English translation

As a member of a multidisciplinary team concerned with chronic pain, involving pain specialist Gary Bennett, psychologist Ann Gamsa, epidemiologists Stan Shapiro and Jean-Paul Collet, as well as Vainio, Ware assesses people suffering from "pain that just won't go away." He sees patients suffering "phantom limb pain," the pain in a limb that's been amputated; post-trauma pain, often the result of a car accident which afflicts the neck or lower back; and chronic post-surgical pain.

While analgesics, physiotherapy, group therapy and the relaxation techniques used in the Pain Centre help some patients, much of the pain caused by damage to nerve roots eludes the standard medical responses. "There's a huge unmet clinical need [for better pain management]," says Ware.

AIDS patients have long known this: an estimated 30% smoke marijuana to assuage the pain, nausea and loss of appetite caused by the disease and AIDS medication. Ware just finished a contract with the Community Research Initiative of Toronto, where he helped design the research protocol for a clinical study on the effect of smoking pot on various symptoms of AIDS.

Among his own patients, some are cannabis users and Ware will note any observations they offer of how the herb helps - but only if the information is volunteered. Revealing information on illegal drug use, even in a clinical context, requires the patients to sign a consent form in which they acknowledge that if the police ever question the researchers about a particular patient, that patient runs a very small risk of being turned in.

"It's a theoretical risk, but we do it [get signed consent] just in case," says Ware. "It happened in Australia where researchers were looking at LSD and ecstasy."

His own trial will be a small pilot study - small to ensure that all the bases are covered. There will be questions of licensing the hospital pharmacy, having the police on side, handling the media and finding a government-approved source of low-THC cannabis to act as the placebo. "It will only be by getting the study started that we'll know what to look for in a larger study."

Concerning the potent stuff, the government has already got its supply growing - 365 metres underground in Flin Flon, Manitoba. The first crop will supposedly be ready for harvest this fall and will allow the government to dispense 100,000 joints of marijuana with a 6% THC level. THC is the psychoactive and best-known cannabinoid, but Ware points out that there are at least 60 others, and though the drug companies are busy teasing out just which cannabinoid is good for what, the character of each is not well understood.

What the pharmaceutical industry will not do is study smoked cannabis, making the work done in universities and community research initiatives doubly important in Ware's estimation, "since we have to consider the plant's efficacy and safety."

It's work Ware is anxious to get on with and he takes heart from the fact that the government is soon going to have a harvest of cannabis to distribute to approved users and researchers. He wants to understand, for instance, just what it is in the actual smoke or all that's associated with taking a deep puff and holding it that seems to ease so many symptoms. "It's not clear to me," he says, "that the cannabis reduces pain. It may be that it improves the quality of life by reducing depression or insomnia, for instance, which in turn makes the patient less vulnerable to pain."

It's fitting that McGill is supporting the demystification via science of this misunderstood agent. The University has a long history of research into pain and once the study is up and going it won't be the first time that marijuana has been prescribed by McGill physicians. More than 100 years ago, Sir William Osler prescribed the herb to relieve migraine headaches; prescribing cannabis at the time was commonplace.

Ware isn't sure why cannabis, both as a medicine and as a source of fibre used to make cloth and rope, fell out of favour in the 20th century after thousands of years of "occupying an enormous place in human history." The word canvas, for instance, reminds Ware of its origins in the plant name, as does Hampstead, England, where hemp, a species of cannabis grown for fibre, was cultivated. Some suggest that the industries which produced synthetic fibres, such as nylon and polyester, and which also synthesized painkillers, played a role in first discrediting then demonizing the ancient herb.

But Ware is optimistic that with the public's interest in plant-source medicines and the pressure on governments to study and regulate herbal remedies, there will be an opening in medical science. "To me, the cannabis study represents a kind of template with which to cross from a plant-based medicine to a clinical trial, to see if the two can intersect. I'd like to look at other herbal medicines, to check for their potency and safety," he says, naming the popular echinacea, St. John's Wort and evening primrose.

"Cannabis today is where alcohol was in the 1920s and morphine was in the '40s and '50s. There's the attitude that Ôwe can't touch this, it's too dangerous.' But all the fears about morphine weren't realized."