It was a slip that started it all.
A moment of carelessness that, had the planets been aligned differently, may have had few consequences beyond bruises and a couple days of walking around with a limp.
But it was not Wayne Lalonde’s lucky day, and when he fell down a flight of stairs while moving furniture, he fell hard.
“I impacted my spine on 14 stairs on the way down,” he says. It sounds painful, but Lalonde (not his real name) didn’t think he was badly hurt. He got up, dusted himself off and finished the move. He even went to work the next day, sore but functional. It wasn’t until the next morning he began to realize the extent of the damage one misstep had caused. Eventually he would learn he had broken a bone in his neck and suffered compression fractures to two vertebrae, a ruptured disc in his lower back as well as nerve damage to his neck and back.
“I woke up and couldn’t move,” he recalls. “I went to the doctor, went for X-rays, but they only detected the compression fractures. It took four years for them find everything that was wrong.”
It was eight years ago that he fell, and since then Lalonde has lived with pain. He hasn’t worked. In his early 40s, he can’t leave the house without a cane. Sitting down at his kitchen table to talk, he begins to fidget almost immediately, trying to get comfortable. He has varying loss of function in his legs and feet and hands. Perhaps worst of all, he gets frequent migraine headaches.
He’s seen a number of medical professionals and been through a battery of tests, and still doctors can’t figure out exactly what is wrong or why his symptoms have remained constant over all these years. He’s been through physical therapy and acupuncture and spent hours with a chiropractor. There have been more X-rays and MRIs and CT scans. Not to mention a laundry list of pain medication.
“They’ve tested me on a number of different medications,” he says. “I’ve had nerve blocks done, I’ve had botox done, they’ve had me on dilaudid, they’ve had me on amitriptyline—I can’t even remember them all. A bunch of different ones to try and see if they would relieve the headaches, more so than helping with my walking ability.”
Nothing really helped, Lalonde says—in fact, often the headaches were worse, and he would get nauseous, to boot. But now, due in part to his on-going status as a patient at the QE II Pain Management Clinic, Lalonde is one of hundreds of people across Canada involved in testing a different kind of pain management treatment.
Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS) will follow 1,400 chronic pain sufferers over the course of one year, 350 of whom will be treating their pain with government provided medical marijuana. In announcing the study, researchers made clear the point was not so much to test the effectiveness of cannabis in pain relief, but rather what side-effects may result. Although the government’s medical marijuana program—which allows patients under doctor’s recommendation and with approval of Health Canada access to prescription marijuana—has been in place since 1999, COMPASS is the first study of its kind in the country.
The QE II Pain Management Clinic is one of seven such centres across the country currently involved in the study. The local research is lead by Dr. Mary Lynch, acting director of the Pain Management Clinic.
“The criteria for inclusion is very similar to Medical Marijuana Access Regulations program,” she says, adding that the Pain Management Clinic began enrolling people after the official launch of the study in December 2004, and that the one-year trial begins at the time each patient passes the screening process and signs their consent.
“Individuals have to have ongoing chronic pain, with an appropriate work up where a diagnosis has been given and where traditional treatments have been pursued or considered, and have been either unsuccessful or deemed to be inappropriate.”
Dr. Lynch explains the QE II study will include 50 patients who will receive the medical marijuana and a 50-person control group that will not. Although some patients, such as Lalonde, come to the study already smoking marijuana on their own to deal with their pain, previous use is not a pre-requisite.
“If the patient is not already cannabis, or even tobacco, for that matter, we are not recommending that they start doing so,” she says. “But if they still want access to cannabis orally then that is also acceptable. They can bake it in something, or make a tea.”
In the beginning of the study, patients are given a one week-supply of marijuana, returning every week for the first month for an assessment. Afterwards, the dosage is given in a one-month supply. In Lalonde’s case, this means 90 grams of bud, provided by Prairie Plant Systems of Saskatoon, which holds the contract to grow the government marijuana, dispensed from the hospital pharmacy. As a security measure, the dispensing package must be returned each month for a patient to receive a new supply. Patients are also issued with a letter to be carried with them at all times while in possession of the medical marijuana, signed by researchers, indicating to whom it may concern that they are involved in the study and legally allowed to be in possession of the drug. Any restrictions—such as not operating a vehicle while under medication and transporting the marijuana only in the gold foil packaging issued by the pharmacy—are also clearly spelled out.
Dr. Lynch says that while there have been a number of studies done on the negative effects of prolonged recreational marijuana use, few studies have been undertaken to track the pros and cons of using marijuana in a prescribed program of medical treatment. She says that the six years between the start of the federal government’s medical marijuana program and the beginning of research is a bit longer than usual, but can partly be explained by the high level of protocol that must be established before any type of study is approved by the Canadian Institute of Health Researchers.
“The science on this is growing, and the animal science is compelling and robust and shows us cannabinoids do have a potential therapeutic implication in many different areas besides pain,” she says. “I think a part of why the Medical Marijuana Access Regulations and program was successful in coming forward is because the animal science has been so compelling. But at the same time, because of the connection of cannabinoids with marijuana, and the higher regulatory climate, that slows research down, more than if we were looking at a new drug for hypertension, for example. If that drug for hypertension was a highly regulated or illegal substance, then those researchers would be facing the same level of regulatory climate.”
Despite the Harper government’s recent multi-million-dollar cut to medical marijuana research, Health Canada has announced no changes to current programs, and QE II patients have been assured COMPASS will continue.
Wherever the science leads, it can’t be fast enough for those dealing with chronic pain. Terry Bremner is a member of the Canadian Pain Coalition and a patient advocate with Action Atlantic, an organization of patients and healthcare providers working to improve chronic pain care in Atlantic Canada. In addition, he works full time setting up pain management support groups across the country on behalf of the Chronic Pain Association of Canada. He also leads a Halifax monthly support group that has a contact list of 50 members (currently there are 3,500 Nova Scotians on an up to five-year waiting list to receive treatment at the QE II Pain Management Clinic) and their families. He lives with chronic pain as the result of a childhood hip problem, which was then made worse following a near-fatal car accident several years ago.
He points to an Action Atlantic study released last year that shows 460,000 Atlantic Canadians can be classified as living with chronic pain.
“Chronic pain as defined by the doctors is any pain that lasts for more than six months,” he says. “It’s a constant thing that you don’t have any control over and can effect many facets of life such as sleep, appetite, mood and fatigue. And more often than not, when you have pain for that long depression comes in. A chronic pain patient is basically handcuffed when there isn’t a solid diagnosis. Many people who are in car accidents, for example, suffer injuries that don’t show up on an X-ray or an MRI or even a CT scan, and they suffer for years. And it becomes a psychological problem, because you start to wonder: “If all these medical people can’t find the problem, what’s wrong with me?”
Although none of the organizations Bremner works with have adopted a formal position on the use of medical marijuana to manage pain, any scientific advancement to relieve the suffering of even a few patients is welcome. A few of the members of his monthly support group have joined in the COMPASS program, and his personal observation is that it has been nothing but positive.
“From what I’ve heard some people have had amazing results,” he says. “One woman came back to the group one month after getting involved in the study, and she says it has saved her life.”
He says that the role of medical marijuana for chronic pain patients and others seemed to be moving along pretty well a couple years ago, until talk of decriminalization of marijuana sidetracked the medical debate.
“All of a sudden it seemed like it became a discussion about teenagers and recreational use and the medical benefits were pushed under the rug,” he says.
Currently, 1,400 Canadians have the Health Canada approval to posses marijuana as a medicinal aid (up from 477 in 2002), and those who do typically are afflicted with a specific identifiable disease such as cancer or MS. Those with chronic pain from a vaguely diagnosed source are not eligible, and most doctors, lacking hard science, are still reluctant to even suggest marijuana as a health care alternative. Knowing that when his year in COMPASS is up he’ll be back to illegally finding his own medication, Wayne Lalonde is hoping his participation in the COMPASS research can play some small part in making medicinal marijuana available to chronic pain patients.
“Legalizing or decriminalizing marijuana is a whole separate political issue,” he says. “This is a health issue. So if I can play a part in making Canada a more knowledgeable country in regard to medicinal marijuana, and help people like me in chronic pain get legal access to a product that can help them live better, I want to do it.”