple diagnoses, including fibromyalgia and chronic pain jobs, being evicted from their homes, being ‘fired’ by syndrome. For over a decade, he has been seeking help their physicians, being targeted as a ‘criminal,’ and so- from specialists—trying to find relief from the intense cial isolation. They were also worried about the influ- pain he experiences, with little success. His family ence of their marijuana use on children in their social does not support his use of medical marijuana. So, for circles. Some individuals also expressed concern about a period of time, John “gave up” marijuana. possible health-related side effects, such as the effect “I quit and started pursuing much more rigorously on their lung health. Despite these concerns, partici- the medical aspect of it. I went through all the medi- pants were very clear that the benefits of marijuana far footnotes cations they said should work, might work, never did outweighed the risks or concerns they had. visit heretohelp.bc.ca/ work and I gave them a full shot at it...” The HEMMP research study is now in its second publications/visions for John later returned to using marijuana and found year. With interviews now complete, data analysis is the article’s complete instant relief. underway and reports are being prepared to submit footnotes or contact us “Having one short toke was enough to make my mus- for publication this fall. If you would like more infor- by phone, fax or e-mail cles all relax... It has a dramatic effect on muscle pain, mation about the study, contact Dr. Lynda Balneaves at (see page 3) stiffness, aches and pain.” 604-822-7679 or at [email protected].

Vaporizers Safe Alternatives to Smoking? Mridula Morgan e’re regularly exposed to prits we’re warned to avoid. The ef- What if the negative health anti-smoking campaigns. fects of smoking taboo substances risks related to smoking were re- Mridula is a Vancouver WAds on TV, on websites such as cannabis aren’t any better. moved? What if one could simply writer and researcher. She and on buses warn us about the Cannabis smoke also contains a inhale without absorbing most of is currently a Program health risks linked to smoking cig- range of harmful chemicals.3 the harmful toxins of cannabis, to- Coordinator at Canadian arettes. Tobacco smoke contains Cannabis users generally smoke bacco or other plants? Mental Health Association, many harmful substances that can the plant form of the drug. They in- BC Division lead to cancer, heart disease, stroke hale the smoke and hold it in their Vaporization: and lung disease.1 Furthermore, lungs for long periods of time. This a not-so-new ‘technology’ people who inhale second-hand may increase the risk of cancer, A technique called vaporization is smoke are also exposed to toxins lung damage, respiratory problems considered a relatively safe alterna- that can cause breathing problems and poor pregnancy outcomes.4 tive to smoking. Herbs and plants and irritate the eyes, lungs and A recent study shows that aren’t heated to where they burn throat.2 “Butt out,” the ads warn, when both tobacco and marijuana and release combustion toxins. before your health and the health are smoked they work together to They’re heated just enough to re- of those you love is compromised. further increase the risk of respira- lease their active compounds into Cigarettes aren’t the only cul- tory symptoms and lung disease.5 vapour for inhalation. The vapour is

28 Visions Journal | Vol. 5 No. 4 | 2009 alternatives and approaches then drawn through a mouth piece of California, San Fran- attached to a hose or pipe, a section cisco, studied how inhal- of which may run through a water ing Cannabis sativa (the bowl for cooling before inhaling or most widespread variety storing for later use. of cannabis) through the The vaporizer principle is Volcano Vaporizer differs based on a device commonly from smoking a standard known as a hookah, which has joint of marijuana. Abrams been used for hundreds of years. and his fellow researchers Its origins are in India, but it is found that vaporization re- widely used in the Middle East for duced the amount of car- and is gaining bon monoxide and tar that popularity in other countries. was generated compared

In recent years (1990s) the to smoking, possibly re- 2007 Storz & Bickel © by technique of vaporization has been ducing exposure to gase- A woman removes the expandable bag from the Volcano Vaporizer after it has filled with extended to the use of cannabis ous combustion toxins.9 rising vapour. She passes the ready bag to her partner so he can inhale the vapour. and together with that many dif- Other researchers ferent types of devices have been found that electric vaporizers can 1993 to 2002. However, the asso- developed. Canada was at the fore- completely suppress the forma- ciation claims that the US National front of this development with the tion of harmful compounds such Institute on Drug Abuse (NIDA) has first electric vaporizer prototypes in as benzene.10 Exposure to benzene discouraged further vaporizer re- 1994.6 However, a device that has has been reported to have major search by enforcing a tight monop- received considerable attention is long-term health effects.11 oly on the supply of marijuana that the Volcano® vaporizer. What does this mean for can- can be used in research. This has nabis users? It may open the door been interpreted as an unwelcome The Volcano Vaporizer: to using cannabis while promising triumph of Drug War politics over a high-tech ‘hookah’ to lessen the negative health effects science.13-14 In the late 1990s, a German named normally linked to smoking. It may Finally, access to, or compli- Marcus Storz invented what is also give hope for an emerging safe ance with, using vaporizers may known as the Volcano vaporization use of cannabis for medicinal and also be an issue. There are dozens system.7 This device has been for- therapeutic purposes. This would of models of cannabis vaporizers mally validated by researchers as a be good news for those who use on the market and some are not “safe and effective cannabinoid de- cannabis to manage chronic health cheap. They run anywhere from livery system” for clinical trials.8 conditions. around $50 to upwards of $550 for The Volcano is made up of a the Volcano vaporizer. For many few easy-to-assemble parts. There Are vaporizers an answer to people, a vaporizer may be a luxury is a plug-in cone-shaped base (the the smoking dilemma? item. For many others, a vaporizer ‘volcano’) that has a heating ele- The Volcano vaporizer Internet may be simply unaffordable. Why ment and temperature regulator. sites and blogs market the Volcano invest in a vaporizer when you can Herbs such as cannabis are put into Vaporizer as a device that helps simply light up for much cheaper? the conical filling chamber and va- people to “quit smoking.” One Debate surrounding the use of porized. At temperatures between can be weaned off the toxins and substances such as cannabis and 180oC and 200oC, cannabinoids are simply “inhale the benefits.” This tobacco, with or without a vaporiz- released in a gaseous form, before is designed to dispel the common er, continues. Smokers continue to footnotes they reach a burning point. The mantra that “smoking is bad for indulge in cigarettes and cannabis visit heretohelp.bc.ca/ cannabinoids are thus extracted you.” In fact, smokers are made to users toke their joints. The use of publications/visions without creating smoke toxins. believe that they can indulge, with- vaporizers is relatively new and still for Mridula’s complete The herb is put in a heating out experiencing the negatives con- under scrutiny but hopefully fur- footnotes or contact us chamber that sits at the top of the nected with smoking.12 ther research will prove them to be by phone, fax or e-mail ‘volcano.’ A valve connects a heat- The evidence around safe use effective, safe and affordable tools (see page 3) proof bag or balloon to the top of of vaporizers is not yet conclusive. for smokers. the cone. When the expandable Much research is necessary to sci- bag is filled with rising vapour, it’s entifically resolve the issue of medi- removed from the cone. A mouth cal marijuana use, yet research it- piece is inserted so the vapour can self seems to be controversial. The be inhaled from the bag. Multidisciplinary Association for In 2006, Dr. Donald Abrams, a Psychedelic Studies (MAPS) spon- cancer specialist at the University sored solid scientific research from

Visions Journal | Vol. 5 No. 4 | 2009 29 regional programs

Compassion Clubs Working for Health and Liberty

Kailey Willetts he BC Compassion Club Society can now claim The BC Compassion Club “12 years of civil disobedience and 12 years Compassion clubs came to Canada in the late 1990s, Kailey is a T of non-profit medical cannabis distribution in based on similar medicinal marijuana clubs in the Unit- Communications intern Canada... The BCCCS will continue to work towards ed States. The goal of compassion clubs is to provide safe at the Canadian Mental ensuring that those who use cannabis as a medicine access to medicinal, or medical, marijuana when there Health Association, BC never have to choose between their liberty and their is no government-sanctioned program, or when such a Division and an English health...”1 program is not effectively meeting the need. About 12 Honours student at the major clubs currently provide medicinal marijuana to an University of Victoria Meet Louis estimated 10,000 people across Canada.2 When Louis* was diagnosed with cancer in 2005, he The BC Compassion Club Society—Canada’s larg- immediately applied for membership in the BC Com- est compassion club, located in Vancouver—opened its * pseudonym passion Club Society (BCCCS). Louis is also a licensed doors in 1997. At that time, there was no government- user through Health Canada’s Medicinal Marihuana sanctioned program to provide medical marijuana in Medical Access Division. Canada. Louis used marijuana through several rounds of The Health Canada Marihuana Medical Access chemotherapy. Regulations (MMAR)3 was enacted in 2001. Now people “Not only was I not overcome with nausea, but I can apply for federal government approval to use mari- was able to gain weight during the last, difficult six- juana for medical purposes. However, the Health Can- month course of chemotherapy,” Louis wrote in an e- ada eligibility requirements are very restricted and the mail interview. application process is lengthy. There are currently only “This last chemotherapy course devastated the around 2,800 people licensed by Health Canada to ac- nerve endings in my hands and my feet, and I now cess medical marijuana,4 out of an estimated 600,000 suffer from peripheral neuropathy,” he added. “Associ- Canadians that use marijuana for medical purposes.5 ated with peripheral neuropathy are throbbing pains in Currently, the BCCCS has around 5,000 members.6 my feet that come by for a visit each evening, usually “The courts have ruled that people who are ill have in bed. My neurologist concedes that there are thera- the right to access medicinal cannabis if they have peutic properties in marijuana and encourages me to need of it, without fear of prosecution,” says Jay Le- use it.” ung, communications coordinator for the BCCCS (see Despite being a Health Canada licensed user, Louis sidebar re court rulings). doesn’t get his medicine from Health Canada. Instead, Compassion clubs exist to provide medical mari- he relies on the BC Compassion Club. juana to people in need, but not all their members are licensed by Health Canada. While the clubs usually have their own strict guidelines for membership and providing cannabis—for chronic conditions, most clubs require a doctor’s note confirming a patient’s condi- tion; for some conditions, a doctor’s prescription may be required—this does not make unlicensed members’ use legal. So, fear of prosecution is still a concern. Compassion club operations, in fact, are illegal un- der Canadian law. Under the MMAR, growers can ap- ply for a licence to produce medical marijuana for a licensed user. But the regulations restrict the number of users a producer can grow for (was one; now two) and restrict the number of plants they can grow based on how much cannabis the user is licensed to smoke (usually enough to ensure a constant supply of 1 to 3 grams a day). Producers must also get their seeds J.K. Leung 2008 J.K. A member hands her membership card to the receptionist in the waiting room at the British Columbia from Health Canada.7 To provide the quality product Compassion Club Society. and quantity that their members need, however, BC-

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CCS contracts growers who operate outside the Health Canada regulations, so are “engaged in civil disobedi- Medical Marijuana in the Courts ence, and risk getting arrested and charged.”1 “Health Canada programs have been a half-heart- Section 7 of the Charter of Rights and ed attempt to meet the requirements that the court Freedoms says that everyone has the right to rulings have mandated,” says Leung. life, liberty and security of person.1 So, why does Louis get his marijuana from the compassion club and not Health Canada? 1997: An Ontario judge ruled that sections of Canada’s nar- Many Health Canada licensed users choose to use cotics and controlled substance laws violate an individual’s compassion club or other sources instead of the Health Charter rights when marijuana is needed for medical purpos- Canada product. Often, it’s a quality concern. es. The ruling came during the trial of Terry Parker, who was “I have never used MMAR [cannabis] because they found not guilty of growing and possessing marijuana. Mr. sell an inferior, overpriced product,” wrote Louis. Parker used marijuana to help control his epilepsy.2 “We provide a much higher quality of medicine,” says Leung. The BCCCS offers organic cannabis and 2000: The 1997 decision was upheld in the Ontario has different strains of cannabis (at least seven), Court of Appeal.3 which affect people and conditions differently. Health Canada offers one strain, and only sells cannabis as 2003: The Ontario Court of Appeal upheld the decision by seeds or dried. While the BCCCS only measures po- the Ontario Superior Court that the rules for producing your tency (THC levels) anecdotally, they trust their expe- own marijuana were too restrictive and forced many medicinal rienced suppliers to provide them with high-quality users to turn to the black market. It further ruled that medi- 4 medicine, which is tested for mould and other harm- cal users are entitled to reasonable access. In response, the ful products. High-potency cannabis is supposed to government didn’t change its regulations, but opened up its contain 15% THC (main active ingredient).1 According own growth operation in Manitoba to Health Canada’s website, their product currently averages 12.5% THC. But an independent study in 2008: The Federal Court of Appeal upheld a decision by a 2004 found an average 5% THC level, when Health Federal Court judge in BC, who ruled that the regulation that Canada was claiming 10.2%.8 said a designated medical marijuana producer could only grow for one approved user was unconstitutional because BCCCS: more than a dispensary it created a barrier to access. Health Canada was given According to Leung, the BC Compassion Club also has one year to fix the regulation.5 In April 2009, the Supreme “a lot more resources on hand for people to access— Court of Canada refused to hear an appeal that loosening just in knowledge and expertise.” The people who dis- federal restrictions would promote deregulation.6 In May pense the cannabis are able to assist clients in picking 2009, Health Canada introduced a new regulation: produc- a strain that will best help their symptoms. Members ers could grow for two users. Medical marijuana advocates browse the dispensary “menu” while they sit in the called the new legislation “a slap in the face” and said it ran plant-filled waiting room, before being called upon to contrary to the court ruling.7 receive their medicine. Cannabis is dispensed and paid for in privacy, behind a curtain or bamboo divider. Medicinal cannabis from the BCCCS is typically $8 dropped or sprayed orally) and a variety of baked to $9 per gram; however, the society offers cannabis goods. And the dispensary sells items such as the va- at $3/gram up to two days a week. Also, any donated porizers, forest-friendly rolling papers, glass pipes and cannabis is passed along to BCCCS members free of more, which help members consume cannabis safely charge.1 Health Canada cannabis, comparatively, is and effectively. $5/gram, plus GST and PST where applicable.7 Health Additionally, BCCCS runs a Wellness Centre in Van- Canada also charges interest on amounts unpaid for couver that is supported by produce sales. The Wellness more than 30 days9—and, as has been said, the quality Centre offers services by licensed/certified alternative is considered to be inferior. medical practitioners such as herbalists, nutritionists, The compassion club offers more options than counsellors, traditional Chinese medicine doctors and the traditional cannabis ‘cigarette.’ “Most of the harm acupuncturists. Most of these services aren’t covered associated with cannabis is actually due to the act of by the health care system, but are available on a sliding footnotes price scale between $5 and $30 a visit.1 combusting,” notes Leung. He adds that BCCCS has visit heretohelp.bc.ca/ vaporizers for their clients to use, which produce the “[The wellness centre] is just as important as the publications/visions for same effects as smoking without the health risks. The dispensary, but much less well known,” said Leung. It’s the article’s complete club also provides non-smoking options such as can- part of a holistic approach to health care. footnotes or contact us nabis-infused oils and butter, tinctures (cannabinoids by phone, fax or e-mail are extracted into an alcohol or glycerine base, then (see page 3)

Visions Journal | Vol. 5 No. 4 | 2009 31 Have you stopped feeling like yourself lately?

guilt and shame sleep problems .heretohelp.bc.ca October 8, 2009 * www loss of enjoyment in life feel worthless • free, anonymous, confidential, drop-in can’t seem to concentrate • learn about why you or someone trouble functioning you care about may be feeling turning to alcohol something beyond the blues and that there is help and hope appetite changes • at most sites, fill out a short self- thoughts of suicide test and meet with a clinician to

restless discuss the results and worried • get information about and local support options for mood and anxiety disorders, plus risky drinking • telephone screening also available

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Should We Have Been More Aware? Epilogue—mom’s view Gina • Cannabis: A read more mental challenge Mark Ware visions only on the web Free, but only at www.heretohelp.bc.ca/publications/visions

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