An Ontario Physician's Concern about Marijuana

On January 22, 2018, Canada’s public broadcaster (the Canadian Broadcasting Corporation) on their program “The Current” with host Anna Maria Tremonti featured an interview with Dr. Brian Hart, an Ontario family physician who has significant concerns about marijuana, especially for young people under age twenty-five.

Here is the audio excerpt:

And the transcript:

AMT: You’re listening to The Current on CBC Radio One and Sirius XM. I’m Anna Maria Tremonti. Last week on The Current we looked into the coming legalization of recreational marijuana, and the concerns about its safety and contamination. Medical marijuana users have reported concerns. And I spoke with Dan Clarke who tests medical marijuana at A&L laboratories in London, Ontario.

AMT: Well the discussion generated a lot of interest from listeners, including from Dr. Brian Hart, who said contamination is not the only thing people should be concerned about. He wrote to us in part: “I am a family physician and deal with the side effects of marijuana in my practice every day. Believe me, they’re serious—but not due to pesticides—rather the drug! Marijuana is NOT benign. When an 18-year-old comes into my clinic with anxiety and a 35-pound weight loss, I put my pen down and ask how much he’s smoking. I have yet to be wrong.” Dr. Brian Hart practices in Gananoque, Ontario. That’s where we’ve reached him now. Hello.

DR. BRIAN HART: Good morning Anna Maria. Thanks for including me in the conversation.

AMT: First of all, how often do you get requests for prescriptions for medical marijuana?

DR. BRIAN HART: I would say probably, increasing frequency, but probably two to three times per week.

AMT: And what do your patients want it for?

DR. BRIAN HART: I would say there are two types of patients. A lot of patients that come in are already using it. Some of them may have cannabis use disorder. Some of them may be looking to switch from a drug that they don’t want to be on like alcohol over to marijuana. And these would be inappropriate referrals. The other type of patient are the patients that actually have really serious medical issues. Those that have essential tremor that we haven’t been able to control. People that have M.S. fatigue. People that have the indications that traditionally medical marijuana has been indicated for.

AMT: And do you not prescribe it at all then? Even in a case like that.

DR. BRIAN HART: Well it’s really difficult in that—so usually when medications come to market they come to market with a proven efficacy. There are studies that are done that show that it work. And we know that it works in a certain percentage of people. And we know what to expect in terms of short-term side effects. With medical marijuana it’s come to market and then we’re trying to find what it works for. And we really don’t have the appropriate studies to show the short and certainly not the long-term side effects. But in people that have exhausted everything else, so people that come in with severe essential tremor or with multiple sclerosis related spasms, I have no trouble referring them along to be counselled and receive medical marijuana as long as they go into it eyes open. But it is a third or fourth line intervention. It’s not a first line.

AMT: And where do you send them?

DR. BRIAN HART: Well in Kingston there’s three or four different marijuana referral centres. And I think these folks have doctors and they do interviews and then they’ll prescribe it. So when you say I don’t prescribe it, so my brother is a lawyer and he says there’s a term have done or cause to have done, and I know that if I refer them they will 100 percent of the time receive the medication and receive the drug.

AMT: And is that a problem in your mind that if they’re referred to some other clinic they’ll get it automatically or usually.

DR. BRIAN HART: Yeah, you interviewed Rosy Mondin last week and you wondered why pesticides that shouldn’t be in the marijuana were there, and she referred to it as a bit of the Wild West. And when it first started I saw everybody that went was given medical marijuana. And we do know with medical marijuana there are some absolute contraindications. For example anyone under 25 should not receive medical marijuana. Anyone with a marijuana use disorder should not be prescribed marijuana. Anybody with significant anxiety or an untreated psychiatric illness should not receive medical marijuana. And I have seen numerous cases where these people have been given the drug without much follow up or supervision.

AMT: And this goes back to your first point which is that normally if a drug comes on the market it’s been clinically tested. We know a lot more about it and we’re going by anecdotal now.

DR. BRIAN HART: Oh absolutely. And please don’t get me wrong. I go to work every day trying to help my patients. And the issue is if marijuana is proven to be a benefit I’m going to be the first one to prescribe it. And if we’ve run out of everything else and there’s a hint that it may be a benefit I will help my patients receive it. But the trouble is I do radio interviews, I guess what once every 53 years, so I Googled performance anxiety. And if you actually look at Health Canada, medical marijuana one of the indications is performance anxiety. And if you actually look at this study, 23 people were given synthetic THC before doing a simulated performance and 95 percent reported that they felt better about the performance afterwards. That’s not a study. That’s hearsay. I would argue that if I had put a little scotch in my coffee this morning I might feel a little less nervous right now.

AMT: You sound just fine Brian Hart [laughs].

DR. BRIAN HART: [Laughs].

AMT: But I want to ask you about that because you also said you wouldn’t prescribe to someone under the age of 25. Why not?

DR. BRIAN HART: I think you may have had articles on before, but the brain is under construction really until age 25 and the younger you are the more harm marijuana can do. And it can be permanent. And I see it in my clinic. My real concern is that this is an epidemic among high school students and I often see young man in particular coming in and they’re suffering from tremendous anxiety and weight loss and anorexia. And this was a bit of a learning curve for me. I mean remember back in the 80s if anyone bought marijuan, the next stop was the grocery store for Doritos. You would expect weight gain and apathy. But you’re experiencing significant anxiety and weight loss. The issue is that under 25 these folks are most susceptible to that. And there is some evidence that it can decrease long term IQ and have permanent bad effects.

AMT: You raise many questions that we in the media need to follow up on. Thank you for your letter to us and for speaking to me today.

DR. BRIAN HART: Thank you very much. It was a pleasure.

AMT: Bye bye. That is Dr. Brian Hart. He’s a family physician in Gananoque, Ontario. That’s our program for today.