April 12, 2019

Glaucoma and Cannabis

Ten US states and all of Canada have legalized use of cannabis. This year's 4/20 event in Vancouver is called a protest festival but it should be called a celebration; it is the first year you can click on a government website, choose a product, enter a credit card and have a postal worker deliver it to your door in 48 hours. Those who have wanted to try medical marijuana but didn't want the hassle of the pre-legalization regime can celebrate the new ease of access.

There is acceptance of the use of medical marijuana for seizures, including epilepsy, multiple sclerosis, cancer pain and some other conditions but there is little or no information on recommended method of consumption (smoke, vape, oil, gel caps or in sweets), not much information on frequency of dose or ratio of delta-9-tetrahydrocannabinol (THC) to cannabidiol (CBD) in each dose for therapeutic purposes.

I have glaucoma and am allergic to three of the four classes of medications for lowering intra ocular pressure (IOP). I also have extreme dry eye and blepharitis which is often very painful. The literature on dry eye is extensive and well documented by the Tear Film and Ocular Surface Society (TFOS) The bottom line is many millions are spent on diagnostics and treatments for an incurable condition. I've spent thousands and nothing has worked for me. That motivated me to see whether cannabis oil could give me some relief.

The basic message for the use of cannabis oil is to start slowly and experiment with different THC/CBD ratos and dosages;5.0 mg of THC in oil with an equal amount of CBD has improved some of my blepharitis symptoms without producing a "high". In the 1970s research showed that smoking marijuana lowered IOP. An excellent 2017 summary of the literature on Cannabinoids for Glaucoma concluded "In 2010, the Canadian Ophthalmological Society (COS) noted that the COS does not support the medical use of marijuana for the treatment of glaucoma due to the short duration of action, the incidence of undesirable psychotropic and other systemic side-effects, and the absence of scientific evidence showing a beneficial effect on the course of the disease".

With the widespread legalization of cannabis, my hope is that it will now be easier to research the effect of cannabis oils or gel caps on IOP, thereby avoiding the concern of not being able to smoke often enough to maintain a consistently lower IOP. A 2006 study on just six patients concluded "A single 5 mg sublingual dose of Delta-9-THC reduced the IOP temporarily and was well tolerated by most patients." A study on mice was published in December 2018 and amongst other findings, it observed that CBD may counteract the effects of THC in lowering IOP, an observation that has been widely reported elsewhere. I haven't found any studies on humans to advance that observation. Like many who suffer, I would be happy to volunteer as a subject to determine the effect on IOPs and other eye symptoms after various doses, mixes, and methods of consumption for CBD and THC.

Hopefully the emergence of industrial scale marijuana production facilities will bring with it substantial research dollars to answer questions posed by those with currently untreatable conditions. It is in their interest as it would not only help those who need guidance on using their products but it would also expand their markets.

April 6, 2018

Wasteful MSP Referal Requirement

Honorable Adrian Dix
Minister of Health
PO Box 9050
Victoria, BC V8W 9E2

Dear Minister Dix:

The purpose of this letter is to encourage you to eliminate the requirement that family doctors make annual referrals in order for someone with a chronic condition continue to see a specialist.

I was diagnosed with glaucoma in June 2012; I now also suffer from very painful Blepharitis. Since my diagnosis I have been seen by my ophthalmologist, Dr. A. Goldberg, at least every four months, sometimes more often. On June 14, 2016 the receptionist told me that prior to my next appointment I must obtain a referral. I was handed a card that says: “MSP requires an annual referral for all specialist appointments; our doctors are specialists.”

An annual referral to keep the family doctor in the loop is meaningless for people like me since I must regularly see a specialist for the rest of my life. Like many thousands of British Columbians I do not have a family doctor, so for me the referral requirement means going to a walk-in-clinic solely to obtain a referral, thereby wasting both my time and MSP’s money. Family physicians can offer nothing to help with the care, monitoring or treatment for my condition as they lack the equipment and qualifications to deal with it.

I sent a letter like this to your predecessor and after several months received what I can best describe as a form letter from the Ministry’s Director, Compensation Policy and Programs Branch, which did not adequately address my concern (enclosed).

Since this letter has no chance of getting through your correspondence unit and before your eyes, I am copying MLA Bowinn Ma and asking that she help assure that you see this. I am also posting it to my website.


David D. Schreck