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How science is learning from patients about cannabis

How science is learning from patients about cannabis

Patients have been using cannabis for much longer than scientists have been seriously studying its medical value and applications. Of course there’s no substitute for clinical trials, but that doesn’t mean we should dismiss patient experience as merely anecdotal, Tilray’s VP of patient research, Philippe Lucas, says.

“We have 10 clinical studies either completed or underway, but we’re also equally committed to gathering real world evidence,” Lucas explains of his company’s dual approach to researching medical cannabis. “Ultimately patients can tell us a lot about what works best for specific conditions or what dosages are most effective.”

What does successful cannabis legalization look like? Medical cannabis has been legal in Canada for nearly 20 years and recreational for over a year, and that experience can be of immense value.

“I don’t want [the rest of the world] to just learn from our successes, they have a lot to learn from our failures,” Lucas says of the lessons Canada’s legalization holds for other countries considering a similar path.

Make sure to stick around until the end of the episode [33:50], where we sit down with Dr. Roni Sharon to get a physician’s perspective on the vaping crisis that has killed at least 47 people. Listen to hear how that has changed some doctors’ approach to prescribing cannabis.

“It’s a big dilemma for us prescribers because it’s actually one of the best ways of prescribing cannabis for patients,” Dr. Sharon says.

This episode was produced by Elana Goldberg and Matan Weil, edited by Michael Schaeffer Omer-Man, and Yoav Morder was the sound engineer. Music by Desca.

Part 1: Philippe Lucas, VP of Tilray

Elana Goldberg: Philippe, thanks so much for joining us here today.

Philippe Lucas: It’s an absolutely a pleasure to be here. Thanks for the interest in our work.

Elana: Yeah, definitely. So the last time we saw each other, I was in Tel Aviv and I saw some numbers you presented there and I was particularly interested in some of the numbers you showed about the different consumption methods that you’re seeing. Um, can you tell us a bit more about that? Uh, breakdown the numbers and, and what we’re starting to understand specifically from Canada, but I guess from a global perspective as well.

Philippe: Sure. I’ve been a cannabis researcher for about 15 years and really my… the focus of my research looks at patient patterns of use and the impact of that use on the use of prescription drugs, alcohol, tobacco and illicit substances. And in recent longitudinal studies we’ve been doing as well as some cross sectional studies, what we’re really seeing is a shift away from the inhalation of high THC products towards the oral ingestion of high CBD products. 

I think we all know that, you know, CBD is a growing kind of a craze. There’s a lot of interest in CBD right now, but what we did is we stratified from um, a study called the Tilray observational patient study, which is the largest national longitudinal study of Canadian patients today. We stratified the patterns of use based on age and what we see is that this emergence of oral ingestion of CBD is v- very much age mediated. We see that patients under 25 are far more likely to inhale THC products as a preferred method of use whereas patients over 55, almost overwhelmingly to the rate of 75 or 80% use oral ingested of CBD. And because that older patient group is one of the fastest rising groups of patients not just in Canada but around the world right now — it’s swaying and skewing the data over to the oral ingestion of CBD. So it’s, it’s really caused a big change because if we were doing this interview five years ago and talking about medical cannabis, we’d really be talking about inhaled THC, but more and more as we’re talking about can, medical cannabis, now we’re talking about orally ingested CBD.

Elana:  It’s really interesting also, I think it, it makes me think about the stigma of what people have in their minds when they’re thinking about cannabis and it, and it clashes with that.

Philippe:  Yeah, I agree. And I think, uh… you know, I’ve been an advocate over the last 10 or 15 years to no longer say that cannabis does this or cannabis doesn’t do that because it really clouds the message. Um, w- we really need to start classifying what kind of cannabis or cannabis products we’re talking about when it comes to both positive and negative effects. And a great example of that is when people say, “Well, cannabis is associated with psychosis,” um, that’s not actually true.

THC is associated with psychosis. When I say associated, it’s not causal, but if you have a predisposition because of familiar or genetic traits associated with psychosis or schizophrenia, THC can cause an earlier expression of that psychosis. It’s not causal, but certainly it would be what we would call a vulnerable population in using THC products. CBD on the other hand is being studied right now for the treatment of anxiety and even more serious mental health conditions and is not associated with psychosis. So instead of saying, “Cannabis is associated with psychosis,” we have to be much more specific and start saying that, “THC is, you know, either …  you can benefit from the use of the substance or you need to be wary of the use of the substance, but we need to be clear about the between THC and CBD and ultimately all the other cannabinoids that we’re going to start studying and seeing the medicines as well.

Elana:  Sounds like this is, you know, where education comes in both in terms of the public and well, I suppose like patients and lay people and also within the medical community.

Philippe:  It’s funny because I think that patients are still ahead of the game on this you know? I mean, we all know, I’ve, I work with doctors all the time, you know, you don’t want to trust Dr. Google too much when you’re trying to do self-diagnosis. But when it comes to information on cannabis and cannabis products, patients do a lot of research before they ingest anything. A lot of these patients who are early adopters of cannabis medicines are very concerned about the health impacts. There are more likely to believe in naturopathic medications or natural medicines.

And a lot of the time they’ve had treatment failures using traditional pharmaceuticals, so they may be looking for simple alternatives to that. So I do think that the patient population obviously can benefit from education, but I sometimes, you know, I’m led to believe that they’re ahead of their understanding. I certainly on things like the difference between THC and CBD or oral ingestion and inhalation, then physicians in new jurisdictions. 

So if a place like Portugal where there hasn’t been a lot of exposure to medical cannabis, it took years for the medical community in Canada to start to understand medical cannabis. And even at this point the overwhelming majority of medical schools in Canada will not talk about the endocannabinoid system. They will not… the only time that they’ll study cannabis as a sort of drug of abuse even in Canada with a, a 15, 20 year old medical cannabis program right now. So yeah, that education really has to increase, but I think that we also need to make sure that we’re listening to patients and their experiences ’cause they may be ahead of the game on this.

Elana:  Interesting. So, so when the physicians learn about the endocannabinoid ’cause I like to think that a physician who’s recommending or prescribing medical cannabis does have an understanding of the mechanisms. When does that kind of come into their knowledge?

Philippe:  Well, unfortunately right now physicians are left to their own largely to learn about these things. So there are a lot of companies, both licensed producers like Tilray but also education, medical education companies who have developed curricula around medical cannabis, the endocannabinoid system. Um, and physicians are s, and also there’s been a significant growth in publications looking at therapeutic applications for cannabinoids over the last 10 years. We’re really seeing a Renaissance-

Elana:  Yeah.

Philippe:  … of medical cannabis research these days looking at both harms and benefits rather than just harms, which we studied for, for, you know, 60 years [laughs] without studying potential benefits. So there is information out there, but we have to understand physicians are busy people, they get inundated by new drug development and having to learn about new drugs and new treatments as it goes along. And cannabis in many ways is just one other new drug that they’ve got to learn about.

At Tilray, we use pharmaceutical reps that kind of strategy to, to educate physicians. We’ve developed curriculum that that physicians, pharmacists can learn from online as  well. Um, and of course, you know, conferences like this really help a lot when they focus on physician education and, and downstairs, you know, few floors beneath me right now there’s, there’s 40 or so physicians that are here all day to learn about the therapeutic applications of cannabis. It’s growing, but it takes some effort right now from the medical community, it’s not something that they’re going to learn in medical school at this point.

Elana:  Right. Well, it’s good that it’s happening [laughs].

Philippe:  Yeah, it is, it is. And I find… you know, I’ve worked in a lot of different jurisdictions on medical cannabis and I feel very privileged to have been invited to share my research with the governments of Uruguay, and I’ve been invited by the Mayor of Bogota and, and uh, worked in in a number of dif, different jurisdictions to try and help them better understand medical cannabis as they developed these regulations.

Um, and, and so there is an openness and a desire to learn right now. But what I’ve learned is that different cultures and societies, and this isn’t just unique to cannabis, they adopt knowledge in different ways and at their own pace and we have to be patient with a society that’s now being introduced to medical cannabis and how quickly that adoption is going to be. And typically what… the way that it starts is you have a few physicians who start using medical cannabis when it’s legal, they get good patient reports and they become the knowledge bearers and they’re the key opinion leaders, and they can bring other physicians along because doctors love to learn from doctors and they, they’re, they’re more resistant to learning from people who are not MDs.

But once they hear about positive experience from other physicians, they’re more open to these treatment modalities. And and then there’s a slow growth that happens, but it can take years for for medical cannabis to, you know, become a common treatment in a, in a society in Canada. We’ve had a medical cannabis program since 2001 and right now that 18,000 physicians have prescribed cannabis in at least one occasion, that’s about 20%. So by that definition, I think we can look at it as a br, you know, a really successful new drug. But that also means that there’s 80% of physicians out there despite 20 years of experience who have not prescribed medical cannabis in Canada. So it’s, it’s, it shows the growth that’s still needed if we’re going to consider this a traditional or common part of the pharmacopeia.

Elana:  Yeah, definitely. Well you mentioned before about patient’s being better educated sometimes than physicians and then also what were talking about with doctors preferring to, to learn from each other. It makes me kind of think about the role of anecdotal evidence in this story here. What do you think is the role of anecdotal evidence, together with preclinical and clinical research?

Philippe:  I think that’s a really good question because I often talk about… well, almost everything that we know about medical cannabis we’ve learned because patients have shared their experience, so at Tilray, we’ve done a, a, a clinical study on medical cannabis for pediatric epilepsy a medical cannabis preparation in oil that we did on pediatric epilepsy. We didn’t do that study because we heard there was a mice model that suggested it might be helpful in pediatric epilepsy. We did that study because families had been sharing their experiences in treating seizure disorder with CBD and seem to be having some success.

And in fact, it was family sharing the fact that they found a little bit of THC to be helpful that helped us develop a formulation as well, that contain a little bit of THC. So I think that science in many ways is trying to catch up to what patients have been telling us for so long and I’m a social researcher and I like to really differentiate between an anecdote, which is basically if you told me that your mother’s, that her sister’s daughter cured her cancer smoking a joint.

To me that’s an anecdote, but when you hear a thousand or 10,000 patients say that it’s useful in the treatment of arthritis, I think that raises above the level of evidence of anecdote and there we’re talking about what social research sometimes defined as community defined evidence or what’s now being known as real world evidence and Tilray is committed to clinical research. 

We have 10 clinical studies either completed or underway, but we’re also equally committed to gathering real world evidence and that’s where these observational studies that we have going on right now which are large scale tracking patients over you know, prospectively or in some cases doing large scale cross-sectional surveys can really give us some useful information very quickly. That can then inform clinical trial development as well. And the data that I’m sharing here and that I shared in Israel is from um, this, this Tilray observational patient study-

Elana:  Yeah.

Philippe:  … which is a super large scale real world evidence study but it gives us very clear indications about how patients are using medical cannabis in a naturalistic setting. And ultimately patients can tell us a lot about what works best for specific conditions or what dosages are most effective by… when you’ve got this large plurality patients, and can look at data over time because patients will obviously not use something over an extended period of time that’s not effective or that’s causing uh, a large series of adverse events. So looking at patient use data and in kind of an open label fashion like that can really provide useful evidence.

Elana:  One of the things I find really interesting about kind of drawing this line between the recreational market and the medical market is that so much of medical use of cannabis verges on recreational and definitely the opposite. So much recreational use is often therapeutic, even if it’s not, you know, initiated for that reason. When you do these observational studies, do you look at recreational use in Canada as well, or only patients that have been prescribed medical cannabis?

Philippe:  My focus really, uh… the focus of my research focuses on medical use, but I do ask a few things that I think are kind of fascinating.

 I ask about in a cross sectional studies that we’ve done and we just did the largest cross sectional survey of Canadian patients to date in January of 2019. I’m writing up a few papers for publication right now. We asked about substitution, not just for prescription drugs, which you might expect in a medical community but also substitution for alcohol, tobacco, and illicit drugs.

Now, there’s no one who starts using medical cannabis that says, “I’m going to start using medical cannabis to deal with, you know, to try and quit smoking tobacco.” That’s typically, that the only in rare occasions would you see a prescription associated with tobacco dependence. But what we do see is that those weren’t using tobacco when they start using medical cannabis, report a significant reduction, and oftentimes report quitting tobacco completely, and we see the exact same thing with alcohol and in a lot of cases with other illicit substances, whether it be elicit opioids, psychedelics or stimulants. 

So to me, that shows that within a medical cannabis community, if we’re seeing the substitution along with uh, you know epidemiological data in the U.S. in, in jurisdictions that have legalized cannabis, were seeing a reduction in these potentially more dangerous drugs associated with… and, and a clear association with the, you know, the legalization of medical or recreational cannabis.So I find it interesting that… and I suggest that we can look at the potential harms or benefits of cannabis in society in isolation.

Elana:  Yeah.

Philippe:  We really have to look at the way that cannabis use and cannabis regulations impact the use of alcohol, tobacco, opioids illicit drugs, because what we may see as you legalize cannabis, a small increase in the amount or use of cannabis, if you see a subsequent decrease in tobacco use or alcohol use and illicit drug use and, and, and related problems, you actually get a net public health benefit and I find that, you know, really important for us to look at in conjunction from a [inaudible] production perspective. If you shift someone from using opioids, a very harmful, addictive, potentially harmful addictive drug to cannabis, then you’ve got a net public health benefit out of it. 

The other thing I wanted to mention in light of what you, you suggested earlier, in this cross-sectional survey, I actually ask patients just the patient population, “How much of your cannabis use is recreational and how much of that is medical?” And they cited that the, the mean, or the average that we saw is about 75% of the you know, overall then of a scale of one to hundred, the patient’s suggested on average about 75% of their use is medical and 25% is recreational. 

So there seems… there’s always been in the studies that I’ve done a clear distinction in those patient populations between what they consider their therapeutic use of cannabis and their medical use. And you’ll see that also when you ask them, “When did you first start using cannabis recreationally?” Which on average is about 16, 18 years old in Canada “And when did you start using cannabis medically?” Which is a much older age, and so patients, if not society clearly distinguish between their, their past recreational use and maybe their current medical use as well. 

Elana: Right, makes sense. This is really fascinating to me what you’re saying about the the kind of overall health benefit we can start to understand, a year out after legalization, right, in Canada. Do we have any or do you have any understanding of, of the overall benefit on Canadian society?

Philippe:  Well, it’s interesting because right now we’re really geared towards looking for and expecting harms associated with legalization. And it’s very important that we track… and Canada… you know, when we looked at, at when… before legalization came into place, we talked to other jurisdictions including U.S. States and they said the one thing they wished they’d done is gather more and better baseline data prior to legalization so that they can look at the impacts of legalization on public health overall. 

So in Canada we did a bit of a better job of it, and what we’ve seen so far is encouraging. And the first thing that we’ve seen that I think is particularly is encouraging, is the early data on charges associated with impairment and impaired driving with cannabis have not gone up, and I think that’s incredibly encouraging. And I’ll tell you why it’s particularly encouraging. 

Charges associated with impairment are different than mortality rates associated with accident rates. Mortality rates will not shift they will shift according to policy, but they won’t shift according to uh, enforcement priorities. Impairment is typically associated with enforcement priorities. So if we look and have more police officers looking for people who are impaired of cannabis or alcohol on our streets, we’d find more people.

In this case, we clearly had the police now looking more actively for people who might be impaired associated with cannabis. So the fact that we didn’t see a rise in impairment, is really encouraging from my point of view.

I think it means that our public education messaging that we’re doing about not driving stoned is likely having some positive impact, because we know that police forces out there are definitely looking for it more than they did prior to legalization.

So it’s very encouraging not to see that. The other statistics that I think are really interesting that I’m looking forward to seeing in the next year are a bit of a road shark test for whether cannabis legalization has been positive or negative. The two things that I want to see that I think are positive indicators of the benefits of legalization, would be increased ER visit and increases in people looking for treatment for cannabis. 

Now, if you’re against legalization, you might look at that you know, listen to what I just said and say, “Well that’s a sign of things getting worse. More people showing up at the ER and more people showing up to try and get treatment for cannabis use.” But prior to legalization, if you showed up in the ER and said, “I’m too stoned, I think I’m gonna die to cannabis brownie,” it could lead to criminal charges, it could lead to a loss of employment. Uh, and then same thing with showing up, you know what, and senior doctors saying, “I think I’m dependent on cannabis.” That could have repercussions on your ability to travel, your work, et cetera.

I’m hopeful that under legalization, that more people will feel comfortable going to the ER if they’re having an unpleasant cannabis experience and that more people who might be having dependence issues with cannabis, were going to seek help and treatment. So I’m interested in seeing over the next year, if those metrics have shifted at all ’cause we haven’t seen any reports yet associated with, you know, now as being over a year into into the legalization experiment.

The data that we have seen is interesting. What we’re seeing is more and more older people are using cannabis right now [laughs], [crosstalk 00:19:27]. And that’s the biggest news that have the latest stats Canada report is that older users are the fastest growing demographic right now in terms of cannabis use. So, that’s interesting in and of itself. And what we haven’t seen are increases in youth use of cannabis, and that of course is encouraging, and one of the reasons to legalize and take control out of the black of… cannabis out of the black market is to reduce the use by youth.

Elana:  Oh, it sounds really positive.

Philippe:  Yeah, for now. We’ll see how it goes.

Elana:  So we’re here in Portugal, at the Portugal medical conference and Tilray has a, a large growing facility a couple of hours away from where we are now. Uh, tell us about why Portugal?

Philippe:  Well, I think we looked around at a lot of different jurisdictions initially to see where in the EU would be, you know, would be kind of a welcoming jurisdictions and a good place to, to grow cannabis in terms of physical space.

 And Portugal had so much to offer in that area. We’ve got a highly educated workforce, we’ve got a very supportive government, we’ve got, you know, a country that’s been a leader in drug policy by decriminalizing the personal use of all drugs about 20 years ago  and seeing that radically positive impact that’s had on the rates of HIV AIDS and Hep C transmission increases in the folks who are willing to seek treatment-

Elana:  Yeah.

Philippe:  … uh, for illicit drug use uh, dependence. So it was a welcoming political up uh, climate where we’ve been located in Kenton Yard in a tech park called Bio Kent, it’s a phenomenal, phenomenal facility. And uh we’ve got this great workforce of highly educated folks who are happy to have full time work in this industry. We have now over 200 full time staff, and I understand we’ve got another hundred folks on side working everyday, so there’s about 300 folks working up there on any given day, which is quite remarkable.

And of course, you know, just like in Canada, small, medium size communities where these large scale production facilities get established end up reaping a lot of benefits in, in, in IMO or our primary facility, GMP facility in Canada. We’ve actually won the chamber of commerce best uh, best employer award on a number of occasions because we bring these high paying, you know uh, very technical jobs and employment as well as entry level jobs to a community that that can really benefit from it and we’re seeing that in Kenton yard right now where we’re one of the primary private employers right now as well.

Elana:  And, and the plants that are growing here, that becomes the products that are circulated around Europe or, or also back to Canada.

Philippe:  That’s right. Right now, our facility is at at GMP 2, we expect to have GMP 1 before the end of the year and we’ve successfully done an export of flower products already to Germany. Um, right now most of our EU exports are still coming from Canada, but at this time next year, the whole goal is that the EU and frankly s, you know, a lot of our other international jurisdictions are serviced out of Portugal, which is a huge facility with indoor outdoor cultivation in order to redirect the energies of our Canadian production facilities to North America, Canada and the, the U.S. ultimately.

Elana:  Ikay. I want to jump topics. Um, how did you get into the industry? Why cannabis?

Philippe:  You know, for me it started with a, a very personal experience in 1995 when I was 25 years old, I was studying to be a, a high school teacher and I was working with kids and went in for just um a standard blood test just to see how my health was and do a health check and my liver functions came back high and it ultimately got diagnosed that what at the time was called non HEP-A and non Hep-B hepatitis which we now know as hepatitis C.

And at the time I said to the university, you know, clinic doctor, I said, “Am I dying?” And he said, “I, I don’t know.” And I said [laughs]… he said, “There’s no cure.” He said, “You’ve got to give up alcohol and tobacco,” and I’m French Canadian, and those were definitely my drugs of choice at the time. But I made a conscious decision on that day to, to give up alcohol and tobacco, and I’d been an occasional cannabis user at the time. And I, I started using it initially to help me deal with cravings of alcohol and tobacco and ultimately that led to to my finding that it was helpful with the symptoms of my hepatitis C, but I had a lot of difficulty finding a safe, consistent supply. 

So in 1999, after studying some models in California for compassionate access to cannabis and also spending some time at Canada’s first medical cannabis dispensary, the British Columbia Compassion Club Society in Vancouver, I opened up what’s, what’s what’s called the Vancouver Island Compassion Society, a nonprofit medical cannabis dispensary to provide medical cannabis to patients in need. So I ran that organization as a nonprofit for 10 years from 2009 to 2000… uh, from 1999 to 2009. I took a brief segue, I was elected to Victoria city council.

I was a municipal counselor working on pros, progressive social justice issues, homelessness, harm reduction and food security. Um, and then the Canadian government started changing the medical cannabis program. So in 2014, I was hired at Tilray, I was the second employee hired at Tilray. And February 2014 and then we now have, I think, over 1400 employees around the world. But it was during my time at the Vancouver Island Compassion Society where I had so many patients every day sharing their personal experiences on cannabis. And yet when I was talking to doctors or policy makers, they would always say, you know, “We don’t know enough about medical cannabis. We need more research,” but no one was doing the research.

And so I went back to school and got a masters and I’m now finishing up a, a PhD to continue my work and research on medical cannabis to try and capture that patient experience and share it with the world who, who kept saying, you know, “We need more data, we need more we need more research.” So I was happy to be able to pursue that and happy to say that right now there’s a lot of opportunities for young academics in this field of studying, you know, therapeutic harms and benefits of cannabis or even looking at cannabis regulation and how it’s impacting public health impact, so I encourage anyone else listening right now that’s interested in this field to consider it as a professional career.

Elana:  Wow! That’s pretty fascinating how you’re-

Philippe:  It’s never dull, it’s never dull in the cannabis industry. I have a low tolerance for boredom. If you’re [laughs]…

Elana:  [Laughs].

Philippe:  If you have a low tolerance for boredom, come and join us [laughs].

Elana: So just to finish up my last question, as we’ve been discussing, it’s been a real boom in the industry over the past few years. What do you think is next for the cannabis industry?

Philippe:  Right now we’ve got medical cannabis laws in 41 countries, but we’ve got, you know, practically 200 countries around the world. So we’re going to see this constant expansion of medical cannabis. We’ve got Tilray products are available in 13 countries on five continents right now. So we’re working hard to continue to build up the science and understanding of medical cannabis. We’ve got 10 clinical trials completed that are active right now. We’ll be announcing a number of other clinical trials in the coming months that are all… uh, as well as observational studies that hopefully will add to the overall academic understanding of cannabis as well. Different methods of ingestion are going to be really interesting as we see the professionalization that can happen under a regulated industry. So I think that, you know, and, and also right now we’re mostly talking about medical cannabis as, as THC CBD. So I think in the future we’re going to be looking at other minor cannabinoids, we’re going to be looking at slow release medications f you know, and then on the flip side, fast acting and fast evacuation medications topical patches.

We’re going to see a lot of novel development in terms of methods of use. And I also think that we’re going to see cannabis products being developed that are adjunct treatments to traditional treatments as well. And certainly some of our researchers looking at that, looking at not just THC and CBD in isolation, but as combination treatments, for example, for the treatment of nausea and vomiting associated with chemotherapy and that kind of thing.

Elana:  Wow! It’s a really exciting time to be out in the industry.

Philippe: I agree, I agree. And it’s a, it’s a real honor and privilege to be able to travel around the world, share the work and research that that we’ve been doing for so long and to help these new jurisdictions find their way around medical cannabis. You know, in, in Canada, we’ve had this for a long time, but as I like to share with other jurisdictions, we… I don’t want them to just learn from our successes, they have a lot to learn from our failures.

And in Canada for the first 10 years of our medical cannabis program, it was a real disaster. There’s a lot to learn there, and I hope that other jurisdictions, for the sake of the patients who need this most can avoid some of the mistakes that we made and benefit from some of the lessons we’ve learned.

Elana:  I said last question, but I have to ask a follow up question there [laughs].

Philippe:  [Laughs].

Elana:  What went wrong, you know, in the first 10 years?

Philippe:  Well, I think that um, there was active consultation with police and with physicians and with fire departments and with municipal councils and elected officials and public health officials and no consultation at all with patients.

So if you’re designing a program without talking to the primary recipients of the service you’re trying to to develop, it’s going to be a real challenge to get it right. And so in Canada, we had a program that launched in 2001 called the Medical Marijuana Access Regulations, but it was a total oxymoron. Those regulations were really designed to stop Canadians from having access to medical cannabis. That’s not just my opinion, that program was sued over 300 times in the first 10 years by patients. And it was found unconstitutional and thereby acting illegally on 10 different occasions for not providing safe access to medical cannabis for patients. 

And it took a long time for the government to finally decide to decentralize this program, to realize that, you know, this was… that the access to medical cannabis may cause more benefits than the supposed harms it might cause and to finally let this program flourish. Um, and certainly in the last few years in Canada, we’ve seen that as the program has grown from about 40,000 patients to over 350,000 patients right now. 

The next big step in Canada is to get that medicine in a pharmacies ’cause we still ship out directly to patients. Um, and I think once it’s in pharmacies and it feels like every other medicine in Canada I think that we can finally look back, those of us who’ve been working on this for a long time and see that we’ve had a, a good amount of success. 

Patients are allowed to grow it for themselves in Canada, they’ll be able to access it through pharmacies. Once we can take care of healthcare coverage, they don’t have to worry about costs. And that is starting to happen through the private payer system. Then and only then really I think will I, I look back and say that our has been a success.

Elana:  Wow! Really important takeaways and, and kind of what not to do is for, for countries all around the world. Philippe, I want to really thank you for your work and your contribution to the industry and also for talking with us today.

Philippe:  Well, thank you so much. I really appreciate this opportunity and uh, yeah, I’ll look forward to seeing you more around the world as we travel around and try and bring some some honest information, research and data to countries around the world that are looking to move into medical cannabis.

Elana:  Definitely. Thanks so much.

Philippe:  Thank you.

Part 2: A Doctor’s Perspective on the Vaping Crisis

Michael Omer-Man: We’re trying a new little segment on the podcast where we talk about things that are in the news or questions that people ask us or questions that keep coming up in our work. So one of the things we wanted to talk about first is the vaping crisis. As of late November 47 people had died of the mystery lung illness caused by vaping over 2000 more others had fallen ill and the authorities in the United States had yet to say definitively what’s behind it — although it’s broadly believed, including by the Centers for Disease Control, the CDC that an additive called vitamin E acetate, which is usually a food additive, is likely behind it.

So with me today is Dr. Roni Sharon, the medical director here at Cannigma, and a physician — a neurologist — who prescribes cannabis himself to patients in New York and in Israel. 

So Ronnie, what’s your take? What’s your take on the vaping crisis and what we know and what we don’t know and how people are looking at it?

Dr. Roni Sharon: Well, the vaping crisis is a big problem. It’s a big dilemma for us prescribers because it’s actually one of the best ways of prescribing cannabis for patients. It bypasses the GI tract. The absorption is quite high. It’s more affordable because the absorption is quite high. We can dose it a very specific way.

We can allow patients to really start at a very low dose and go up slowly, which is generally what we do. And now with a cloud hanging over it, it’s been a very big problem for us because I’ve recommended it hundreds of times and you know, right when the crisis started and we didn’t know what’s going on and we didn’t know if it was killing people or significantly hurting people — there was a lot of regret in the beginning that maybe I actually had hurt many patients. 

And there’s still a big cloud hanging over whether we should be prescribing it, if it’s safe enough, and even where to get more information about it. 

Michael: So it seems to be limited, at least as far as we know for now in the United States. But the United States is also a place where there’s really no consistency in regulation. How much of a role does that play in all of this?  

Dr. Sharon: Well, I think you really hit on target what the problem is. I think that once you have regulation and once you have standards that are equivalent to what we see in the pharmaceutical industry and the food industry, whether it’s inspections, those regulations and their standards of quality, we’re going to see things like this happen less and less, and we’re going to understand them quicker and better.

And that’s a big problem. You know. I hope that this is limited to a certain geographic area, even if it’s the United States and we understand what it is and then we can avoid it in the future. Until then it’s a little bit problematic. I can tell you that I’ve switched over to generally recommending more oil tincture for patients, which I think for many patients does not work as well until I have more clarity until I… 

You know, in America we say “do no harm first,” and that’s a big priority, especially in a product that’s federally illegal that we’re prescribing, even though it’s protected by states. So we really do need to organize both nationally in the USA, a better regulatory framework, but also internationally when, you know, we’re moving forward in, in really running forward with cannabis as a pharmaceutical and medical product for many patients.

Michael: And do you think the fear that a lot of patients, do you think that fear will, will, will dissipate, that it’ll get better, and considering the regulatory problems, is it inevitable that something like this happens again?

Dr. Sharon: Well, actually, I think ultimately, uh, this will lead to positive developments. I think that we’re going to learn from this. I think we’re going to understand that, uh, cannabis is here to stay as a medical product. It’s prescribed in a majority of states now, and we need to organize more and we need to have a regulatory framework where we can investigate these things and we can solve them quickly.

I have patients every single day calling me, asking me if it’s safe to vape, and I wish I had a substantial concrete response for them. Until now, I don’t yet, but I think ultimately we will find a solution to it. I think people will be vaping, and I think that the question of whether it’s safe to vape will dissipate.

Michael: Thank you, Dr Sharon. 

Dr. Sharon: Thank you.

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