The cold weather is here and smokers everywhere have started their huddling in courtyards, under awnings, out back doors, to gather for their habitual inhalations. Those left with clean air to breathe in an increasingly smoke-free indoor world have little sympathy for the dwindling minority of shivering puffers.
But what if that cold group of smokers you see in the back alley have AIDS, and that smoking is their medication? Suffering silently in one’s own home, smoking marijuana can be a warm and welcome respite to symptoms of pain, nausea, and more. But as an in-patient in a facility, that much-needed hit of THC might not be as easy as it should be.
Todd Glanville has HIV (at one time he had full-blown AIDS but his T4 cell count is back slightly up over the delineation mark that defines AIDS). He smokes marijuana for nausea, to stimulate his appetite, and for aches and pains. He also suffers from clinical depression and has been in and out of various facilities in Toronto because of his physical and mental illness.
“At Mount Sinai I was an in-patient in, to put it bluntly, the psycho ward,” Glanville said. “Depression has been a big problem for me.”
He has also spent time in Toronto Western Hospital, the Centre for Addiction and Mental Health (CAMH), and Casey House, an AIDS hospice.
The facility that was the most conservative, uncooperative, and downright hostile to his Section 56 card: much to his surprise, Casey House.
“The policy itself surprised me,” Glanville said. “Especially for a place like Casey House. Especially after being treated so well at the hospital.”
When he first went into Casey House he was told that not only would he not be able to access his medicine inside the house, he wasn’t allowed to even smoke on the property, and if any pot was found in his possession, or in his things, it would be confiscated.
The heartlessness aside, on this last point Glanville got clarification from a lawyer regarding his so-called “illegal drug use.” He was told that anyone confiscating marijuana from a Section 56 cardholder could be charged with theft.
“My lawyer told me that if they ever confiscated it, to call the police,” he said. “But my concern was I’d have one of their nurses get charged with theft. And you know that is the last thing I want to do, but if it had come down to it, I would have done it.”
It never did come down to that because despite the insensitive Casey House policy from on high, the reality was the nurses and employees on the floor looked the other way.
“The staff themselves were cooperative and thought it was very silly,” he said. “We had a situation where one of the resident’s marijuana fell out of his pocket onto his bed, and we had a nurse come down and say, ‘by the way, your tea leaves were on the bed and I put them in your dresser drawer.'”
What really disturbed Glanville about this situation was not just the policy of an AIDS hospice (and one incidentally that offers many complementary therapies such as homeopathy, acupuncture, massage therapy, and chiropractic), but how the policy contrasted with his treatment at other larger facilities.
While Casey House’s strict policy banned his medical marijuana, he was met with acceptance and cooperation during hospital stays at Toronto Western, Mount Sinai, and the Centre for Addiction and Mental Health.
“Once they saw I had the card it was no problem,” he said. “At CAMH it was a little stickier. They went several chains of command up about it because apparently I was their first. But the ‘big guy’ came down, looked at my card and said, ‘okay, no problem, he has a card.'”
At these other facilities the staff held his marijuana in their narcotics drawer and dispensed it to him upon his request, according to Glanville. He would then go outside to smoke in the designated smoking area on hospital property. He even got protection when he felt he needed it.
“At Toronto Western I actually had a bit of a scare because I had some people coming up and bothering me. At that point I asked for security to come out with me and they sent security out.”
The Section 56 exemption, and the Authorization to Possess card are nothing new on the health scene, but the small number of in-patients requiring medical marijuana hasn’t led medical facilities to develop concrete polices. According to Health Canada’s latest published numbers, for September, there are 692 people who hold an Authorization to Possess card under the Marihuana Medical Access Regulations (MMAR), and just 65 who hold an exemption card under Section 56 of the Controlled Drugs and Substances Act (CDSA).
Staff at CAMH told Glanville that he was the first-ever patient to bring this issue to their attention, and when first asked the media relations department was surprised Glanville would have been allowed to smoke marijuana on the property. Sylvia Hagopian of CAMH looked into their policy regarding medical marijuana use and came up empty.
“It’s taken me a long time to find out what our policy is on Section 56 cardholders, and that is because we don’t have a policy,” she said.
A spokesperson for Toronto Western Hospital said that the issue came up once in all of 2003, but they worked out a procedure.
“The case was an in-patient who had his own supply,” said Vince Rice of University Health Network, (clearly speaking about Glanville although not using his name). “We basically confirmed the medical need, verified that it was necessary during his medical visit, and his supply was kept in a secure medical supply machine.”
Beth Snyder is the interim executive director at Casey House. Despite the simple, logical, and sympathetic treatment he received at these other facilities, she said that the problem is the federal government has been very unclear regarding the rules, and they have made it very confusing for organizations like Casey House.
“Section 56 allows the individual to have the medication, the marijuana, on their person,” Snyder said. “Here’s the thing: When they are in Casey House it opens up a whole different set of rules, regs, etcetera.”
Part of the confusion is that the facility falls under the Hospital Act, which forbids the use of “illegal drugs.” Despite the confusion of Casey House management, the Section 56 exemption gives hospitals the right to ignore that part of the Hospital Act based on the medical need for marijuana. At least that’s what the facilities other than Casey House decided.
“It’s not illegal drug use if the person is shown to have a medical need for that drug,” said Rice of University Health Network. “There are lots of drugs in a hospital that this would become an issue with if that were the case.”
Glanville has used marijuana for relief of aches and pains, for relief of nausea, and to stimulate his appetite. He has held his Section 56 card for about two years, and he says that while he loved his treatment in general at Casey House, his problem is this policy, and that they are dragging their feet about it.
“I loved my treatment at Casey House,” he said. “I have no problem with Casey House. My only problem is the policy. They made the claim that it was the Hospital Act that they were following, and I’m going, ‘hold on, hospitals are under the Hospital Act, what part of it?'” Glanville said. “They went on further to define the consumption of illegal substances, but this (Section 56 card) makes it a legal medicine so that doesn’t apply.”
Snyder at Casey House said that they are trying to work out the government’s confusing rules regarding medical marijuana.
“The legislation is not clear in how to handle it and that’s what organizations are struggling with,” Snyder said.
A representative for the Office of Cannabis Medical Access (OCMA) at Health Canada suggested that someone from Casey House just needs to make a phone call to sort out their confusion.
“The decision whether their patients can use marijuana for medical purposes is left up to the facility,” said Catherine Saunders, media relations spokesperson for OCMA. “We would advise any facility that has questions can contact the OCMA, and we’d be happy to provide them with the background.”
Saunders told Cannabis Culture that all patients who are authorized to possess marijuana by Health Canada are sent a form telling them that they are required to abide by all other federal, provincial, municipal, or facility policies regarding their marijuana. So, naturally, Section 56 cardholders need to abide by no smoking rules, but this also means that despite their Health Canada authorization to possess, any facility can make a rule and do just what Casey House has done: deny patients their medicine.
Glanville sent a formal letter to Casey House in February 2004 explaining his whole story and requesting to be invited to a board meeting to discuss the policy of the popular AIDS hospice. As of November he still hadn’t received anything more than a couple of phone calls telling him it is under review.
“I do apologize it has taken a bit of time since I came here (June) and got up to speed,” said Snyder. “As I mentioned to the client, we would absolutely intend to respond when we were finished our review and give a response back. We need to go through and look at what does it mean for us, what’s the clarity for the organization. So that’s what we’re reviewing now. Receiving that letter has really sparked that in us.”
After more than eight months that “spark” feels more like a fizzle for Todd Glanville, who is now living at home in the home care program through Casey House.
Despite management forbidding medical marijuana use on Casey House property, most of the residents are in the same situation, according to Glanville. But according to Snyder, Glanville is the first one who has brought this issue to their attention.
“All the guys smoked when I was in. A couple of them have passed away since,” Glanville said. “We all smoked medical marijuana.”
A neighbor down the street from Casey House even took pity on the HIV and AIDS sufferers smoking their marijuana on the streets, and let them use his garage area to congregate, smoke, and have a bit of shelter.
“Every few weeks we would send him flowers and thank him,” Glanville said.
This is news to Snyder who insists that, to her knowledge, this is the first person who has brought this issue up. The two big hospitals Glanville was at and the mental health facility hadn’t seen much of this before, but given the nature of Casey House – an AIDS hospice -there are clearly many who, either legally or otherwise, use medical marijuana for symptoms.
“I don’t believe that there are a lot in general out there,” Snyder said. “We haven’t dealt with it as a burning issue. We’re not getting in the way of people using off site at all.”
Does it seem like a good idea for those suffering from an immune-system wasting disease to be out in a cold rain, or in the Toronto winter?
“No, it’s not,” said Glanville. “Not at all. Especially if someone is under chemotherapy. You’re just not up for even moving.”
Casey House management is less than sympathetic to this critique of their policy.
“Patients that are here are not in their final days,” Snyder said. “They come and go from Casey House, so they are in various degrees of sickness and wellness. They are ambulatory and move around. A lot of them go on day passes so they are absolutely in and out of the building.”
Snyder added that there is still too much confusion with how this legislation, and how federal and provincial rules, affect Casey House. “We certainly support the cause, it is just if we can get some clarity on some of the issues that affect an organization that is what we are trying to do.”
* Office of Cannabis Medical Access (OCMA): 1-866-337-7705.