Toronto_City_Hall_Presentation_August_4th,_2015[1]

Canada's war on Pain not Pot

Municipal Level Engagement & Partnership

CHRONIC PAIN TORONTOKEVIN HALL & SARAH JOVEY

AUGUST 3, 2015

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To collaborate with municipal government and law enforcement, creating policies allowing reasonable and dignified access to medical cannabis that satisfies both patient and law enforcement.

Our Objective

Chronic pain affects every aspect of a person’s life including their ability to work, their emotional, mental and physical health, as well as their relationships with family, friends and society. The general lack of understanding about the nature of pain results in the stigmatization of people living with chronic pain as malingerers and drug seekers.

What is Chronic Pain?

Traditionally, all pain has been conceptualized as a symptom of disease or injury and it was assumed that once the disease was treated or the injury healed, the pain would resolve.

It is now recognized that approximately 10-15% of the time, pain persists beyond the time where normal healing should take place and becomes chronic.

Although few people die of pain, many die in pain and even more live in pain

WHO/EFIC Declaration on Chronic Pain

Access to pain management is a fundamental human right

International Academy for the Study of Pain (IASP)

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Why is pain so poorly treated?

Barriers… …to better pain management

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Chronic Pain in Canada: Workplace Costs

19% of Canadians complain of moderate – severe pain daily or most days of the week 1 in 6 have constant pain 40% suffered from concurrent anxiety or depression

Among those Canadians with moderate or severe pain:

33% - lost a job because of their pain 47% - reduced job responsibilities because of their

pain on average lost $12,558 dollars in income over a

one-year period because of their pain.CPS Nanos Survey 2007-2008

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Work losses: $42 Billion / yrHealth Care: $11 Billion / yr

Total: $53 Billion / yr

Chronic Pain: Societal Costs

Schopflocher, 2011

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PHYSICAL PSYCHOLOGICAL PHARMACOLOGIC INTERVENTIONAL

Normal activitiesSplinting / Taping AquafitnessPhysio• Passive• ActiveStretchingConditioningWeight trainingMassageTENSrTMStDCSChiropracticAcupunctureTai Chi / Yoga

HypnosisStress ManagementCBTFamily therapyPsychotherapyMindfulness- Based Stress ReductionMirror Visual Reprogramming

OTC medicationAlternative therapiesTopical medicationsNSAIDs / COXIBsDMARDsImmune modulatorsTricyclicsAnti-epileptic drugsOpioidsCannabinoidsLocal anestheticcongenersMuscle relaxantsSympathetic agentsNMDA blockers

I.A. steroidsI.A. hyaluronanTrigger pt. therapyIntraMuscular stim.ProlotherapyNerve blocks BOTOXEpiduralsOrthopedic surgeryRadio frequency facet neurotomyNeurectomyImplantable stimulatorsImplantable pain pumps

Treatment Options for Pain

Medical Cannabis

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Awareness - Issue Insights

Medical Cannabis & Pain An impressive body of literature supports cannabinoid analgesia,

and recently, this has been supplemented by an increasing number of phase I-III clinical trials

Health Canada: “about half of the 400,000 marihuana users say they use cannabis mainly for chronic pain”

Access to alternatives is more important than ever in light of the current controversy over prescription painkillers.

biggest goal is increase capacity for pain care in multidisciplinary/community based care models – eg. PainBC; The ILC Charitable Foundation

Heath Canada Guidelines

Proof of authority to possess125. On demand, an individual who, in accordance with these Regulations, obtains dried marihuana for their own medical purposes must show to a police officer proof that they are authorized to possess the dried marihuana.Medical document 129. (1) A medical document provided by a health care practitioner to a person who is under their professional treatment must indicate: the practitioner’s given name, surname, profession, business

address and telephone number, facsimile number and email address, if applicable, the province in which the practitioner is authorized to practice their profession and the number assigned by the province to that authorization;

the person’s given name, surname and date of birth; the address of the location at which the person consulted with the

practitioner; the daily quantity of dried marihuana to be used by the person,

expressed in grams; and the period of use.

Vancouver’s Approach

The city has the right to use their land as they see fit providing it doesn’t cause and public safety concerns.

Received endorsements from both the Municipal and Provincial Chief Medical Officers

Stayed out of the politics surrounding marijuana Reviewed two court decisions 1999, 2015 Reviewed international research done on cannabis Costs of policing marijuana detracting from other Police Priorities Created two specialized licensing systems. Compassion Clubs/Non Profit For profit groups Determined that the federal government had not met the criteria

“for reasonable access,” and had caused undue harm to patients through it’s guidelines set out by Health Canada and Provincial Colleges of Physicians

Completed a legal review on the of a law suit from the Federal Government but after a legal review were prepared to take matters in their own hands

Data

Financial Considerations

Applicants will pay a flat rate preliminary Development Permit fee, plus the standard area-based fee. As well, an annual Business Licence fee of $30,000 must be paid.

Revenues will contribute to cost recovery for the additional time spent by Property Use Inspectors, Licencing staff, development review staff, Police, Fire Inspectors and Communications Coordinators in regulating this sector.

“Hopefully what the federal government will see is what we have said all along: that their current regulations around medical marijuana are unworkable and have actually lead to the growth of the dispensary industry. When people can’t get their medicine they have go elsewhere. They created this market”

Kerry Jang, Vancouver City Counsellor

Current Police Policies

• What are the current policies and procedures related to Medical Cannabis patients?

• We have sent 10 requests for information since September 2014 to Victor Kwong at Toronto Police Services. The only responses to date have “I will get back to you” and “It’s stuck in legal”.

• We were told by several Police Officers that it is up to their discretion. Is this true?

• How are these policies communicated to all officers?• The following are actual patient experiences even though they had all of the

required documentation:• I was surrounded by at least a dozen police officers on Blue Jays Way. I

was medicating before a TFC game and following all of the city bylaws. I was detained for at least 20 minutes. The officers told me I was not allowed to medicate in public which is not true. They were rude and behaving like bullies. I felt threatened and intimated and it caused me to have an anxiety attack.

• I was put in handcuffs in a busy public place and left in the back of a cruiser while the police tried to figure out what to do with me. I felt embarrassed, intimidated and judge. The officers were talking down to me like I was a criminal. They later decided to let me go after a short detention.

• A Halifax couple were falsely arrested with their medicine and equipment confiscated and not returned even after all charges were dropped. Both have been medically declared disabled. They are now suing the city.

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Next Steps

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Appendix

About Chronic Pain TorontoChronic Pain Toronto was founded in November 2012 by Kevin Hall, who serves as Executive Director.  Mr. Hall has suffered from chronic pain since 2008 following a hit-and-run accident and has gained a deep appreciation for and knowledge of the debilitating pain and day-to-day challenges faced by those who suffer.  Unable to continue his previous vocation in the financial sector, he initially set out to educate himself regarding options for treatment.  What he found was a significant lack of understanding and numerous impediments to access the right physicians for diagnosis and treatment. Since that time Mr. Hall has conferred with hundreds of individuals connected to the world of pain management spanning from other sufferers, their families and friends, medical practitioners, pharmaceutical industry representatives, legal professionals and members of law enforcement.

Chronic Pain Toronto is a 100% volunteer based patient advocacy and support group. Chronic Pain Toronto does not recommend any one treatment, but rather supports the education and awareness of different options so that chronic pain patients and medical practitioners can make informed decisions.

Current CPT Initiatives CPT Best Doctors Network Giving Pain a Voice Patient Coaching on communication with health care professionals

(HCP) Providing education of different treatment options and how to

access them Providing training for support group facilitators Organizing education sessions for both patients and HCP Accompanying patients to their medical appointments Patient education on the responsible use of Medical Cannabis Assisting patients in navigating their way through the health care

system

About Sarah Jovey Director of Regulatory and Professional Affairs for Viable

Healthworks Corporation President of MedicOps Consulting Board Member for Chronic Pain Toronto 10 years experience with CPM Centres for Pain Management in

various roles Co-creator of The CaNPass Program. A National nurse led pain

project to educate primary care professionals Developed the Chronic Pain Lifestyle Management Program for

patients with a Naturopathic Doctor and a physiotherapist. Created partnerships with Loblaws Superstore and the YMCA for delivery of specific modules.

Organized multiple accredited continuing medical education programs

OHPIP Expert

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A Survey of Pain Curricula in Health Science Faculties

in Canada – CPS 2007

Total Hours (mean) Range

Dentistry 15 0 - 24

Medicine 16 0-38

Nursing 31 0-109

Occupational Therapy 28 0-48

Pharmacy 13 2-33

Physical Therapy 41 18-69

Veterinary Medicine 87 27-200

Watt-Watson J, et al. Pain Research Manage 2009; 14(6): 439-444