Clarke H, Fitzcharles M
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, ON, Canada.
Front Pharmacol. 2023 Apr 7;14:1153584. doi: 10.3389/fphar.2023.1153584. eCollection 2023.
Although used therapeutically for millennia, cannabis has been a prohibited substance worldwide for most of the 20th Century. With revision of prohibitive regulations in many jurisdictions during the past 2 decades, cannabis is increasingly available to patients as a potential treatment option for various symptoms. Pain relief, sleep promotion and alleviation of distress, depression and anxiety are the most common reasons for cannabis use. Canada has been at the forefront of medical cannabis (MC) legislation revisions to enable and facilitate access for therapeutic use. Although initially viewed with caution and stigma, attitudes to cannabis in general have changed. Medical cannabis is identified as the herbal plant product sourced from a grower/producer and is not at present a regulated pharmaceutical product. Medical cannabis use is currently prevalent in Canada but has bypassed the rigorous study required for usual drug approval. Although uptake has been enthusiastic by patients, the medical community has voiced cautions and concerns. Access to medical cannabis is fairly easy once an approval document is obtained from a healthcare professional, but without obligation for medical or pharmacy oversight. The greatest concern is a dearth of sound clinical evidence for effects and harms. Emerging concerns include prevalent patient self-management with information based on personal research, an abundance of on-line information which may not always be accurate, the emergence of designated "cannabis clinics," potential risks to society due to accidents, and high cost of the legal medical product leading to access the recreational market. With cannabis now entrenched in Canadian healthcare, physicians must be sufficiently knowledgeable to provide guidance that is evidence-based and will ensure personal and societal harm reduction. Examination of the changing culture of medical cannabis in Canada will provide insight for countries that may be anticipating similar revisions of cannabis regulations to allow cannabis access for their patient population and learn from the issues created by recreational legalization.
尽管大麻已被用于治疗目的达数千年之久，但在20世纪的大部分时间里，它在全球范围内都是被禁止的物质。在过去20年里，随着许多司法管辖区对禁令的修订，大麻越来越多地被患者用作治疗各种症状的潜在选择。缓解疼痛、促进睡眠以及减轻痛苦、抑郁和焦虑是使用大麻最常见的原因。加拿大在医用大麻（MC）立法修订方面走在前列，以促进和便利其用于治疗。尽管最初人们对大麻持谨慎和歧视态度，但总体上对大麻的态度已经改变。医用大麻被认定为源自种植者/生产者的草药产品，目前并非受监管的药品。目前，医用大麻在加拿大很普遍，但尚未经过常规药物批准所需的严格研究。尽管患者对此热情高涨，但医学界已表达了谨慎和担忧。一旦从医疗保健专业人员那里获得批准文件，获取医用大麻相当容易，而且无需接受医疗或药房监督。最令人担忧的是缺乏关于其效果和危害的可靠临床证据。新出现的担忧包括患者普遍基于个人研究的信息进行自我管理、大量可能并不总是准确的在线信息、指定“大麻诊所”的出现、事故对社会造成的潜在风险，以及合法医用产品成本高昂导致转向娱乐市场。鉴于大麻现已在加拿大医疗保健领域确立了地位，医生必须具备足够的知识，以提供基于证据的指导，并确保减少对个人和社会的危害。审视加拿大医用大麻文化的变化，将为那些可能预期对大麻法规进行类似修订以允许患者使用大麻的国家提供见解，并让它们从娱乐合法化引发的问题中吸取教训。
