Medical Marijuana: kicking opiates to the curb!

I routinely recommend medical marijuana to our patients who suffer with chronic pain. Medical marijuana is recommended by the Canadian Pain Society after a trial of other pharmaceuticals such as Gabapentin, Amitriptyline, Duloxetine, or an opioid-based drug. For many, these commonly prescribed drugs simply don’t work or have side effects that are dangerous or intolerable. Study after study show that opiates are not effective for chronic pain. The recent SPACE Randomized Clinical Trial compared immediate release opioids (e.g. morphine, oxycodone) or sustained-release opioids (e.g. Fentanyl patch) to a nonopioid (e.g. Tylenol, Ibuprofen) for chronic back pain, or hip or knee osteoarthritic pain. The study found that the opiates were no better than over-the-counter Tylenol or Ibuprofen for chronic pain.

Despite what the studies say there are millions of prescriptions written for opiates, like Tramadol, Tylenol #3, Oxycodone, and Hydromorphone every year. Interestingly, the SPACE study noted that patients receiving an opioid compared to a nonopioid had significantly less anxiety. Perhaps this is part of the reason why so many people feel that opiates improve their pain? This is not surprising as opiates mimic our natural endorphins and give us a feeling of well-being. However, they can be incredibly dangerous causing more than 12,800 deaths in Canada between, 2016 and 2019, according to the National Report: Apparent opioid-related deaths in Canada, and 4,588 deaths in 2018 alone – 1 life lost every 2 hours!

This is a staggering number and doctors are undoubtedly under pressure to not prescribe them and to get their patients off altogether. Yet, if our nonopioid drugs are not effective or cause too many unwanted side effects what are we supposed to do? This is a question asked equally by physicians and patients alike. Increasingly, cannabis is being considered as an alternative by mainstream medicine as research is exploding and we are learning the potential benefits of medical marijuana and how safe it is for patients.

What does scientific research say about medical marijuana and chronic pain?

Studies that look at medical marijuana for chronic pain are conflicting. The Lancet journal article, Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study published in 2018, found that patient pain didn’t improve with cannabis, it didn’t reduce opioid-based medications, and patients were more likely to have generalized anxiety. While a meta-analysis, also published in 2018, The Benefits and Effects of Using Marijuana as a Pain Agent to Treat Opioid Addiction describe significant reductions in opiate use, improvement in quality of life and no significant side effects even after taking cannabis for more than a year.

Why would two respected studies draw such opposite conclusions? Part of the reason might be the design of the studies. The Lancet study asked patients who were taking opiates to self-report their marijuana use and then followed them over 4 years to see how they were doing. While in the other study, patients were prescribed cannabis through their, Marijuana Care Program, suggesting that support and guidance from healthcare professionals leads to better outcomes.

Why does medical marijuana work better – isn’t it all the same stuff?

It’s hard to understand why getting medical support results in such stunning differences in health outcomes but I’ve seen this dichotomy with our patients as well. I was initially surprised when I had people who were experienced cannabis users ask for our medical advice. In these cases, our patients used recreational marijuana regularly but didn’t find that it worked for their pain. Should they be taking it differently or trying another strain, they asked? While we didn’t ask them to stop their recreational, or non-prescribed, use of marijuana we did add cannabidiol (CBD) oil and titrated up slowly adding micro doses of tetrahydrocannabinol (THC) oil if needed.

In one instance, our patient had experienced debilitating migraines several days a week for more than 10 years. None of the prescription drugs helped and she was unable to take Tylenol or Ibuprofen. She had started vaping Indica-dominant flower a few years prior in the evenings to help her sleep. Still this made no difference in the frequency or severity of her migraines. We had her start with Avidekel by MedReleaf CBD drops twice a day. After 4 weeks she had increased her dose to 0.5 mLs (containing CBD 25mg/mL and THC < 2 mg/mL) at breakfast and dinnertime. Four weeks later she’d only had one migraine in that entire time! To say that this therapy was life-changing for her is an understatement.

In another example, our patient had unrelenting pain on the right-side of her neck, shoulder, and arm due to a car accident 5 years prior. She had tried physical therapies, steroid and lidocaine injections and several pharmaceuticals, all to no avail. She was also an experienced cannabis user choosing to smoke marijuana in the evenings as a way to relax. The recreational marijuana helped her fall asleep but she still struggled, waking up at 3 or 4 AM unable to fall back to sleep. After working for a few weeks with our team she found that taking Aphria 10:13 oil (10 mg/mL THC and 12 mg/mL) 0.2 mLs sublingually twice daily and 0.4 mLs at bedtime dramatically improved her pain and sleep. If she woke up in the middle of the night she was able to fall back to sleep more easily and didn’t feel groggy in the morning. As well, her 5-year long struggle with pain disappeared. In fact, the pain was so improved that she would forget to take the medical cannabis, only to be reminded when her pain returned 3 or 4 days later.

Will medical marijuana be safe and effective for my chronic pain?

Chronic pain is a difficult-to-treat condition, over-the-counter remedies, like Tylenol or Ibuprofen, are usually not effective and can damage the liver, kidneys and stomach. Prescription drugs like Gabapentin, Amitriptyline, and Duloxetine are routinely recommended but lack convincing evidence and can cause sedation, excessive dry mouth, constipation, and weight gain. Opiates may not be appropriate for chronic pain and come with serious risks.

Marijuana contains THC, CBD, and more than 400 plant molecules that have anti-inflammatory and pain-relieving properties. There has never been a fatality due to overdose reported. Chemical addiction and symptoms of withdrawal don’t happen with marijuana like that seen in opiate-users. However, people can become dependent on marijuana – this is a psychological, not a chemical dependence.

In our practice I’ve seen people have complete resolution of their pain but this is not true for everyone. Even more interestingly, some people find that CBD works wonders while others find no benefit at all and will need to add a micro dose of THC. However, most people describe feeling generally better, with improved mood, focus, and sleep.

How do I get help to try medical marijuana for chronic pain?

Finding medical marijuana that is approved by Health Canada can be confusing and challenging. There are a number of online suppliers of cannabis that look legitimate but are not regulated, tested, or pesticide-free. If you’re unsure if you are buying from a Health Canada approved supplier of medical marijuana check out, Licensed Producers Canada to help you make a safe choice.

The Canadian Pain Society states that treatment of pain is a basic human right, but finding a doctor that has experience and is willing to prescribe can be challenging. That’s why we’re committed to working with our patients to help them get a prescription that is safe and effective for their medical condition. Contact Wellness Pharmacies to find the support and guidance you need to find out if this therapy is right for you.

Medical Marijuana in Canada: where do we go from here?

It should be no surprise that it was the people who needed medical marijuana the most that fought the hardest for it to be legalized. Famously, Terry Parker appealed to the charter rights to “life, liberty, and security” after being arrested in Ontario for possession, cultivation, and trafficking in 1996. It wasn’t his first brush with the law over marijuana possession but this time he decided to fight back and this marked our path to legalization in Canada.

Parker developed epilepsy after being hit in the head by a swing when he was 4 years old. Heavy doses of antiseizure drugs were ineffective, and radical brain surgeries (i.e. removal of his right temporal lobe) against his will when he was a teenager made his seizures worse. Thankfully, Parker was introduced to cannabis soon after and he and his doctor noticed that his seizures were drastically controlled when he smoked marijuana.

Without cannabis Parker lived with uncontrollable seizures and was hospitalized numerous times. Smoking marijuana was necessary for him to have a quality of life and likely save his life. Compassionately, the trial judge agreed that Parker’s rights had been violated and ordered the police to return the 71 plants they had seized. Four years later, 31 July 2000, the Ontario Court of Appeal made a landmark decision in Parker’s case stating that the law prohibiting marijuana possession and cultivation was unconstitutional because it did not consider people who required it out of medical necessity. If you would like to read more about Terry Parker and hear him speak about his case please check out the CBC archives at

The high courts deemed the law too broad, putting Canadians in the unfortunate situation of having to choose between their health or jail. One year later in 2001, the Medical Marijuana Access Regulations (MMAR) was created giving hundreds of patients exemptions to cultivate and possess cannabis. Under the MMAR patients were allowed to grow themselves or designate someone to grow for them. Over time growers became more organized and cannabis became more accessible for people with a reliable contact. Compassion clubs and marijuana dispensaries started to pop up in cities that were tolerant. The medical marijuana culture matured and more and more people came to rely on these growers and suppliers for their medical needs.

The government saw that they were losing control of the industry and decided in 2013 to change the MMAR to the Marijuana for Medical Purposes Regulations (MMPR) that banned growing, only allowing patients to purchase dried flower from a licensed producer. The MMPR claimed that people growing in their homes could harm those exposed to the plant, pose security and fire risks. This new law was quickly challenged in the Allerd vs Regina (BC Supreme Court) where the lawyers argued that these “potential” risks involved in growing were factually inaccurate and that forcing people to buy from a licensed producer was cost prohibitive. The courts agreed stating that the MMPR created an unreasonable barrier to access and was amended in 2016 and replaced by the Access to Cannabis for Medical Purposes Regulations (ACMPR).

Thus, medical marijuana has been available through these various legal incarnations since 2001 and nothing has really changed. Patients are required to have a doctor sign a medical document (prescription) and register them with a Health Canada approved Licensed Producer. The prescribed medical marijuana is delivered to either the physician’s office or the patient’s home. However, now that marijuana is legal many people want to try it to treat or cure their symptoms. Yet there is less advice and support than ever before as traditional marijuana dispensaries are being replaced by the recreational market.

Prior to legalization theses quasi-legal medical dispensaries would only sell to a person who presented a medical document or a prescription from a doctor. Although, it was never clear if the dispensary checked to see if it was a valid prescription – but you definitely needed it to buy anything. In a way these businesses operating in the grey-market were policing themselves in the hopes that the authorities would let them be. Many believed that this self-regulation would mean that once cannabis was legalized they would be grandfathered into the new legal framework.

However, it was never the goal of the government to create greater access for medical patients but instead to capture the recreational market and squash illegal suppliers of marijuana. Sadly for patients seeking medical cannabis there is less access than ever. Consequently, medical users will continue to get their cannabis therapies from a well-entrenched grey-market gone underground, or more correctly online, or buy from a Canada approved recreational outlet.

Legalization means that more people are interested in trying and learning about medical cannabis but its availability as a recreational product makes doctors even more nervous about recommending it to their patients. This is too bad for the many people that could benefit from getting advice and support to use cannabis in low safe doses to improve symptoms for many difficult-to-treat conditions such as insomnia, anxiety, depression, chronic pain, neurodegenerative disorders, and certain cancers.

Instead, people are going it alone. But you don’t have to. There are medical practitioners out there who are listening and want to help. Cannabis is not a one-size-fits-all therapy and each person will need an individualized protocol depending on the condition you are treating, the pharmaceutical therapies you take and the goals that you have. At the Wellness Pharmacies it is our goal to empower you with knowledge and provide guidance to find the right product, strain, and dose that works for you.

How Medical Cannabis Helps Parkinson’s Patients feel Better

Patients with Parkinson’s are fighting back with diet, exercise, mindfulness practices, nutraceuticals, and especially medical cannabis. This unforgiving disease is inadequately treated by our current medical model and imprecise pharmaceutical therapies that cause side effects as devasting as the disease itself. If you, or someone you love has been given a diagnosis of Parkinson’s there is no choice but to get educated and informed and make a detailed plan to support your nervous system, stave off the severe dyskinesias (uncontrollable movement disorders), and slow the progression of brain damage caused by Parkinson’s and the side effects of the pharmaceutical therapies routinely prescribed.

Cannabis is legal so why would someone need a prescription?

Opponents of medical cannabis will argue cannabis is legal so there is no reason for physicians to prescribe it to their patients. While there is plenty of information online about cannabis and its benefits this is not the same as having an experienced practitioner to ensure this therapy is safe depending on your specific symptoms and the pharmaceuticals you’re taking. Patients living with Parkinson’s should also have access to therapies that are affordable. In Canada, most marijuana producers (e.g. Aurora, Tilray, Spectrum Therapeutics) offer compassionate pricing based on income if the patient has a medical document from their physician.

Studies found in Neurology Reviews and Innovations in Clinical Neuroscience show that cannabis has a therapeutic role to improve symptoms and slow the progression of Parkinson’s, not to mention overwhelming anecdotal evidence that can’t be ignored by our medical community. Yet, medical cannabis is difficult to access due to lack of physician support, high costs, and social stigma which stop people from exploring this natural therapy.

Still, people are getting empowered and learning for themselves how cannabis can improve their quality of life. An inspiring story went viral worldwide when Larry, a retired police captain, tried a cannabis extract on camera as seen in the documentary, Ride with Larry. Twenty years of living with Parkinson’s and the long-term side effects of levodopa therapy, like Sinemet, caused him to have a severe movement disorder. As is commonly seen in advanced Parkinson’s Larry’s body twists and contorts, making it very difficult for him to talk or move. But within a few minutes of putting a concentrated cannabis extract under his tongue, Larry’s tremors are controlled, his speech normalized and his body finally at rest.

Why is it so hard to get medical advice to take cannabis?

While cannabis is becoming easily accessible for recreational users this doesn’t help people who need advice to determine if cannabis is safe or appropriate depending on the chronic conditions they have or the pharmaceutical therapies they’re taking.

While there is a growing number of physicians that are helping patients access cannabis in a safe and supportive way, many are not willing. This may seem unjust but there are some very valid reasons for their stance. First, it is inappropriate for a doctor to recommend a therapy they are not educated or experienced in. To understand the complex interplay that cannabis has on our body systems it requires in depth study of neurochemistry, immunology and pharmacology which many physicians with busy practices don’t have time to learn.

Also, physicians are concerned that their patients may take too much cannabis causing them to get high and be at risk for a fall or driving impaired. Correctly, the physician has legitimate concerns about their professional responsibility and liability and would rather not risk their license. However, there is no reason why your physician can’t refer you to an experienced and trusted source for medical advice.

Who should consider medical cannabis for Parkinson’s?

A diagnosis of Parkinson’s requires lifelong planning and support. While conventional pharmaceutical therapies help alleviate some symptoms they are overall grossly inadequate. Drugs like, Sinemet, containing levodopa help manage symptoms but also overshoot causing dyskinesia, or abnormal movements, of the head, limbs, eyes, and mouth making coordination and speaking difficult or impossible as the disease progresses.

Over time these pharmaceuticals become less effective forcing the patient to take more with less benefit causing more unacceptable side effects. Not everyone may see the swift results that Larry did but anyone who has Parkinson’s should be supported to try it, not just to control dyskinesia, but to slow the progression of neurodegeneration, improve mood, sleep and cognitive decline.

How do I take medical cannabis for Parkinson’s?

The strain of cannabis, dosing and how you take it will depend on your endocannabinoid system, and how much damage Parkinson’s has caused the part of your brain that produces dopamine which regulates body movement. Importantly, if you want to use cannabis for Parkinson’s, or any other serious neurodegenerative disorder, seek out compassionate advice from an experienced doctor. Practitioners should be aware of any potential drug therapy interactions and how they can be managed depending on what stage of disease you have. There is no one absolute right way to take cannabis – strain, dosing and method of ingestion, whether vaped, eaten, or sublingual, will have to be determined by experimenting with intention.

If we treat cannabis as an important part of our therapy we can learn to use it safely for life-long management of symptoms and to slow neurodegeneration caused by Parkinson’s. If this is your goal there is no room for taking cannabis recreationally. Taking marijuana from an unknown supplier means you never really know what it is that you need to feel good. Every new batch is a new experience and taking too much THC, especially as an edible, can lead to dizziness, drowsiness, or risk of a fall for persons with Parkinson’s. Equally, buying hemp oil or any other product from an unregulated supplier may have little, if any, CBD in it. Always choose a standardized, pesticide-free Health Canada regulated cannabis producer.

What else can be done to support healing and lifelong management?

Cannabis is remarkable for creating homeostasis, or balance, in the nervous system but it is only one piece of the puzzle. There are natural therapies, eating plans, specific exercise programs, and mindfulness practices that help nourish, alleviate, and protect us over time making symptoms more manageable and slowing the progression of the disease.

For example, a study, entitled, Role of diet and nutritional supplements in Parkinson’s Disease progression, suggest that certain nutrients like coenzyme Q10, melatonin, and fish oil high in docosahexaenoic acid (DHA) support the nervous system. Eating a Mediterranean diet rich in non-fried fish, olive oil, coconut oil, vegetables, fruit and nuts, while avoiding red meat and certain dairy products also appears to be beneficial.

Exercise that improves coordination and balance like cycling, running, and yoga improve outcomes, as does mindfulness practices like meditation. To learn more about this check out the Parkinson’s Foundation. It’s easy to get isolated when you live with Parkinson’s. Reach out to the online community so you know you are not alone.

Help to find the right support group can be found at Michael J. Fox’s Foundation for Parkinson’s Research.

Where do I find advice to take Medical Cannabis?

At the Wellness Pharmacies it is our goal to provide guidance and support so that our patients can be empowered to find the right strain, dose and protocol that is safe and effective for the lifelong management of Parkinson’s.

Medical Cannabis and your Local Dispensary: What’s happening in Canada?

Medical Cannabis and your Local Dispensary: What’s happening in Canada?

Medical cannabis and recreational cannabis is now legal in Canada, yet it seems it’s harder to find than ever before! More and more people are excited to try medical cannabis as research has exploded in the last few years showing its potential to help with many difficult-to-treat disorders such as anxiety, mood, insomnia, chronic pain, certain cancers and disorders of the nervous system and brain. But, it’s difficult to get advice and guidance let alone a medical document to access cannabis as medicine.

‘How were patients able to access medical cannabis prior to legalization?’

Prior to legalization of medical cannabis by the Canadian federal government you could get cannabis with a doctor’s recommendation through an online cannabis licensed producer or be licensed to grow your own or elect another person to grow for you. Over the years this evolved into a culture of medical cannabis being available through marijuana dispensaries that provided patients with access to a plethora of different products. The staff at these dispensaries had varying levels of knowledge and expertise in cannabis therapy but often didn’t have medical training so couldn’t give expert advice on drug-drug interactions or provide caution about cannabis with certain disease states. Still, patients learned through trial and error and often found the product they needed to improve or resolve their symptoms. As well, cannabis is an incredibly safe medication as there is no risk of overdose so advising on cannabis didn’t involve a great deal of risk for the patient or the dispensary. These marijuana dispensaries, operating in the so-called ‘grey-market,’ were given business licenses but not considered strictly legal from the government’s point-of-view. Still, the demand for medical cannabis and grew and evolved into a grass-root’s movement as society became more educated and laws began to soften.

‘Why are marijuana dispensaries being shut down now that cannabis is legal?’

Lack of regulation and oversight from Health Canada created some benefits and risks for the consumer. Without regulation from Health Canada products did not go through mandatory testing and the amounts of THC, CBD or other active ingredients listed in medical cannabis were at most a guess as batches changed depending on the growing season. Further, there were no standards with regards to the chemicals used for extraction and pesticide practices. This made it hard for the medical consumer who had to trust the dispensary had received honest information from their many suppliers. This may have been fine for the occasional recreational user who took marijuana on a Friday night like someone has a glass of wine. But for the medical cannabis patient this is unacceptable as every person needs a unique dose and combination of THC and CBD that requires experimentation. Without standardization and accurate labelling the patient was unable to ever find exactly what was right for them. Even more so for patients wanting a high CBD, low THC product who found that sometimes there was more THC than was reported in the ingredients making risk of sedation or getting high problematic.

Without standardization and testing of cannabis products it was difficult for physicians and pharmacists to recommend their patients to seek out these treatments even if they thought they would get therapeutic benefit from them. On the other hand, the lack of regulation and oversight allowed dispensaries to create a variety of ways for patients to get the therapy in a way that best suited them, whether it be a topical salve, vaginal or rectal suppository, concentrated extract or edible. This lack of choice and accessibility is justifiably upsetting to the medical cannabis patient who is watching as their dispensaries are being shut down across Canada one store at a time.

‘How should patients access medical cannabis in this evolving and rapidly growing market?’

The new system that is emerging in Canada has a clearly differentiated market for the recreational and medical cannabis consumers. The recreational market will explode across Canada in the near future as retail outlets, regulated much like beer & wine stores, will sell products but not be allowed to offer medical advice. Conversely, the medical market is not easily accessible and requires patients to get a medical document from their physician and then sign up online for their products. This lack of accessibility is unfortunate as patients who obtain a medical document and are signed up to a medical producer of cannabis (e.g. MedReleaf, Spectrum Therapeutics, Canni-Med, Tilray) have access to compassionate pricing based on income and don’t pay taxes. Unfortunately, physicians and pharmacists have been unwilling to become educated and many patients find themselves given the cold shoulder or treated like they are drug seeking when they ask for advice. Thankfully, there are medical doctors, naturopathic doctors and pharmacists that are educated and highly capable of giving advice and support about dosing, drug-drug interactions, efficacy and safety.

Every person needing or wanting to try medical cannabis should be given support and guidance to find the right product and have their medical questions answered by a compassionate practitioner. If you have been unable to get help with medical cannabis join our Wellness Family and learn about forward thinking ways to find optimal health. We can support and guide you to find the cannabis therapy protocol that is right for you, including selecting the right strain, dose, THC to CBD ratio, and terpene profile.  Further, ongoing advice is provided as patients may need to reduce or be tapered off pharmaceutical therapies that may no longer be needed.

*ErbaLife is designed to provide information only and is not intended to be a substitute for medical advice, diagnosis, or treatment. Always enquire with a health care professional concerning any questions you may have regarding a medical condition or treatment options.*

Knocking out Inflammation in Heart disease CBD to the Rescue!

Knocking out Inflammation in Heart disease: CBD to the Rescue!

We are living in unprecedented times in modern medicine. People are asking for real answers and help with chronic conditions not adequately treated (or with unacceptable side effects) by our modern pharmaceutical therapies. Many modern chronic conditions have inflammation as an underlying cause of the manifested disease and could be improved by cannabis therapy.

Pharmaceutical therapies work to reduce cholesterol, lower blood pressure and improve blood glucose control, all implicated in heart disease; but all anti-inflammatory drugs come with a risk of serious adverse events making them often unjustifiable for long-term therapy. Thankfully, cannabis can reduce chronic inflammation implicated in heart disease.

‘How does THC and CBD work to reduce inflammation and protect our bodies from disease?’

Inflamed and scarred arteries create a plaque, or lesion, that is worsened by chronic inflammation. Overtime chronic inflammation causes further injury and the lesion can eventually rupture blocking major arteries damaging the heart or brain. This chronic inflammation is caused by immune cells that continuously release inflammatory molecules that can be inhibited by molecules of the cannabis plant, tetrahydrocannabinol (THC) and cannabidiol (CBD). CBD is the non-psychoactive (i.e. it doesn’t get you high) molecule found in cannabis. While both THC and CBD are found in cannabis and have powerful anti-inflammatory effects, too much THC can get one “high” causing euphoria, paranoia, or intoxication.

THC activates cannabinoid (CB1) receptors in the central nervous system and cannabinoid (CB2) receptors in the periphery reducing the amount of inflammatory molecules released by immune cells and other signaling systems that lead to inflammation. CBD, has little affinity for CB1 or CB2 receptors and exerts its anti-inflammatory effects by acting on ion channels and blocking metabolizing enzymes, increasing the body’s natural endocannabinoid, anandamide. Studies also show that CBD may have cardioprotective effect reducing the size of a heart attack and reducing injury.

‘Who should consider taking CBD to prevent inflammation and prevent chronic disease?’

Reducing chronic inflammation in the body could be the most important thing we do to improve our overall health. Anyone with a risk factor for cardiovascular disease, like high blood pressure, high cholesterol, obesity, or metabolic syndrome should consider a small dose of CBD oil or edible daily to reduce inflammation.

‘Is cannabis safe for people with risks factors for cardiovascular disease?’

No, not all cannabis is safe for everyone with heart disease. Moderate to high doses of THC can increase heart rate initially and subsequently slow heart rate and lower blood pressure known as orthostatic hypotension, resulting in dizziness upon standing. THC-dominant cannabis varieties are not recommended for persons with irregular heart rhythms, (e.g. uncontrolled atrial fibrillation) or unstable heart disease (e.g. angina).

Instead persons with unstable heart disease should consider taking a CBD-dominant cannabis variety like, Cannatonic, ACDC, or Charlotte’s Web. I like to have my patients start with 0.25 mLs to 0.5 mLs once or twice daily of CBD-dominant cannabis that provides 6.25 mg to 12.5 mg of CBD and 0.5 mg to 1 mg of THC per dose.

Cannabis varieties like, Blueberry Cheesecake, Candyland, and Lavender are higher in caryophyllene, a terpene found in cannabis that also reduces inflammation. However, these have a higher ratio of THC to CBD and would be recommended for prevention and not advised for persons with heart disease. Start with 0.1 mLs to 0.25 mLs of a 1:1 mixture providing 1mg to 2.5 mg of THC and CBD in the evening. At this low dose side effects of euphoria or intoxication are unlikely and become less so with chronic and consistent use. As well, equal amounts of CBD will reduce the side effects of THC.

Remember each person will require a unique dose. Start low and go slow. If you have short-term memory lapses, excessively dry mouth, episodes of dizziness or increased heart rate lower your dose. Medical cannabis is a valuable tool to improve symptoms and underlying causes of disease but should be recommended with the guidance of an experienced practitioner to make sure this therapy is right for you.

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Epilepsy – Cannabis Reduces Seizures according to research

Epilepsy – Cannabis Reduces Seizures according to research

If you or anyone you love has epilepsy you will have heard about the incredible benefits cannabis has had to reduce the number and severity of seizures. Charlotte Figi made cannabidiol (CBD)-dominant cannabis (Charlotte’s Web) famous and influenced governments everywhere to re-evaluate their laws prohibiting this natural therapy. Cannabis has in fact been used for hundreds, if not thousands of years, to control seizures as evidenced in ancient texts and in Dr. JR Reynolds essay written in 1861, entitled, Epilepsy: its symptoms, treatment, and relation to other chronic convulsive diseases. While we have a lot to learn about how cannabis improves seizure disorders researchers are getting closer to understanding the underlying mechanisms.

Epilepsy is thought to affect at least 69 million persons worldwide ( impacting quality-of-life and potentially causing cognitive, psychological, and social impairments. Seizure disorders are commonly described as generalized or focal (affecting a local region in the brain) in nature but can be manifested in a variety of ways. Our modern pharmaceutical therapies are not always effective, leaving many people to live with drug-resistant epilepsy. For some people the drug therapies may work to control seizures but often cause side effects of drowsiness or make concentration difficult enough to be disabling. In other words, our available antiseizure drugs are not as effective or safe as they need to be. As healthcare providers we have no choice but to help our patients find another way to treat these types of difficult-to-treat disorders.

The cannabis plant contains diverse phytocannabinoids, such as delta-9-tetrahydrocannabinl (THC) and cannabidiol (CBD), and terpenoids that act on the abundant cannabinoid G protein-coupled receptors (e.g. CB1, CB2, GPR55) and non-cannabinoid receptors, such as transient receptor potential, serotonin and glycine receptors (e.g. TRPV1, TRPV2, TRP1A,5-HT). Like our natural cannabinoids, called endocannabinoids, THC and CBD create homeostasis, or balance, throughout the human body. In the central nervous system (CNS) THC primarily actives CB1 receptors causing the neurons to reduce excitatory neurotransmitter release, such as glutamate. On the other hand, CBD has a low affinity for CB1 and CB2 receptors and exerts its effects at TRP receptors, T-type voltage-gated calcium channels, and G protein-coupled receptors (GPR55) to maintain balanced neurotransmission or to reduce neuronal hyperexcitability, or overstimulation. CBD restricts neuroinflammation, or inflammation of the brain, by reducing nitirc oxide (NO) and interleukin (IL)-beta, and by limiting glia cell activation, which is involved in brain scarring. CBD also works to increase the body’s own natural endocannabinoids (anandamide, 2-arichidonoylglycerol) to calm down an overexcited nervous system.

A variety of factors, including the type of seizure disorder and natural endocannabinoid tone, or the natural day-to-day function of your endocannabinoid system (ECS), will determine whether cannabis will work for you. By far, the majority of human and animal studies show that both THC and CBD are effective in reducing the frequency or severity of seizures. In 34 animal studies CB1 receptor agonists (THC or THC-like analogues) produced an anticonvulsant effect in 68.1% of subjects, while 5.6% had no response, and 2.9% had increased seizure activity. It is important to note that none of the studies showed that CBD was a proconvulsant.

While case studies in humans gives us some clues it doesn’t provide us with consistent guidelines to recommend any specific cannabis dosing with the many studies recommending CBD 100 mg to 800 mg daily. Phase 1 clinical trials of Epidiolex, a purely isolated CBD molecule, recommends patients start at 2.5 mg to 5 mg/Kg twice daily and increase to a maximum of 20 mg/Kg daily. Subjects of Epidiolex showed convulsive seizures were reduced compared to baseline by 51% recommending doses of 10 mg/Kg daily while Phase 3 studies found that 25 mg/Kg to 50 mg/Kg were safe with about 50% with improved seizure control. Importantly, these studies help us understand the effects of CBD compared to THC or whole plant cannabis therapy. While the benefits seen are encouraging the dose required may make it unpalatable or unaffordable. For example, a person weighing about 110 pounds may need 1,000 mg to 2,500 mg or 10 mLs to 25 mLs divided daily. Besides being difficult to swallow these very high doses of Epidiolex showed some adverse effects such as an increase in liver enzymes.

Generally, studies have tended to use large doses of oral cannabis to produce an antiseizure effect. This might be because many antiseizure pharmaceutical drugs induce liver enzymes in the cytochrome P450 system making THC and CBD less bioavailable. For example, topiramate and oxcarbazepine are CYP 3A4 inducers which may make CBD and THC less effective. An increase in the isoenzyme CYP 3A4 upregulation means that a lot more cannabis oil has to be given to improve symptoms. This is significant because seizure disorder typically requires high doses of CBD to be effective.

Since CBD is able to regulate the nervous system across several neuronal networks and pathways it makes sense to start with a CBD-dominant, low THC chemovar. I always recommend that my patients use cannabis derived from a whole plant so that it can work synergistically together so that less of each molecule is required to produce a positive effect. Most whole plant cannabis oils contain about 25 mg-50 mg/mL of CBD and less than 2 mg/mL of THC. Start with 0.25 mLs twice daily with a small fatty snack. For example, I recommend that patients eat a small fatty snack, like peanut butter or cheese and a cracker on an otherwise empty stomach. Hold the cannabis oil under the tongue for as long as is comfortable then swallow. For seizure disorders I recommend to increase your dose slowly over time every 1 to 2 weeks until you reach at least 1 mL twice daily providing (25 mg to 50 mg twice daily of CBD). You can safely increase the dose every 24 hours but is better to see what improvements occur overtime. Remember cannabis works by keeping one’s nervous system balanced and it may take time for the body to adjust to this new level of support.

At the same time the entourage effect as explained and expanded by, Dr. Ethan Russo, describes how all of the cannabinoid molecules and terpenoids found in the whole plant work in harmony so that both THC and CBD are more effective and safer when taken together. With this body of research growing around the idea of an entourage effect, and with numerous studies showing that THC has antiseizure activity it is reasonable to suggest a 1:1 cannabis oil with a balanced amount of THC to CBD, usually about 10 mg of CBD and 10 mg of THC. If seizure activity has not improved with a CBD dominant cannabis oil consider adding a 1:1 cannabis oil to your protocol. Start with 0.25 mL twice daily with a small fatty snack and increase by 0.1 MLs to 0.2 mLs every 1 to 2 weeks and no more than every 24 hours. Keep a diary of how you took the cannabis (time of day, food eaten), and seizure frequency. Consistency and good journal keeping will help you and your doctor figure out the right THC to CBD ratio, terpene profile, or plant variety (e.g. Sativa versus Indica).

Since our bodies are powerfully affected by cannabis affecting our natural endocannabinoid tone, reducing body and brain inflammation, and balancing neuronal over-excitation it is reasonable to expect that each person will need a unique dose and type of cannabis. This is why it is helpful to work with an experienced healthcare professional to receive a regulated cannabis product who can guide you to find the most effective and safe options. Consider speaking with one of our experienced physicians or pharmacists to see if this is right for you.

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(7)Sylantyev S, et al. Cannabinoid- and lysophosphatidylinositol receptor GPR55 boosts neurotransmitter release at central synapses. Proc Natl Acad Sci USA. 2013;110:5193-8.
(8)Carrier EJ, Auchampach JA, Hillard CJ. Inhibition of an equilibrative nucleoside transporter by cannabidiol: a mechanism of cannabinoid immunosuppression. Proc Natl acad Sci USA. 2006;103:7895-900.
(9)Pandolfo P, et al. Cannabinoids inhibit the synaptic uptake of adenosine and dopamine in the rat and mouse striatum. Eur J Pharmacol. 2011;655:38-45.
(10)Ferre S, et al. Adenosine-cannabinoid receptor interactions. Implications for striatal function. Br J Pharmacol 2010;160:443-53.
(11)De Petrocellis L, Di Marzo V. Non-CB1, non-CB2 receptors for endocannabinoids, plant cannabinoids, and synthetic cannabimimetics: focus on G-protein-coupled receptors and transient receptor potential channels. J Neuroimmune Pharmacol. 2015;5:103-21.
(12)Booz GW. Cannabidiol as an emergent therapeutic strategy for lessoning the impact of inflammation on oxidative stress. Free Radic Biol Med. 2011;51:1054-61.
(13)Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163:1344-64.
(14)Lorenz R. On the application of cannabis in paediatrics and epileptology. Neuro Endocrinol Lett. 2004;25:40-44.
(15)Reynolds JR. Epilepsy: its symptoms, treatment, and relation to other chronic convulsive diseases. J. Churchill (Ed.) London, 1861.


Cannabis for Diabetes – is it safe?


Several exciting recent studies show that cannabis reduces risk of diabetes, and metabolic syndrome, reducing BMI and obesity. In patients with diabetes type 2 (T2D) it improves insulin resistance, and lowers fasting insulin levels, even reducing waist circumference. (2,3,4) It is counter-intuitive to learn that cannabis, which we associate with increased appetite, can have such a stunning ability to reduce risk of diabetes. (6) However, this is what the studies show again and again often to the confusion of the researchers themselves.


With surprising studies like these one might expect a lot more funding for research that helps clinicians prescribe cannabis to improve diabetes and metabolic syndrome considering it is an epidemic in modern healthcare. While the studies are encouraging, especially for metabolic syndrome, obesity and type 2 diabetes (T2D), we need to be cautious about our recommendations to our patients.


A recent study published by JAMA International, funded in part by Sanfo US, and Dexcom Inc, entitled, Association between cannabis use and risk for diabetic ketoacidosis in adults with type 1 diabetes, showed that recreationally smoked cannabis doubled the risk of hospitalization for diabetic ketoacidosis (DKA), a serious complication especially for persons with diabetes type 1 (T1D). (1)


This self-reporting designed study involved 450 participants to determine if cannabis users were more at risk for DKA hospitalization than non-cannabis users. Of the 450 participants 134 persons (who were about 30 years of age) 97 reported primarily smoking cannabis for recreational use. Fifty-four respondents took cannabis 4 or more times per week and 48 took it once or less per month. Sixty-one persons used continuous glucose monitoring and 68 used an insulin pump which implies they were educated in diabetes care.


Twenty-eight of the 134 cannabis users had a DKA hospitalization in the preceding 12 months as did 26 of the 316 non-cannabis users. This suggests that cannabis use, especially smoking cannabis primarily for recreational purposes, increases risk of DKA hospitalization. The study doesn’t state whether it was THC or CBD but one would probably conclude that if 97 respondents smoked cannabis and 101 did so for recreational purposes it’s likely they were expecting to get a euphoric or relaxing benefit that comes with a THC dominant variety.


The researchers of the study didn’t discuss why cannabis may have such a powerful effect on persons with T1D but suggested that cannabinoids can alter gut-motility due to hyperemesis, an unusual syndrome due to chronic cannabis overuse that causes a person to become physically ill, vomiting continuously, sometimes for several hours. (7,8) Although the study didn’t determine if any of the respondents had experienced hyperemesis syndrome in relation to the DKA hospitalization.


On the other hand, one might wonder if cannabis is used medicinally, under the guidance of an educated physician, instead of recreationally, there might be a benefit for persons living with diabetes? While it is reasonable to conclude that persons living with T1D shouldn’t smoke cannabis for recreational purposes we still need further studies to learn how and why cannabis has such a remarkable ability to reduce risk of diabetes and improve metabolic markers such as obesity in humans.


A study published in the Journal of Medicine showed that past and current cannabis use were associated with lower levels of glucose, fasting insulin, insulin resistance, BMI, and hemoglobin A1c. And despite cannabis being associated with increased caloric intake and appetite cannabis use resulted in a lower prevalence of diabetes and BMI. (2,10)


  1. Halis K, Akturk HK, Taylor DD, Camsari UM, Rewers A, Kinney GL, Shah VN. Association between cannabis use and risk for diabetic ketoacidosis in adults with type 1 diabetes. JAMA Intern Med.2019 Jan 1;179(1):115-118.
  2. Penner EA, Buettner H, Mittleman MA. The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults. The American Journal of Medicine. 2013 July 126(7).
  3. Yankey BN, Strasser S, Okosun IS. A cross-sectional analysis of the association between marijuana and cigarette smoking with metabolic syndrome among adults in the United States. Diabetes Metab Syndr. 2016;10(2 Suppl 1):S89–95.
  4. Vidot DC, Prado G, Hlaing WM, Florez HJ, Arheart KL, Messiah SE. Metabolic Syndrome among marijuana users in the United States: an analysis of National Health and Nutrition Examination Survey data. Am J Med. 2016;129(2):173-179.
  5. Sidney S. Marijuana use and type 2 diabetes mellitus: a review. Current Diabetes Reports. 2016 Nov 16:117.
  6. Imtiaz, S, Rehm J. The relationship between cannabis use and diabetes: results from the National Epidemiologic Survey on alcohol and related conditions III. Drug Alcohol. 2018; 37:897– 902.
  7. Lapoint J, Meyer S, Yu CK, et al. Cannabinoid hyperemesis syndrome: Public health implications and a novel model treatment guideline. Western Journal of Emergency Medicine2018;19(2):380–386.
  8.  Kim HS, Anderson JD, Saghafi O, Heard KJ, Monte AA. Cyclic vomiting presentations following marijuana liberalization in Colorado. Academic Emergency Medicine. 2015;22(6):694–699.
  9. Gallo T, Shah VN.  An unusual cause of recurrent diabetic ketoacidosis in type 1 diabetes.  Am J Med. 2016;129(8):e139-e140.
  10. Jadoon KA, Ratcliffe SH, Barrett DA, Thomas EL, Stott C, Bell JD, O’Sullivan SE, Tan GD. Efficacy and safety of cannabidiol and tetrahydrocannabivarin on glycemic and lipid parameters in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled, parallel group pilot study. Diabetes Care 2016 Oct; 39(10): 1777-1786.











Cannabis is a beautiful plant with many exciting molecules that can improve symptoms of a variety of chronic conditions and disease states often not well-treated by conventional medical therapies. Part of the magic of this plant is the ability of the disease modulating molecules to cross the blood brain barrier due to their lipophilic (fat-loving) nature allowing them to interact with many different receptors throughout the brain and body. Hence, the molecules contained within this plant are uniquely capable of making a big difference in a person’s health. Besides the promising medicinal properties of THC and CBD, scientists are discovering the health benefits of terpenoids. Along with phytocannabinoids, such as THC and CBD, these aromatic constituents are made in the secretory cells inside the glandular trichomes of the unfertilized flower and are what give cannabis its unique flavour and aroma. (4)

Important terpenoids found in cannabis are the monoterpenes alpha-pinene, limonene, beta-myrcene, linalool and sesquiterpenes such as humulene, and beta-caryophyllene to name a few. (5) These lipophilic molecules are considered pharmacologically active at concentrations above 0.05% (12) interacting with cell membranes, ion channels, neurotransmitters, g-protein coupled receptors, second messenger systems and enzymes. (4)

Alpha-Pinene is a bicyclic monoterpene found in many conifers and why Christmas trees smell beautiful. Pinene inhibits the enzyme, acetylcholinesterase, in the brain that improves short-term memory. It is thought that high-pinene cannabis varieties, like Kona Gold, don’t interfere with memory like other high-THC chemical varieties, or chemovars, can. (1) Further, it has anti-inflammatory properties and acts as a broad-spectrum antibiotic and bronchodilator (4,9,10,)

Limonene is found in citrus fruit peels and is what gives certain varieties such as Tangerine Dream its citrusy aroma. Cannabis with this scent is associated with stimulating, mood-enhancing, and anti-depressant effects, not to mention powerful anxiolytic effects. (2) A study in mice showed increased serotonin in the prefrontal cortex and increased dopamine in the hippocampus. (7) Further, a clinical study showed that 9 out of 12 hospitalized patients exposed to citrus aroma therapy were found to have improved Hamilton Depression Scores and able to discontinue their antidepressant drugs. (8)

Beta-Myrcene is a highly concentrated terpene found in certain cannabis varieties, like Cannatonic and Blue Dream. Myrcene causes a sedative effect and is associated with relieving pain, relaxing muscles and when combined with THC can cause a “couchlock” effect. (3)

Beta-caryophyllene is a sesquiterpenoid that is able to survive extraction temperatures that other terpenes cannot and is commonly found in cannabis. This terpenoid is a full agonist at CB2 receptors and is found in black pepper and hops and is considered a dietary cannabinoid without psychoactivity. It is effective as an anti-inflammatory both topically and internally and found in the popular Northern Lights chemovar. (4)

D-Linalool is found in lavender and is known for its antianxiety and calming effects that are found in varieties, such as Bubba Kush and other purple indica chemovars. Linalool is used medicinally as a sedative, analgesic, and anesthetic. (6) Linalool modulates GABA and glutamate neurotransmitter release which is part of its anxiolytic and anticonvulsant properties. (11)

Esther Simmons-Foot, RPh


  1. Miyazawa and C. Yamafuji, “Inhibition of Acetylcholinesterase activity by Bicyclic Monoterpenoids,” Journal of Agricultural and Food Chemistry 53, no.5 (2005): 1765-68, doi: 10.1021/jf040019b.
  2. Komori, R. Fujiwara, M. Tanida, J. Nomura, and M. M. Yokoyama, “Effects of Citrus Fragrance on Immune Function and Depressive States,” Neuroimmunomodulation 2, no. 3 (1995): 174-80.
  3. G. do Vale, E.C. Furtado, J.G. Santos Jr., and G.S. Viana, “Central Effects of Citral, Myrcene and Limonene, Constituents of Essential oil Chemotypes from Lippa Alba (Mill.) n.e. Brown,” Phytomedicine 9, no. 8 (2002): 709-14.
  4. Ethan B. Russo, “Taming THC: Potential Cannabis Synergy and Phytocannabinoid-Terpenoid Entourage Effects,” British Journal of Pharmacology 163, no.7 (2011): 1344-64.
  5. Mudge EMBrown PNMurch SJ. The Terroir of Cannabis: Terpene Metabolomics as a Tool to Understand Cannabis sativa Selections. Planta Med.(2019) May doi: 10.1055/a-0915-2550.
  6. Peana AT1D’Aquila PSChessa MLMoretti MDSerra GPippia P. (-)-Linalool produces antinociception in two experimental models of pain. Eur J Pharmacol.(2003) Jan 26;460(1):37-41.
  7. Komiya M, Takeuchi T, Harada E. (2006). Lemon oil vapor causes an anti-stress effect via modulating the 5-HT and DA activities in mice. Behav Brain Res 172:240-249.
  8. Komori T, Fujiwara R, Tanida M, Nomura J, Yokoyama MM. (1995). Efffects of citrus fragrance on immune function and depressive states. Neuroimmunomodulation 2:174-180.
  9. Nissen L, Zatta A, Stefanini I, Grandi S, Sgorbati B, Biavati B et al. (2010) Characterization and antimicrobial activity of essential oils of industrial hemp varieties (Cannabis sativa L.) Fitoterapia 81:413-419.
  10. Falk AA, Hagberg MT, Lof AE, Wigaeus-Hjelm EM, Wang ZP. (1990). Uptake, distribution and elimination of alpha-pinene in man after exposure by inhalation. Scand J Work Environ Health 16:372-378.
  11. Nunes DS, Linck VM, da Silva Al, Figueiro M, Elisabetsky E. (2010). Psychopharmacotherapy of essential oils. In: Baser KHC, Buchbauer G (eds). Handbook of Essential Oils: Science, Technology, and Applications. CRC Press: Boca Raton, FL, pp. 297-314.
  12. Adams TB, Taylor SV. (2010). Safety evaluation of essential oils: a constituent-based approach. In: Baser KHC, Buchbauer G (eds). Handbook of Essential Oils: Science, Technology, and Applications. CRC Press: Boca Raton, FL, pp. 185-208.





Marijuana’s medicinal uses can be traced back to the time of a Chinese Emperor, Shen Neng who reigned in 2737 B.C. In his time cannabis tea was taken as a treatment of gout, rheumatism, malaria and even poor memory, wrote a professor of phycology at the State University of Albany who researches drugs and addiction in “Understanding Marijuana: A New Look at the Scientific Evidence”. The marijuana plant itself consists of more than 500 chemical compounds. Researchers have found THC, the main cannabinoid and CBD as beneficial active ingredients. They believe that these two substances work together to effect on receptors of the human body and reduce inflammatory pain.

Originally the drug’s use as a medicine spread through Asia and the Middle East and India where Hindu sects used it as a stress reliever and a quick method of pain relief.

The importance of this cannot be understated because its use as a medicine was quite essential to its users and was noted that it did not have any negative side effects. The cases in which this statement proved to be untrue was when the drug was misused and people where around it smoke for a very long period of time.

Despite the amount of historical background marijuana’s medicinal uses has, many people still doubt the logic behind it. The root thought that marijuana may have therapeutic effects is originated from solid science because Marijuana contains 60 active ingredients. The body eventually makes its own forms of cannabinoids, as mentioned above and the active ingredients intend to relieve inflammatory pain.

Because of medicinal marijuana’s various benefits, its core values seem to be extending into the city of Vancouver. The city started with less than a dozen marijuana dispensaries in the past couple of years and the number has shot up to about 80 dispensaries. This may be the cause of the rapid demand of the drug and more awareness about its uses.

Activists say that Vancouver is now home to relatively half the dispensaries in Canada and they realize that its effect should not be understated. They believe that this drug is natural and have faith if Canada’s future prospects would adhere legalization.

As this topic is discussed more and more the common issue of youth and marijuana is brought up many times. Many parents have protested to achieve the right that Marijuana dispensaries should not be within 300 meters of schools or between each other.

This concept can be justified in parents views because they do not want their children exposed at a young age. On the other hand it is beneficial to those who see its overall benefits and are willing to spread more awareness about the subject.


Under Mayor Gregor Robertson’s administration the number of illegal pot dispensaries has increased rapidly in the past two years. To deal with the issue there has been a proposal to regulate these dispensaries, which puts Vancouver on the map for being the first city regulate and control pot dispensaries.

Previously Medicinal Cannabis had been issued by mail after patient provided a prescription and legitimate license. This lengthy process was all under the federal jurisdiction; but now with these dispensaries, patients are able to purchase medicinal cannabis over the counter with a valid prescription.

This phenomenon begs the question that there is an adequate amount of people that think medicinal cannabis may be the solution their illnesses.

The Vision Vancouver committee, the majority who represents permissively that marijuana should be regulated says that the proposed framework will take months to implement but have confidence in saying that Vancouver will become the first city on Canada where cannabis will be regulated and permitted to be sold.

The city has seen the opening of about 20 new shops over the past couple of months because the federal government has changed they medicinal cannabis users can buy their medicine.

There are many benefits to these regulatory practices because Cannabis is in fact is essential for some patients to alleviate them from chronic pain. Whereas many others ask the question that does regulating these businesses mean that Vancouver is legalizing Marijuana? But City Councilor Kerry Jang just says “We’re not getting into that argument. We are simply regulating an unregulated business, just as we would any other business.”

However for owners this endeavor will not prove to be cheap because they city intends to charge for business licenses that can cost up to $5000 a year per square footage, and $30, 000 administration fee. Each shop will also have to reapply annually under the city’s official development plan bylaws as a conditional use. Also the businesses cannot be opened by companies and has to be individuals and their employees, who have to go through criminal record checks annually.

Although there may be a flame of hope in order for this medication to be more accessible to the ones that need it, Councilor Jang hopes that these conditions will knock at least 25% of these businesses out of the water.

Although this may prove to be quite expensive for owners and despite the city’s rigid conditions there are many patients who are relieved that they can find easy access to their medication. Comparatively in the past when the federal government had regulated these dispensaries, it imposed a rigid and lengthy process before a patient could have access to their medication.

Due to this fact the leader of the Federal liberal party promises a plan which would make cannabis even more permissible but due to the politics of the whole phenomenon Stephen Harper’s government does not intend to accompany Vancouver’s journey in regulating these businesses.