Cannabis, a Partner in Health Care Planning

Written on 01 March 2023.

Currently, Canada is in a Health Care Crisis. Regardless of our political propensities, all news media is cycling through stories on how our health system is under pressure. Very few, if any, discuss how cannabis can assist. Cannabis has been proven to be a useful analgesic. It lowers our pharmaceutical costs. It will decrease the workload of health care providers and save those dying on the streets. When used as medicine, it can assist with our approach to population health management. If our leaders truly want to maintain the universality of our health system, they must change their thinking about cannabis and the time it takes to create a healthy community.

By digging into available evidence, we know human beings have a deep connection with cannabis. Health systems have associated cannabis with healers from the early Chinese to ancient Egyptians, and even the Imperial Roman Empire, suggesting our civilization has used cannabis as medicine for ages. We have been cultivating and therefore studying different uses for cannabis for as long as we have been building communities around farms. A shaman’s tomb from 750 BC was found to contain 800 grams of cannabis, leading us to believe ancient peoples used cannabis for building material, clothing, food, and of course, medicine. We can associate the voyage of cannabis across the world by tracing human migratory paths from Central Asia through to Europe, into Africa and across to the Americas. Cannabis has been a safe therapeutic for, basically forever. With a little critical thinking, leaders within health systems across Canada will recognize how something old is simply something new again.

Although we had federal regulations for medical cannabis in 2001, the provincial health systems did not really start paying attention to cannabis until 2018. This was when the federal Cannabis Act created the recreational system of consuming cannabis. The problem with the Cannabis Act is how it presents the product as a misused substance, something we must protect our children from consuming. There is very little therapeutic acknowledgement found within this piece of legislation and provincial health systems started preparing for the negative effects of cannabis rather than recognizing how it can be a partner within therapeutic care planning. We need to change this mindset by facing some facts and challenging health systems to get educated on the science and research available on cannabis.

Ultimately, government controls the health care we receive, so it is best to start this discussion by questioning government motivations when creating regulations. I believe it is a government responsibility to create laws and regulations to keep us safe, but I am skeptical, because as a health professional, I understand how creating healthier communities requires us to think in generations. This is not possible with the politically fueled, three-year funding cycle we are trapped in. It is not my goal to get into the weeds of the Canadian political system, except to say economic decisions and regulations created to protect economic interests, when growing or processing our food, does not always benefit the health of individuals. As this is an editorial of cannabis advocacy, I want to compare the importance government places on protecting our children from accessing cannabis with the unhealthy foods found in our supermarkets.

Applying my understanding of population health, which is a way of measuring trends in health outcomes within groups, I know keeping children safe from all misused substances is important. In my clinical practice I have associated the consumption of convenient foods and sugar-laden, caffeine enriched soda drinks to preschool obesity. Although I am cannabis savvy, I have less experience with cannabis induced adolescent psychosis and hyperemesis, the two most talked about harms done by cannabis, than I do treating and educating parents on diabetes attributed to obesity. I believe most, if not all practitioners share this clinical experience, especially when new data suggests one in 10 Canadian children are considered obese. I would like to challenge the government to apply some of the verbiage found in the Cannabis Act to restricting access to those foods known to harm us over long-term consumption. If government was motivated from a viewpoint of population health, some of these misused substances would be removed from the corner stores; often found across the street from schools. Also, the Cannabis Act pretty much ignores all those children who benefit from medical cannabis. Cannabis has risks, most certainly, but I believe government motivation is not totally focused on protecting children when a bag of chips and soda drink is available for daily consumption to any child who has $3 in their pocket.

All health providers, including those elected officials, who continue to besmirch cannabis without providing an educated opinion, are doing us a disservice. These health professionals and politicians are too focused on the Cannabis Act and not the therapeutic benefits offered by cannabis. Saying there is not enough research on cannabis demonstrates plain laziness, especially when many misused pharmaceuticals are prescribed off label. To use a medication off-label means people receive medication without the proper research to justify its use for the ailment it is being prescribed. For example, there is more independent inquiry on cannabis as an analgesic than there is for Gabapentin. We cannot possibly continue to ignore the damage done by misused pharmaceuticals, such as Gabapentin, considering cannabis has the lowest possible LD50 toxicity rating available. Medications are graded using a scale called a “Lethal Dose 50%”, a calculation of an ingested dose at which a substance kills half the members of a tested population, given a specified amount of time. Cannabis has an LD50 rating of zero. This fact alone begs the question. Why are people still receiving Gabapentin, off label for pain, when Pfizer admits to fraudulently marketing and promoting it as a painkiller, not just misrepresenting the medication but also understated its risks, while cannabis is still not considered a first line analgesic when independent quantitative research confirms its benefits?

Another fascinating point about cannabis is how it benefits the population health of our elderly. New research suggests cannabis, when used for associated behaviours caused by dementia, decreases polypharmacy. Polypharmacy is defined as taking five or more classes of medications a day. Those who work in Long Term Care facilities understand the problems that can occur when different drugs interact with each other; manifested by age, polypharmacy severely hampers the care of our elderly. Within these difficult environments, many powerful medications are being used, often off label, never designed for the chronic application of controlling behaviours attributed to dementia. Just take a moment to imagine the positive influence of decreasing the number of medications within individuals’ prescription bubble packs. Remember, with an LD50 rating of zero there is very little risk to the person. So, when adding cannabis to decrease polypharmacy, we lower the potential for metabolic disturbance, which in turn decreases visits to the emergency room, which in turn decreases the number of admissions into acute care beds. With fewer medications to dispense, imagine how care givers would have more time focusing on the active daily living needs of their residents, rather than sticking to a strict schedule of doling out pharmaceuticals three times a shift. The positive changes in patient behaviours when we remove some of these powerful sedatives is reason enough to consider cannabis. The trickledown effect of adding cannabis to the care of our elderly populations is obvious to those focused on the new science available.

Current research speaks to how cannabis decreases the cost of care. If we use cannabis as a partner in health, health systems will spend less money. By decreasing prescription medications for those who suffer from chronic pain and those who have symptoms from dementia, we are slashing budgets. Provincial health departments and insurance companies have yet to figure this out. These are the same agencies ignoring how cannabis assists as an exit drug for those misusing narcotics and other deadly street drugs. There are now protocols many addiction specialists are successfully applying which will decrease the cost of helping vulnerable populations currently dying on our streets. Decreasing costs is simply the most positive trickledown effect of adding cannabis to care planning, yet it continues to be ignored.

Unfortunately, many experienced health workers, who are employed within health systems, are still not up to date with what is relatively new science. The Endocannabinoid System (ECS), by far the most intriguing neurotransmitter system in our bodies, was discovered in the 1990s. This system is known to involve our sleep, metabolism, pain receptors, memory, immune system, mood, appetite, reproductive system and how we manage stress, yet is not taught in many of our higher schools of learning. We are essentially designed for cannabis as a medicine, yet it remains an unorthodox partner in many interdisciplinary collaborative care planning, due to practitioner ignorance. Ignorance is curable. It is the professional responsibility of every health practitioner to apply essential sciences to their practice; applying knowledge of the ECS to the human condition, is important learning.

Declaring cannabis will save the health care system is not hyperbole. Health care workers and our political leaders must change their mindset and apply all the available research when improving systems. As one practitioner said, cannabis research is available, you simply need to read it. We must stop ignoring this plant. To create the change: schools must start teaching the ECS, insurance companies must start considering the money saved by decreasing polypharmacy, government must stop listening to its own propaganda, and health professionals need to get on board this not-so-crazy train of cannabis being a partner. It is not radical to encourage all health systems to apply cannabis to population health planning. It is our professional responsibility to become cannabis advocates. I am very comfortable saying, those health systems ignoring cannabis, those health professionals who are against medical cannabis, and those government leaders who ignore long-term population health planning, are failing our communities.