INRIX 2018’s global traffic scorecard tells us a lot about what’s happening to the average Canadian commute. For the second year, Toronto can moan about Canada’s worst traffic congestion. Hogtown, 19th worst traffic city in the world, traded places with Washington, D.C. (now 20). Montreal sits alone in 34th; Calgary lags at 60th.
It may not seem like it, but Montreal’s traffic congestion has been improving in relation to its worst-traffic competitors. Montreal is down from 28th last year; in 2014, it was Canada’s worst traffic town, with construction and traffic jams adding up to a 21.6% delay and an average of 38.1 hours lost. Internationally, Montreal’s traffic moves faster than it does in Rostov-on-Don. Montreal traffic is worse than Hamburg’s, where the time lost in congestion costs the average motorist more than 1,200 euros annually.
Congestion now costs the average Montreal driver 145 hours annually, says INRIX’s 2018 scorecard. That’s 15% better than in 2017. Montreal drivers average 12 km/hr in the final mile of their commute. The cost of congestion per driver isn’t available from the data collected in Montreal, but we can compare ourselves to Los Angeles (47th, 128 hours lost to congestion), with an average cost per driver of $1,785. Average speed for that last mile: a blistering 14 km/h. Yes, L.A. traffic is less congested than Montreal’s. (Boston, #8 worldwide, has North America’s worst traffic, with the average driver losing 164 hours to congestion.)
How does INRIX know all this? INRIX is a metadata consumer located on the U.S. west coast. It tracks the tower-to-tower handoffs of hundreds of millions of cellphones worldwide and uses movement data to determine at what rate traffic is moving in major cities. You don’t even have to be using your phone to be a droplet in the oceans of data INRIX feeds on.
INRIX began in 2005 and has been on a roll since. INRIX’s Roadway Analysis team works with cities, transport authorities and their agencies. INRIX traffic engineers and programmers produce software for in-vehicle navigation and location tracking systems for autonomous vehicles. In 2016, INRIX Research released its annual worldwide traffic scorecard, crunching data harvested from moving cellphones in 200 major cities around the planet.
INRIX’s scorecard is an effective marketing tool (you can bet that every newsroom in every one of those 200 cities will pick up their story) but it should be obvious it’s not scientific. The data doesn’t differentiate between cellphones riding ground-level public transit and cellphones in cars. Assuming there was a way of separating them, would it make a big difference? Probably not, an INRIX spokesman told me some years back — buses in most cities still move at the speed of traffic.
What does any of this mean to our average Vaudreuil-Soulanges commuter? In a previous blog (Commute from Hell, Nov. 21/16) I explained how INRIX analytics work in determining average commute times and therefore the additional time lost to congestion. Two years ago, the average commute from the Bédard traffic light to the Guy off-ramp was 45-60 minutes. The ride home varied between 60 and 75 minutes.
What I see from the latest INRIX stats is that there is no longer an average commute. Tieups are more frequent and take longer to unsnarl. The Ile aux Tourtes bridge averages an incident serious enough to halt traffic once a week. At what point does congestion become an integral part of the commute?
This brings me to the Reseau express métropolitain (REM), the latest in a string of disappointments for Vaudreuil-Soulanges. As I blogged last week, a preliminary environmental impact assessment found that over half of those who submitted opinions to a consultation regarding the replacement Ile aux Tourtes Bridge want the designers to consider a REM extension from Ste. Anne de Bellevue to Vaudreuil. Current plans for the bridge show dedicated bus, cycling and pedestrian lanes — but no space for a REM extension.
The message is clear: by 2023, public transit from Vaudreuil-Soulanges will require at least one other form of transport to connect with the REM. If the Montreal Metropolitan Community (MMC) follows through with repeated threats to impose tolls on the bridges to Montreal Island, how many commuters will say ‘screw the REM’ and pay the tolls?
Everything I see and hear infers there’s a hidden hand trying to dissuade people from moving off-island. I’ve suspected this to be the MMC’s hidden agenda since the October 2011 adoption of its master plan at the St. Constant Railway Museum. The Vaudreuil-Soulanges delegation was shown perfunctory courtesy and zero respect. I found the public shaming embarrassing.
Oct. 19, 2011 marked the beginning of the end for Vaudreuil-Soulanges political autonomy and it’s my belief the MRC and its 23 mayors still haven’t recovered after being bigfooted by the MMC. The Charest Liberals (followed by the Couillard Liberals) supported the MMC in forcing Vaudreuil-Soulanges to bring its master plan into harmony with the PMAD, the 82-municipality MMC’s master plan. A freeze was placed on farmland dezoning, nixing the original location proposed for the new regional hospital. (Was it any coincidence when history repeated itself with the current site?)
A direct result of the PMAD, picturesque towns like Hudson were ordered to densify their downtown cores on the basis of a spurious transport-oriented development (TOD) pretext leading to the imposition of inappropriate multi-unit projects in heritage sectors. Transport-oriented development based on a train a day each way? Who are they trying to fool?
Officially, the REM changes nothing when the Ste. Anne terminal opens in 2023. The Vaudreuil-Hudson line will continue to operate one train a day in and out of Hudson. The A40 Express will continue to run between Vaudreuil station and the Côte Vertu metro. Shuttlebus and adapted-transport services will continue to those municipalities willing to pay. But the train’s days are numbered unless Vaudreuil-Soulanges elected officials and citizens demand the level of service available to the rest of the Montreal Metropolitan Community. And so is our autonomy.
This Facebook page has been created to advocate for the extension of the Réseau express métropolitain (REM) line to Vaudreuil-Soulanges via the new Ile aux Tourtes bridge.
When the REM surface line to Ste. Anne de Bellevue is completed in 2023, the $6 billion, 26-station automated electric light rail transit (LRT) system will link Montreal, Laval, north and south shores — but not Vaudreuil-Soulanges, Quebec’s fastest growing MRC.
In December, the government announced that a replacement for the nearly 60-year-old Ile aux Tourtes bridge would be completed by 2030. Plans for the new bridge include dedicated bus lanes and separate corridors for cyclists and pedestrians — but no LRT corridor.
Already, proposed parking at West Island REM stations is being cut back. Autorité régionale de transport métropolitain (ARTM), the MMC’s overseer of public transit, favours active transport (walking, cycling) and local shuttlebus service.
Unless regional public transit agencies are prepared to keep operating the existing Vaudreuil-Hudson commuter rail line once the REM is in service, Vaudreuil-Soulanges and its 150,000+ residents will lose their only mass public transit link to Montreal.
Le REM dans/in Vaudreuil-Soulanges will work to raise awareness of the need to redraw plans for the Ile aux Tourtes replacement to include a REM right of way serving Vaudreuil-Soulanges and points west.
Without access to a high-speed mass public transit system:
– Vaudreuil-Soulanges enterprises, including the promised hospital, will struggle to attract labour. By its projected 2026 completion, the hospital will represent some 4,000 jobs;
– Vaudreuil-Soulanges residents will continue to be at the mercy of Montreal’s worsening traffic chaos and the eventuality of tolls;
– the Montreal Metropolitan Community will have missed the opportunity to significantly reduce greenhouse gas emissions in the fight against climate change, a keystone of the MMC’s master plan.
An environmental impact study of the replacement Ile aux Tourtes bridge should include an analysis of extending the Réseau express métropolitain (REM) line to Vaudreuil-Dorion, according to a majority of opinions submitted to a public environment ministry consultation released Monday.
As currently configured, the 26-station automated electric light rail transit (LRT) system will terminate in Ste. Anne de Bellevue when it begins service in 2021. The $6B network will link Montreal, Laval, the north and south shores — but not Vaudreuil-Soulanges and its 150,000+ residents.
The public consultation — on which factors should be taken into account in the planning and reconstruction of the Ile aux Tourtes bridge — began on Dec. 12/18 and concluded Jan. 11/19. The 16-page document is a summary of observations from participants on the factors which they feel should be considered in a future environmental impact study.
In December, the government announced that a replacement bridge would be completed by 2030 to replace the two-kilometre span, built in the early sixties and neglected for long periods. The new bridge will be 45 metres wide (the existing bridge is 29 metres), with dedicated lanes for public transit and carpooling.
The consultation drew 28 briefs, 17 of which specifically urged the transport ministry to include an extension of the REM to Vaudreuil-Dorion as an integral part of the reconstruction project.
Accessibility and public safety were significant concerns of most intervenors. Ten comments focussed on traffic congestion on the bridge and its approaches before, during and after construction. Recommendations including closing some on-ramps and exits to mitigate the risk of accidents and to restore fluidity, both in the planning stage and during construction. Others wanted a speed limit reduction, photo radar, reflective lane markers and the quick removal of snow accumulation. One brief suggested diverting all truck traffic to Highway 30 unless it is headed to the West Island.
Environmental concerns were well represented, with a number of briefs urging the addition of dedicated bicycle/pedestrian lanes and the development of policies to preserve prehistoric sites and natural habitats of Ile aux Tourtes and adjacent islands and shorelines.
Noise and vibration from the roughly 83,000 vehicles a day — 10,000 of them trucks — were also raised as concerns. A number of contributors wanted the new span’s design and construction to reflect best practicesworldwide.
Consultation participants raised concerns about the ongoing lack of transparency on the part of the transport ministry when it comes to the existing bridge and how traffic will be rerouted during construction of its replacement. Many cited a lack of transparency while the existing bridge underwent repairs and expressed concern at the foggy timeline for its replacement.
Article 31.3 of the Environmental Quality Act requires that after having received a directive from the environment minister, a project’s initiator — in this case the Ministère du Transport — is required to publish a notice announcing the start of an environmental impact evaluation, the first step in drafting an environmental impact assessment of the bridge replacement project
Under the law, any person, group or municipality has the right to suggest what factors should be explored in the process of determining the project’s environmental impact. Once the consultation period ends, the environment ministry shares the results with the project’s initiator and posts factors it considers relevant on the Registre des évaluations environnementales page.
Next step is an impact study to detail modifications to be made during the planning process and to address issues raised in the course of this evaluation process. No hard dates have been set for the start of construction or completion. The transport ministry hasn’t indicated whether the existing span will be demolished.
Documentation and citations:
Les observations sur les enjeux que l’étude d’impact devrait aborder:
Reconstruction du pont de l’île-aux-Tourtes entre Vaudreuil-Dorion et Senneville par le ministère des Transports
réalisée par le ministère de l’Environnement
et de la Lutte contre les changements climatiques
3211-05-469 31 janvier 2019
Nom du projet :
Reconstruction du pont de l’Île-aux-Tourtes entre Vaudreuil-Dorion et Senneville
More North Americans die of opioid abuse than in traffic accidents. In 2017, 3,987 Canadians died from opioid overdoses. In the U.S., where widespread opiate and opioid abuse started earlier, the number of deaths topped 72,000. [Ed.: the terms opiate and opioid initially were used to differentiate between drugs derived from opium and synthesized variants. Opioid has become the umbrella term.]
Opioid abuse takes many forms, says a prominent Quebec pain control and addiction specialist. “Patients with prescriptions sell their meds or fail to store them safely.”
He sees adolescents, especially those who consume THC, buying opioids and becoming addicted. “THC consumed in adolescence alters brain structure and chemistry, leading to a decrease in verbal memory, especially if the person is also battle ADHD, anxiety or mood swings. Then they end up self-medicating with THC.”
How widespread is opioid abuse? He cites a study of 570,000 opioid-unaware patients receiving post-operative opioids who were followed for 2.7 years. “One per cent overused or abused, but with serious consequences […] The risk of abuse doubles with every prescription renewal, even one, regardless of dosage.” His conclusion: “Opioids should be prescribed in small doses over the short term, not repeatable.”
My source asked that I not identify him. His campaign to sensitize patients and healthcare bureaucrats to the risks of opioids has led to clashes with regulatory bodies responsible for ensuring the health and safety of patients. Instead, he says, these bodies act as if their sole intent is to ensure that alternatives such as cannabidiol (CBD) are hard to prescribe, obtain and assess for efficacy while giving the opioid industry free rein to do business as usual despite clear evidence of an epidemic of abuse.
I asked him whether opioids are effective, non-addictive painkillers when used as prescribed.
“I came to realize that my patients taking opioids for pain relief were fat, lazy, sweaty, non-functional — and still in pain,” he replied. The condition is called opioid-induced hyperalgesia, characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli.
Urinalysis and close questioning led him to conclude some of his patients were trading their prescribed drugs for more powerful alternatives on the black market. Others were selling all or part of their prescribed drugs for cash. His doctor-patient relationship prevented him from turning them over to the police. The response from the Collège des médecins du Québec (CMQ)? Stop prescribing.
Since his aha! moment, he has pioneered in the prescribing of cannabinoids in the treatment of chronic neuropathic pain. He also seeks to educate, offering two-hour seminars to healthcare professionals during which he dispels misconceptions about cannabinoids and explains the chemistry and psychology of neuropathic pain. (Indicative of an awakening taking place within the industry, his lectures are sponsored by opioid producers Purdue and Janssen.)
He scrupulously maintains an arm’s-length relationship with Canada’s get-rich-quick cannabis industry. “I didn’t invest because I want to remain credible,” he told me in November. “It’s a huge field and it’s just starting…I saw it coming because the current treatments for neuropathic pain are not working.” Big Pharma knows it, federal and provincial regulators know it, doctors and pharmacists know it, he adds, but that knowledge isn’t being shared with the patient.
It’s equally clear to him that unless the medical cannabis industry can demonstrate the science to support efficacy claims, the industry can’t advance. “There’s a real lack of understanding of [the body’s own endocannabinoids and how they act on our pain receptors]. Unless there’s a scientific basis, there’s no research money.” Without research on a proposed substance’s medical indications, attenuating effects, optimum dosage and clinical trials, Health Canada won’t issue a Drug Identification Number (DIN), the basis on which a drug can be prescribed for a specific use and covered by public or private drug insurance.
Theoretically, any licenced Canadian doctor has been able since 2013 to write a prescription for medical marijuana and its derivatives without the patient having to enrol in a clinical trial. Because of the determined efforts of the Collège des médecins du Québec, it’s easier to buy black-market or grey-market cannabis than it is to find a Quebec GP willing to write a prescription.
As of April 1, 2014, cannabis could only be prescribed in Quebec “within a research framework,” as it is not a medically recognized treatment. Quebec patients with the financial wherewithal had the option of consulting one of a growing number of private pain clinics. Those without the means were given the choice of buying products online (with no guarantee of purity or dosage consistency) or from First Nations distributors (the Tyendinaga Mohawk Nation south of Belleville has 57 outlets selling medical and recreational cannabis of varying potency and quality). Until Quebec’s pot police ordered them to stop, the province’s pet stores were selling out their supplies of veterinary-quality CBD to arthritic oldsters of another species.
However, Quebec’s insistence on patients having to enrol in clinical trials may have given cannabinoid researchers a leg up. In May 2015, the world’s first research database on the use of cannabis for medical purposes, the Quebec Cannabis Registry (www.registrecannabisquebec.com) was launched under the auspices of the Research Institute of the McGill University Health Centre (RI-MUHC) and the Canadian Consortium for the Investigation of Cannabinoids (CCIC).
The Registry’s creators set a goal of 3,000 participants over a 10-year period. (The Registry stopped taking registrants in the fall of 2018 after enrolling the 3,000.) It curates clinical data from patients, sites and clinics throughout Quebec; each participant must agree to provide data for four years after recruitment. Any licensed doctor practising in the province wishing to authorize cannabis for their adult patients could enrol participants in the registry.
The CMQ sought to denigrate the Registry, claiming it doesn’t satisfy the criteria of true scientific research and therefore can’t demonstrate that cannabinoids offer a solid alternative to opioids for chronic pain relief. However, most I spoke to believe that research eventually will demonstrate that provincial pharmeconomies can save millions by replacing ineffective, addicting opioids and other prescription drugs with cannabinoids. In the end, it’s a cost-benefit analysis. What’s an overdose death worth? What’s the price tag on addiction? I understand the need for skepticism and caution but I find it incredible that in Canada, medical cannabis isn’t further ahead.
During a trip to Italy last fall, I was blown away by the percentage of Italians who use cannabidiol for pain relief. CBD is widely available throughout Rome, Florence, Milan and most larger cities. Italians who would never dream of smoking to get buzzed use CBD to treat arthritis, chronic pain, anxiety, insomnia and a list of inflammatory and autoimmune disorders. Significantly, Italy does not appear to have an opioid addiction problem.
The CBD sold in Rome was manufactured in Holland and certified 99% pure, which to my experience covering this issue is questionable.
While unlicenced extraction appears to be a crime nationally, one Quebec cannabidiol extractor told me he’s sourcing his CBD from non-psychoactive indica (hemp) plants. The active ingredient can be extracted with various easily available solvents. Ottawa’s legalization legislation, Bills C-45 and C-46, didn’t deal with this other than to stipulate that there would be a year’s delay before consumeables and edibles are legalized. At an industry conference last spring, several major players told me tell me the non-THC demand will dwarf recreational and they’re happy to have the time to source CBD precursors and develop delivery systems.
In November 2018 I was diagnosed with advanced osteoarthritis of the left hip. I’m scheduled to see a specialist in early February, with a surgical date dependent on the surgeon’s hospital OR schedule. According to the Canadian Institute for Health Information, I have an 83% chance of getting my hip replacement within 182 days of my referral.
In the meantime, I walk with a cane or ski pole. The only exercise left to me is swimming. My osteopath has succeeded in reducing associated sciatic pain but walking, standing, sitting and lying down are painful, often acutely. I can no longer control the pain with NSAIDs. I refuse to consider opioids because of their risks.
On the advice of my GP I enrolled in a clinical trial conducted by the Registre de cannabis du Quebec, the Quebec Cannabis Registry. I take 1.5 ml of prescribed cannabidiol oil under my tongue twice daily. CBD reduces the pain’s intensity, allowing me to get on with life. It takes approximately 90 minutes for the dosage to take effect.
Because everyone’s endo-cannabinoid receptors are unique, there is no such thing as a universal optimal dose or CBD/THC balance. Instead, one embarks on a trial-and-error process of finding one’s optimal dosage. Every refill arrives with a Health Canada fact sheet urging the beginner to start low and go slow in increasing one’s dosage.
My pain specialist prescribed Spectrum Yellow, 20% CBD and less than 1% THC. I’ve been keeping a daily journal on my results and observed side effects. On the plus side: my pain is reduced to a manageable dull ache, I enjoy deeper, more restful sleep, a reduced appetite (a positive because my GP says I have to lose 10 pounds or I’ll be using a walker), regularity, and heightened senses of smell and taste. Less welcome are the dry mouth and eyes and a loss of enjoyment for alcohol. I’ve also noticed interactions with coffee (too much or too little triggers fleeting headaches) and a tendency to slight depression if I don’t drink a lot more water than I used to.
Once a month, I complete a Registry questionnaire. Has my quality of life improved or deteriorated? How well am I able to function? I report side effects and possible adverse reactions to the supplier as they occur and fill out their questionnaire.
I talk about CBD because I think others should know about it. People ask me whether it makes me high (it doesn’t), whether I can drive legally (depends on my ability to pass a roadside sobriety test) or visit the U.S. Over the course of the last two months, I’ve been surprised by the number of those taking CBD for a wide variety of conditions. A friend’s COPD has improved, another’s arthritic pain is less crippling. I take them for what they are — anecdotal evidence of the efficacy of CBD as an anti-inflammatory and pain reliever.
As a journalist, I have covered Canada’s transition from Killer Weed and reefer madness to legal pot, beginning with the Le Dain Commission hearings into legalization versus decriminalization. My biggest regret is that the Trudeau Liberals made legalization of recreational marijuana their priority, launching Canada into the big experiment before the medical profession is set up to measure the effects on individuals and the healthcare system. At the same time I find it beyond idiotic that Quebec doctors are still being discouraged from writing medical cannabis prescriptions and I find myself wondering what it will take to show how federal and provincial regulatory bodies are conspiring with those who manufacture, market and distribute opioids to keep patients “sweaty, fat, lazy, unmotivated — and still in pain.”
Is CBD a medical magic bullet? Which markers determine whether someone will respond well to cannabinoids and who might be genetically predisposed to psychotic or allergic reactions? Why do men and women respond differently? Without research, without scientifically conducted clinical trials, we won’t know until the U.S. jumps in — which is happening as I write this.
The Quebec Cannabis Registry is said to be planning to release details from its database this spring. In the meantime, I’ve spent the past month plowing through the contents of Therapeutic and Recreational Cannabis: In Search of Answers, an 83-page Powerpoint shown to doctors, pharmacists and nurse practitioners. It draws case histories from the Registry.
— Current knowledge of the body’s endo-cannabinoid system is fragmentary but we know it is involved in regulating the cognitive system, fertility, pregnancy, appetite, mood, pain sensations and motor learning.
The human body manufactures its own endo-cannabinoids: anandamide, which acts on the same pain receptors as THC, and 2-arachidonoylglycerol, or 2-AG, which appears to control the level of a certain fatty acid that limits body’s anandamide levels. These molecules latch onto CB1 and CB2 receptors to regulate and control a range of bodily functions. The theory is that a correct ratio of cannabis plant-derived analogs tetrahydrocannabinol and cannabidiol can help rebalance the body’s endo-cannabinoid system. But drug basics — counterindications, dosage, interactions and side effects are fragmentary.
We know there’s an individual optimal mix of THC and CBD but we don’t know much about the 140 other compounds found in cannabis strains. We’re beginning to learn about the function of terpenes — aromatic components in cannabis extracts — in modulating the effects of THC and CBD.
Research, most of it anecdotal, has determined that ratios of caryophyllene, limonene, myrcene, pinene and terpineol play a role in determining the psychological effects of different cannabis strains. The farthest the industry goes in assigning specific benefits to terpene combinations is to describe them as having an “entourage effect” — a hypothetical mechanism by which compounds in cannabis largely non-psychoactive by themselves moderate the overall psychoactive effects of the plant.
The Powerpoint’s clinical observations about CBD and THC are convincing, not only in the treatment of neuropathic pain but the generalized symptoms of pain, psychic troubles, inflammatory and auto-immune disorders and neurological complaints can be mitigated. Studies show positive results in treating of epilepsy, anorexia, fibromyalgia, inflammatory bowel and intestinal disease, chronic migraines, acute pain sensitivity, chronic fatigue syndrome, bipolar disorder, autism spectrum disorders, insomnia, anxiety, PTSD, schizophrenia and depression.
The presentation begins with a pharmaceutical history of pain relief, then shows how CBD and THC are being used to treat the same disorders with positive results. By the 63rd slide, the dissertation gets into pain-relief specifics: preliminary results from the Registry show reductions in neurological and mixed back pain, radiating lower neck pain with or without dystonia, CRPS, post-operative visceral pain (abdominal and pelvic), post-traumatic chronic headaches and migraines, jaw pain and cancer-related pain (nausea, wasting).
“We are likely going to be able to show major pharmacological benefits and savings in pain treatment,” the presentation concludes. “Most psychoactive drugs will eventually be phased out.”
This is where some of the research is concentrating — on the use of CBD to wean opioid addicts off their drugs. (This presentation was funded by Purdue Pharma and Janssen Ortho, two major opioid producers.) North America uses 80% of the world’s prescription opioids. It’s a $2.6B industry. Access to replacement treatments using methadone and suboxone is extremely limited. There is an 85% risk of relapse. Even through the genetics and neurobiology of addiction are well known, funding for research is very limited. The subject is poorly or not taught in medical schools.
Pain researchers report immediate effects when CBD is combined with opioids. Pain relief is immediate and tolerance levels are lowered. Some patients stopped taking opioids. Others stopped taking antidepressants, anti-convulsants and anti-spasmodics. “…there is evidence that CBD…can play a role not in opioid withdrawal, but with other stimulants — nicotine, cocaine, amphetamines.” Doctors currently prescribing medical cannabis agree Quebec’s pharmacies are best situated to ensure compliance and provide advice to patients about the side effects of terpene profiles.
Quebec Cannabis Registry case histories:
#3 52-year-old female with chronic back and hip pain, migraines, chronic fatigue, insomnia off work for 2+ years and walking with a cane, treated with 30 mg of CBD and 7.5 mg. THC/day. No longer uses fentenyl patches, gabapentin, naproxyn, Cymbalta, Tramacet, Elavil, clonazepam.
#4: male, 70, with progressive chronic pain since 2004, fibromyalgia, neuropathic pain in hands, chronic fatigue and insomnia, treated with CBD 30 mg/day and THC 2×23 mg/day. Has ceased taking Cymbalta, oxycodone, ketamine, Tylenol, naproxyn, OxyNeo, gabapentin, Nabilone, Elavil, Senecot/Colace.
#5: 42-year-old woman with Lynch Syndrome underwent colon, brain and breast surgeries in adolescence.Suffers from chronic head and abdominal pain. Treated with CBD and THC, she has stopped using Elavil, Constella, Effexor, dicyclomine,Prevacid, naproxyn, gabapentin, citalopram. She continues to take meds prescribed for bipolar disorder.
#6: Female, 52, with Crohn’s disease underwent total colectomy, suffers from rheumatoid arthritis, chronic abdominal pain. Medications included prednisone, Statex, Gravol, Serax, Tylenol, Pantoloc, Purinethol. Since being placed on 15 mg of CBD and 10 mg THC at bedtime, she no longer uses prescription meds.
#7: 38-year-old woman diagnosed with fibromyalgia in 2005 and spinal arthritis in 2007, was given 26.3 mg of THC at bedtime and 20 mg. of CBD twice daily. She stopped using fentanyl patch, Elavil, Cyclopenzaprine, Topamax, Dexilant, Seroquel, Lax A Day and Gabapentin. By September, she was receiving injections of Certolizumab, a biologic medication prescribed for Crohn’s and several forms of arthritis.
#8: 35-year-old mother of four suffered kidney stones and related infections. Diagnosed with psychiatric disorder, addicted to dilaudid and other prescription painkillers. Unable to tolerate methadone, she was switched to the opiod Tapenadol. She is undergoing cannabis therapy while continuing Tapenadol and the antidepressant Effexor.
#9: 32-year-old woman underwent total colectomy and ileostomy in the course of an emergency caeserian and underwent nine more surgical procedures for adhesions. Suffers from chronic abdominal pain, took to injecting prescription meds to cope. Hospitalized, she was switched from hydromorphone to metadol and is undergoing cannabis therapy to wean her from metadol. She’s off opioids dilaudid and Contin and will stop taking the tranquilizer clonazepam and Trintellix, an antidepressant.
#10: Male, 37, suffered a crushed wrist in 2015 and subsequent neuropathic pain. Unable to tolerate prescription painkillers, consumed 6-8 grammes of dried cannabis per day. Switched to 2 grammes of THC/CBD hybrid cannabis flowers and daily doses of THC and CBD oils.
#11: Female, 56, severe chronic back pain, multiple intolerances to prescription painkillers, walks with a cane with difficulty. Placed on a dosage of 1-3 grammes of a mix of CBD and THC cannabis strains, she stopped taking her daily mix — Lyrica, Kadian, Emtec, Contin, dilaudid, naproxyn, Flexeril.
#12: 60-year-old male injured his left knee in a 2005 workplace accident and was forced to stop working 10 years ago as the result of chronic neuropathic pain. Opioid dependent, he became obese. Since starting to take gelcaps of a THC/CBD oil mix at suppertime, he stopped taking Oxyneo and oxycodone and has reduced his metadol prescription by two thirds. He has since returned to work and has lost 47 pounds.
The presentation’s conclusions:
— Our lack of understanding of neuropathic pain, addiction and pain hypersensitivity has led to the misuse of opioids.
— Opioids have their place, but new restrictions must be placed on their use.
— The preliminary results of the Quebec Cannabis Registry demonstrate an efficacy inneuropathic pain, inflammatory diseases, and possibly in relieving pain hypersensitivity and the symptoms of opioid withdrawal.
— Cannabis isn’t tolerated by everyone and will not be covered until in-depth studies are published, which will take considerable time unless demonstrated savings in [drug, hospital and social costs] generate the political will to effect change.
— The Colleges [of Physicians and Surgeons] the faculties of medicine and the Order of Pharmacists should promote the teaching of these subjects to their members.
— What is considered recreational usage is often the result of self-medication for an undiagnosed condition. These individuals should be able to access the information required for healthy use of these products.
He’s a biker, even if his shoulder-length hair and beard are turning white and his once muscled body has wasted to lean bordering on frail. His Moto Guzzi sits in the shed, in front of the bench where he grows cannabis under LED lights. He’s smoked weed most of his life, but these “girls” as he refers to his female plants, will never be immolated. Gray says he hasn’t smoked since he began extracting cannabis oils a year ago.
Gray has MDS, myelodysplastic syndrome, a form of blood cancer. The immature blood cells his bone marrow produces don’t mature. Some patients with lower-risk forms of MDS can live five years or more. In 30 per cent of cases MDS degenerates into acute myeloid leukaemia, a form with a far shorter life expectancy.
When Gray was diagnosed with MDS, his doctor told him he had 18 months and put him on Darbepoetin to raise his hemoglobin level. For three years he received the $1,580 injections every three weeks. He was also prescribed up to eight Oxycontin tablets a day.
Three years later, Gray was barely functioning. His hemoglobin/white cell counts continued to decline. That and the Oxycontin left him wasted, so he stopped the darbepoetin and replaced the Oxy with Percocet, a combination of acetaminophen and oxycontin. Online, he’d been following the advice of Rick Smith, a Canadian cancer survivor who counsels supplanting or supplementing conventional treatments with a mix of tetrahydrocannabinol (THC) and cannabidiol (CBD) extracted from dried cannabis. Like Smith, Gray believes a THC-rich blend is more effective in killing cancer cells.
He continued to monitor his hemoglobin level and white cell count, both of which rebounded. When his cannabis extract supply ran out in October, his levels dropped so fast and far, he required two blood transfusions. Since then, he makes sure he has the raw materials to maintain a steady supply.
He’s still taking the opioid Percocet, but at lower levels than prescribed. “There are days I’ll feel like popping a perk,” he says. He believes opioids helps him function in the mornings.
He doesn’t share his self-medicating details with his doctors. “Oh, they know, but they don’t want to know.” He’s a firm believer in the conspiracy theory placing the self-regulating bodies that oversee Canadian medical professionals in bed with Big Pharma. Doctors are encouraged to continue prescribing prescription painkillers and discouraged from assisting their patients in exploring alternatives. Career-wise, it’s safer for a doctor to continue prescribing opioids despite a North American epidemic of overdose-related deaths.
Long before the Oct. 17/18 legalization of recreational cannabis, the federal health establishment and its provincial agencies strove to keep the cannabis discussion focussed on regulatory issues for fear of being drawn into a larger discussion concerning the use of cannabinoids as effective, health-insurable prescription drugs.
Since 2013, any doctor in Canada is legally permitted to prescribe cannabinoids without the patient having to enrol in a clinical trial. The exception at that time was Quebec, where as of April 2014 cannabis could only be prescribed “within a research framework,” as it is not a medically recognized treatment.
To satisfy the Collège des medécins’ demand for a framework, a group of doctors and researchers announced in May 2015 the creation of the world’s first research database on the use of cannabis for medical purposes, the Quebec Cannabis Registry (www.registrecannabisquebec.com).
“We need this database to help develop and answer future questions on the medical use of cannabis, such as who uses it, for what reasons, through which methods, and at what dose.” — Dr. Mark Ware, Director of Clinical Research of the Alan Edwards Pain Management Unit at the MUHC and associate professor in Family Medicine and Anesthesia at McGill University.
The Quebec Cannabis Registry collects, compiles and store clinical data collected from patients who use medical marijuana. Participants agree to provide data for four years after recruitment. Any licensed doctor practising in the province wishing to authorize cannabis for their adult patients can thus enrol participants in the registry. The Registry’s creators set a goal of 3,000 participants over a 10-year period beginning in 2015. (It stopped taking registrants this fall after enrolling the 3,000.)
April, 2018: Quebec’s Collège des medécins cautions members against prescribing cannabinoids pending further research into efficacy, dosage and side effects. “Does one prescribe three grammes a day or five,” demands Collège secretary Yves Robert. “And five grammes of what? Cookies? Oil? Inhalation?” Doctors who prescribe cannabinoids instead of opiates had better be able to justify their choice, Robert warns.
The Collège argues that the Registry doesn’t satisfy the criteria of true scientific research and therefore can’t demonstrate that cannabinoids offer a solid alternative to opioids for chronic pain relief.
Quebec’s growing network of private cannabis clinics accuses the Collège of using veiled threats to fearmonger doctors into refusing to consider cannabis as an alternative to opioid painkillers.
Sept 20/18: Three weeks prior to the legalization of recreational cannabis, the CMQ revises its prescription protocols for medical cannabis. Quebec doctors can now prescribe cannabis outside the framework of a research project subject to the following caveats:
— A doctor must know the limits of his expertise and should not prescribe unless medically necessary.
— Based on the principle of ‘first, do no harm,’ the doctor must also ensure that a prescription’s therapeutic benefits must outweigh undesirable potential effects and risks such as dependency.
— Cannabis must not be the first treatment choice. Before considering it for treatment of a medical condition, the doctor must ensure that the patient’s response to other treatments is inconclusive. The doctor must make note of treatments tried and deemed ineffective by the patient.
— The doctor must become aware of policies regarding the use of cannabis for medical purposes as listed on the Health Canada website. The prescription of cannabis isn’t appropriate for anyone under the age of 25, anyone presenting a risk or history of dependancy, those with a family history of psychosis, anyone with cardiovascular or respiratory disease, women breastfeeding, expecting or hoping to be. The doctor must also weigh the risk to ex-smokers of prescribing inhaled cannabis.
— Upon prescribing, the doctor must carry out a full medical evaluation, in person, and must note the patient’s free and informed consent in his file. He must inform the patient of possible effects and complications on the patient’s health (depression, psychosis, mental illnesses, lung disease, connitive decline, memory loss, reduction in professional or scholastic performance). — The patient must be aware of his responsibilities in following this treatment, specifically while driving and preventing the drug’s use by minors.
— The patient must schedule visits to the doctor as needed to ensure adequate followup of his medical condition. A first followup visit should take place within three months of the initial prescription depending on the clinical conditions and until the stabilization of the patient.
The patient must not sell or traffic in prescribed drugs.
— The doctor must cease prescribing cannabis in the event of a complication or if the patient doesn’t fulfill his obligations.
— Treatment must begin with the lowest possible dose and increases must be managed with care.
— In all cases, treatment must be signalled to the the treating physician as well as to other doctors following the patient with the patient’s consent.
— The doctor must note in the patient’s file the indication for which the cannabis is prescribed.
— The doctor must keep a register of patients for whom he has prescribed cannabis so as to permit control and adequate followup of his clientele and rapid access to files.
The CMQ protocol also addresses potential conflicts of interest:
The authorization or prescription for the use of medical cannabis or supplementary fees cannot be billed by the physician. The doctor cannot derive profit from prescribing medical cannabis and cannot directly sell or provide it to the patient.
— The prescribing physician must allow the patient the freedom to choose a supplier.
— The physician must safeguard his professional independence at all times and avoid any situation in which he would be in a conflict of interests. To this end, if the physician has financial interests in an enterprise engaged in the production of cannabis, must so inform the patient as well as the milieu where he practices.
Pain specialists expressed disgust at the CMQ’s latest edicts, arguing that opioids, with their known risks of addiction and abuse, are the real problem. Research has shown phytocannabinoids THC and CBD can work in harmony with the body’s own endocannabinoids to mitigate pain. “The pharmeconomy would save millions, maybe billions, in drug and treatment costs with cannabinoids,” a Quebec GP told me.
October 2018: The Quebec Automobile Insurance Board refuses to reimburse the cost of cannabinoids prescribed as a cost-effective pain treatment alternative to opioids such as dilaudid, fentanyl and methadone. Only medications bearing a DIN and listed in the Régime général d’assurance médicaments (RGAM) are reimbursable. (CNESST, Quebec’s workplace health and safety agency, will consider reimbursing the cost of prescribed cannabinoids.)
Of the provinces, Quebec maintains the hardest stance on cannabis. The current government proposes to raise the legal consumption age to 21 regardless of the federal legal age, 18. Quebec is the only province to ban unlicenced cannabis production (not even the federally sanctioned four plants), yet outlets of the SCDQ, the provincially managed cannabis marketing structure, are closed half the week for lack of product. Who benefits from that?
This past April, I attended a cannabis industry conference in Montreal and blogged about it (https://thousandlashes.ca/2018/04/16/cannabis-update-risk-vs-potential/). Major producers Canopy Growth, Aurora and Hypothecary were there, along with Health Canada and a jam of lawyers and lobbyists — regulatory and governance specialists, branding and trademark lawyers, M&A suits. I met venture capitalists and insurance actuaries, producers and foodies.
Researchers provided a reality check to the gold-rush huckerism. A mid-morning panel on the scientific and medical implications of legalization featured McGill’s Dr. Mark Ware, the Université de Sherbrooke’s Dr. Serge Marchand and New Brunswick Health Research Foundation head Dr. Bruno Battistini. They foresaw serious public health issues resulting from Canada’s legalization of the recreational use of cannabis, at that point still six months away. Their biggest concern —the 20 per cent of recreational pot users at risk of mental illness. THC, the psychoactive component of cannabis, latches onto receptors in the brain that trigger certain pleasure reflexes. This 20% is at risk of developing psychotic reactions, especially among adolescents and young adults.
The panel stressed the need for extensive research into phyto-cannabinoids, the collective label given to 142 molecules found in various cannabis strains. The two best-known cannabinoids are delta-9-tetrahydrocannabidiol, or THC, and cannabidiol, or CBD. THC is responsible for many of the pharmacological effects of cannabis, including the psychoactive effect — the high. CBD doesn’t have any of the intoxicating, euphoric effects of THC.
The researchers described CBD’s potential as a medical ‘magic bullet.” Cannabidiol is being used to treat a growing list of conditions — Crohn’s and other inflammatory bowel diseases, PTSD and other psychological disorders, fibromyalgia, rheumatoid arthritis, epilepsy, MS, Parkinson’s, Alzheimer and dementia, austism spectrum disorders, acne — and opioid addiction. But without clinical trials and scientific methodology, the medical cannabis industry can’t advance past the anecdotal stage and opiates will remain North America’s default prescription painkillers despite their toxicity and potential for abuse.
Ware, who has since gone on to become chief medical officer for Canopy Growth, is a West Island family doctor who co-founded the Canadian Consortium for the Investigation of Cannabinoids (CCIC) while serving as director of clinical research at the MUHC’s Alan Edwards Pain Management Unit. He described how difficult it was to convince doctors to enrol their patients in cannabinoid clinical trials because of resistance from the profession’s governing bodies. (To get around Quebec’s Collège des médecins and its convoluted protocol for the prescribing of cannabinoids, Ware and a group of pain specialists in May 2015 launched the Quebec Cannabis Registry (www.registrecannabisquebec.com), the world’s first research database on the use of cannabis for medical purposes. In late 2018, registration was closed at 3,000 patients.)
Drs. Ware, Marchand and Battistini concluded on a down note: In legalizing recreational weed, Canada has opened the door to cannabis’s medical applications. However, they warned, it was a matter of time before the U.S. removed CBD from the DEA’s list of Schedule 1 drugs (no currently accepted medical use, high potential for abuse). Once that happens, Canada would lose its advantage.
As they predicted, the U.S. Drug Enforcement Administration five months later moved CBD from Schedule 1 to Schedule 5, allowing the prescribing and sale of CBD-derived formulations with levels of THC below 0.1%. In December, the Hemp Farming Act of 2018 was signed into law, making CBD a legal agricultural product. Estimates peg the U.S. CBD market at $23B annually within 10 years.
Equally sudden has been the opioid backlash directed at producers and distributors. In the U.S. the attorneys-general of 41 states have served five major opioid producers and three distributors with subpoenas seeking information about how these companies marketed, sold and distributed prescription opioids. Civil class-action lawsuits alleging the industry misrepresented the effectiveness and addictive nature of opioid painkillers are being filed across America.
In Canada, the opioid backlash so far has been limited to B.C., which in August announced it would file a class-action lawsuit against dozens of players in the opioid industry. The province’s attorney-general alleges 20 years of misinformation and deception about the effectiveness and risks of addiction and asked other provinces to join B.C.’s action. Although a number of provinces with their own skyrocketing opioid-overdose death rates said they would review B.C.’s action with an eye to joining it, none have stepped forward.
Why the silence? None of the professionals I spoke with wished to be quoted, but they generally agreed the problem lies with Canada’s medical insurance structure. Public and private insurers buy in bulk from the distributors, who motivate doctors and pharmacists to prescribe.
Are opioids effective, non-addictive painkillers when used as prescribed? Here’s what one Quebec pain and addiction specialist told me: “I came to realize that my patients taking opioids for pain relief were fat, lazy, sweaty, non-functional — and still in pain.” The condition is called opioid-induced hyperalgesia, characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli.
Urinalysis and close questioning led to his discovery that some of his pain patients were trading their prescribed drugs for more powerful alternatives. Others were selling all or part of their prescription for cash. His doctor-patient relationship prevented him from turning them over to the police. The response from the Quebec Collège des médecins? Stop prescribing.
Hudsonites may remember this. For a town struggling to reverse the demise of its Main Street retail, the sight of a trainload of day trippers spending a vehicle-free day shopping, dining and playgoing was all it took to launch talk of a resurgent local economy. (Many visitors said there wasn’t enough to see or do to fill the time, but that’s another issue.)
The idea of train travel generates a lot of feel-good baggage, especially for we who grew up with a dozen daily trains and the Sunday-morning Hangover Special. Old photos are a reminder of what Hudson has lost as service dwindled to a single commuter train weekday mornings and evenings and shuttlebuses, collectively costing taxpayers roughly $270,000 a year.
One of Hudson’s perennial debates is whether subsidizing public transport is worth it. The late mayor Steve Shaar used to quip it was cheaper to buy a car for every one of those taking the train. Since then, I’ve realized the extent to which the taxpayer subsidizes the use of the car (and the driver doubly so). I’m running into more and more people done with a three-hour commute, traffic and lost personal time. I’m also meeting Millennials who reject car ownership and the illusion of personal freedom it conveys.
Is there a social shift underway in Vaudreuil-Soulanges? With a population topping 150,000 and 15% growth between censuses, is it sustainable enough to attract investment in an hourly light-rail shuttle between Rigaud, Hudson’s heritage stations and the bus/rail terminus in Vaudreuil? Will the new Réseau express métropolitain (REM) line terminating in northern Ste. Anne de Bellevue eventually cross the Ottawa River via the Ile aux Tourtes bridge replacement planned for 2028? Shouldn’t we be planning now for what will happen a decade away?
Hudson’s current administration has just begun its second year in office. Council’s orientations include a planning exercise that may or may not result in changes to transport-oriented development (TOD) established by the previous council. Under current densification designations and Hudson’s 10-year-old master plan, the town has limited control over the size and social impact of multi-unit developments within the current one-kilometre TOD zone. It’s another of those inherited headaches we’re having to deal with.
It was with these thoughts that I headed to Trois-Rivières last Friday for the Nov. 9 Forum municipal sur le transport ferroviaire sponsored by the Union des municipalités du Québec. Alone and by car, onto the island on the 40, off the island via the 13 to the 640, to the 40. There is simply no other means getting to and from Trois-Rivières in less than 24 hours — the amount of time it took by steamboat 150 years ago.
The forum drew some 150 participants from throughout the province. During that afternoon’s interactive online survey, we learned that 96% of us arrived by car —most by ourselves. (I confess to not having made an effort to carpool with Hudson mayor Jamie Nicholls and Rigaud’s Hans Gruenwald.) I met mayors, prefects and councillors from among the 500 Quebec municipalities transected by at least one operating rail line. Most of those I spoke with said their priorities were public security and moving freight. Public mass transit wasn’t at the top of most attendees’ lists of priorities despite UMQ president and Drummondville mayor Alexandre Cusson’s opening remarks warning us the planet is at a turning point, that sustainable transport is an essential next step and we, the municipalities, have to sell this to our residents.
With Lac Mégantic mayor Diane Morin in the audience and Transport Canada’s role in creating conditions for the 2013 oil train explosion fresh in many minds, federal transport minister Marc Garneau concentrated on vaunting his government’s doubling of the number of Transport Canada inspectors and investment in level crossing safety. He was followed by Infrastructure and Communities Minister François-Philippe Champagne, who touted the many areas in which the feds and the provinces can partner on rail transport projects.
Quebec’s new CAQ government declared itself behind whatever François Legault promised during the election campaign. In his maiden speech as transport minister, François Bonnardel touched on everything from passenger service in the Gaspé to developing Contrecoeur, on the South Shore downriver from Montreal, as Quebec’s new containerport and intermodal terminus. He noted how the premier is involved “haut et fort” in Via Rail’s plans to double service to Quebec’s smaller population centres — like Trois-Rivières. Again, Bonnardel’s emphasis was on the need to partner with Ottawa and municipalities and to let citizens know what’s happening.
Corporate interests were heavily represented by lobbyists and the forum’s panelists. VIA Rail CEO Yves Desjardins-Siciliano shared a glowing report (below) of VIA Rail’s blue-sky expansion plans for eastern Canada. CN executive president Sean Finn delivered a jolly hundredth-anniversary cheer for CN’s Quebec operations (2,038 miles of track, eight major clients across Canada) and a bold mission statement: we’re ready to help you move goods while removing trucks from Quebec’s highways. He made it clear people-moving isn’t part of CN’s mandate.
Stéphane Forget, chairman and CEO of the Fédération des chambres de commerce du Québec, was alone in mentioning Montreal’s Réseau express métropolitain (REM) light rail transit system due to start moving Greater Montreal residents in 2021. The big challenge in building new lines or reviving old ones, he added, is finding the financing.
Last up at the podium was Martin Soucy, CEO of the Alliance de l’industrie touristique, who tried to convince the crowd Quebec rail tourism can become world-class if enough money is thrown at it.
La présentation de monsieur Yves Desjardins-Siciliano, président et chef de la direction de Via Rail;
La présentation de monsieur Sean Finn, président exécutif des services corporatifs et chef de la direction des Affaires juridiques du CN;
La présentation de monsieur Stéphane Forget, président-directeur général de la Fédération des chambres de commerce du Québec;
La présentation de monsieur Martin Soucy, président-directeur général de l’Alliance de l’industrie touristique;
The forum produced a formal declaration, the Déclaration de Trois-Rivières, creating a UMQ’s rail transportation committee dedicated to making rail transport safer, more competitive and more convenient. Like the day’s event, I found the declaration to be vague and flabby — deliberately so. Is the focus on moving freight more cheaply, more safely and conveniently? In that case, what happens on lines where passenger rail schedules are forced to mesh with freight? Greater Montreal’s commuter lines — and their users — pay the price in dependability and frequency.
Environmental concerns got the requisite lip service. The UMQ commissioned a CROP poll which found nearly nine out of 10 Quebecers (87%) use their cars for trips of 100 or more kilometres, compared to 4% who take the train. Fewer than one in four (22%) use the train as an alternative to driving. At the same time, more than a third (37%) of those polled think government should invest in public transit by rail because it’s the best existing alternative to the car. One in four (28%) say it’s because rail transit reduces greenhouse gas emissions. In other words, a significant percentage of those who say we need more rail transportation aren’t using it now.
In one aspect, the Forum was an incredible success. Everyone with business in rail was there and available. I walked into a conversation between La Megantic’s mayor Diane Morin and François Rebello, a former PQ-turned-ADQ MNA who now lobbies on behalf of municipalities looking to resurrect disused rail lines for freight and passenger service. Morin told me her town’s chief concern is ensuring its industrial park has punctual freight service. What about passenger service? The line is too old and bumpy to allow passenger trains.
We talked with Jean Bouchard, the mayor of Mirabel, a sprawling suburb north of Montreal. Like Hudson, Mirabel is part of the 82-municipality Montreal Metropolitan Community and Bouchard sits on the board of the Réseau de transport métropolitain (RTM), the organism responsible for developing MMC public transit policy. Despite being crisscrossed with old rail lines, Mirabel has no rail commuter service. A new station is planned as part of Exo’s St. Jerome commuter rail line, but there’s no hard completion date.
Bouchard explained how the RTM is responsible for policy, while Exo, the aptly named melange of ARTM, AMT, STM and a half-dozen other public transit entities, oversees operations. Most of the conversation centred on the dog’s breakfast of schedules, services and bad decisions the RTM is having to work its way through in creating a single public transit structure that will guarantee the same level of service throughout the MMC. It wasn’t encouraging, but I took some relief from knowing Quebec’s best entrepreneurial minds are on the job.
As I made the 150-minute drive back to Hudson via the 40, 640, 13, 40 and 342 in steadily worsening Friday-afternoon traffic I wondered what it will take to break Quebec’s addiction to personal transportation. Ever-longer commutes won’t do it, because for many, the commute by public transit is still longer and less convenient. Either deliver on promises such as those made at the UMQ Forum, or continue to pretend there isn’t a worsening public transit crisis.