Doctors can now prescribe a visit to the ROM through a new initiative to combat anxiety and loneliness

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When Nafisa Nezam Omar was diagnosed with post-traumatic stress disorder, she got an unusual prescription: T’ai Chi.

Several months after enrolling in the traditional style of martial arts, Omar, who lost her husband to a heart attack as well as a brother to gunfire and a sister to rocket shelling in Kabul, says she’s “finally being able to enjoy my life.”

“I’m now volunteering and doing well,” she said.

The Rexdale Community Health Centre, where her doctor is based, is among Ontario community health centres taking part in a pilot program that offers social and artistic remedies — including choir classes, fishing lessons, knitting and a visit to the Royal Ontario Museum — as an alternative treatment for certain health issues such as anxiety and loneliness.

The ROM announced Thursday it would be offering 5,000 free passes, each valid for four people, as part of the project.

“One of the things they’re trying to promote is a sense of belonging and empowering people to participate,” said Kate Mulligan, director of policy and communications for the Alliance for Healthier Communities, which represents 107 community-governed primary health care organizations and is leading the one-year program.

“It might be that the physician or nurse practitioner sees that you’ve been coming in 10 times and a medical solution is not readily available for what’s bothering you.”

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Among the most common complaints — gobbling up physician time and cost OHIP — is loneliness, Mulligan said.

She said through the program patients who meet the criteria are referred to a link worker, who walks them through a menu of treatment alternatives. The full menu of programs are free of charge to participants.

“The Rexdale program has focused on ROM-type things and getting people to participate in the community,” Mulligan said.

The concept of “social prescriptions” — where health practitioners prescribe artistic and social activities as alternatives to medication for people with mental health difficulties — started in the U.K., and has caught on in Montreal.

The Ontario program was launched this summer with a $600,000 grant from the provincial health ministry, targeting health needs of people who aren’t well-served by the mainstream health system, such as people who are racialized, LGBTQ, those facing employment barriers and Indigenous people, Mulligan said.

“The money is not for us to hire staff at the centres or implement,” she said. “It’s more to do with how to evaluate this, so we can learn how it works and see if it improves health outcomes and reduces costs to the health system.”

Aided by a group of mentors parachuted in from the U.K. — where social prescribing shows promising results — the local team commenced designing Ontario’s first model for social prescribing in June.

An evaluation of a similar project in Gloucestershire, England, done by the University of West England in 2016, showed a 23 per cent decline in attendance and emergency admissions, decreasing dependence on primary care, and physician appointments declining by 21 per cent in the six months after a social prescription.

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“It’s really taking off in the U.K and their context is similar enough that we could see a strong connection and a way to sort of transfer the approach to here,” Mulligan said.

She’s keen on tracking how singing groups, such as choirs, might increase lung capacity for people battling chronic obstructive pulmonary disease.

“There can also be singing groups for people with Alzheimer’s,” she said.

The fate of the program will hinge on final outcomes, but Mulligan said if uptake figures are any barometer, then the thousands of people she estimates are already socially prescribed in Ontario is a precursor to success.

“Within the next six to 10 months we will have answers for the type of health outcomes we’re seeing,” Mulligan said.

The objective is to draft a final report recommending how to make social prescribing permanent for the 11 participating community health centres and potentially expand out to others under the Alliance’s banner.

“The plan is to make this sustainable for them without having to infuse any new workers or new money,” Mulligan said. “It’s an expectation that all 11 will continue doing it.”

The program is being heralded as a groundbreaking yet vastly underrated method by supporters, such as Dr. Iris Gorfinkel, a general practitioner in Toronto.

“I’m a huge proponent of this idea,” said Gorfinkel, who wants to see the practice expanded. “As family doctor I see so much loneliness and so much problems that arise directly from loneliness.”

With medical evidence linking loneliness to several psychiatric disorders, it represents a “very large aspect” of Gorfinkel’s work as a general practitioner.

“Consider that about 25 per cent of visits to a family doctor are related to psychological matters,” she said.

She said studies in England have found loneliness can be equivalent to smoking in terms of its health effects.

“It’s extremely damaging,” she said, so much so that she contends it should be a part of doctors’ routine questions during patient visits.

The outcome of the study will be highly anticipated in medical circles, she said.

“I’m looking forward to their findings,” Gorfinkel said.

Jason Miller is a breaking news reporter based in Toronto. Reach him on email: jasonmiller@thestar.ca

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Why is Shoppers Drug Mart training doctors to prescribe medical cannabis?

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This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

« Shoppers Drug Mart presents: ‘Medical Cannabis: The Future is Now.' »

That was the notice sent to Canadian doctors who were invited to register for « an exciting educational event » that would give them tools « to capably and confidently authorize medical cannabis for your patients. »

Interested doctors could sign up for one of four sessions being held across Canada.

Why is Shoppers Drug Mart holding education sessions for doctors on how to prescribe cannabis for their patients?

« Somebody has to do it, » said one family doctor on his way into the Vancouver event on Thursday evening. « On the whole for me I am confused. Who do I listen to? Who do I send my patients to, because I know I do not have adequate knowledge? »

Who should train doctors on prescribing medical cannabis?

But Toronto family doctor Sharon Cirone questions whether this medical education should be offered by a drug store chain that wants to get into the business of selling medical cannabis.

« It’s not appropriate and it’s not necessary » she said, adding that there are resources being developed by the College of Family Physicians of Canada, and other medical associations that don’t have a vested financial interest in cannabis.

The issue brings into sharp focus two increasingly controversial questions — how should a product that has not been approved through the normal drug approval process be used in medical practice? And who should be selling it?

Some doctors say they have no idea how to properly prescribe a product patients ingest though smoking. (Livia Manywounds/CBC)

Right now, pharmacies are not allowed to dispense medical cannabis. Instead patients must get it through the mail, after first getting authorization from a doctor and then registering with a licensed producer.

(Last week CBC News reported that medical cannabis users are facing supply disruptions in the first rush to supply newly legalized recreational market.)

National pharmacy chains are lobbying for legislation that would let them sell medical cannabis.

« This is basically the only product for medicinal purposes that does not go through a pharmacy, » said Justin Bates, CEO of The Neighbourhood Pharmacy Association of Canada which represents major drugstore chains and large retailers with in-store pharmacies.

The Canadian Pharmacists Association (CPhA) said patients would be better served if pharmacists were the ones dispensing medical cannabis.

« Typically the patients who are using cannabis for medical purposes are not using it as first line, » said CPhA spokesperson Shelita Dattani. « They’re on other medications which may have drug interactions with cannabis, they may be experiencing adverse effects, and we’d like to make sure we’re helping to keep patients safe. »

Lack of evidence still a concern, says CMA

But the professional pharmacist licensing agencies are not as keen for their pharmacists to jump into the medical cannabis field. The National Association of Pharmacy Regulatory Associations outlines that hesitation in a position statement.

There is similar hesitation from the Canadian Medical Association about doctors embracing cannabis use in their practices.

« The CMA remains concerned about the lack of clinical research, guidance and regulatory oversight for cannabis as a potential medical intervention, » the CMA states on its website.

« Physicians [are] being asked to prescribe something that is not approved, and that is largely ingested by smoking, » said Cirone. « Physicians have never been put in the position to prescribe a smoked product before and expose the lungs to disease. »

Right now, some doctors avoid dealing with the problem and instead direct patients to the recreational cannabis market, even though medical users might have different medical cannabis needs, such as achieving pain relief without getting high.  

Canada has two separate cannabis markets— recreational and medical. (CBC)

Is there a conflict of interest?

« Now with it being legal, many patients are going forward and getting a product and asking afterwards for guidance on how to use it, » said Winnipeg oncologist Dr. Paul Daeninck. He routinely gives talks to doctors about his experience using cannabis to treat cancer pain and other palliative conditions. He’s one of the panelists involved in the Shoppers Drug Mart seminars.

Is there a potential conflict of interest?

« I feel that a company or a group that’s providing education and trying to do it in an unbiased manner is really doing the right thing, and bringing in experts to talk about it is important, » Daeninck said. 

This is the first step in our journey to provide medical cannabis to our patients, »– Catherine Thomas, Loblaw Companies Limited

« The sessions, developed and presented by key opinion leaders from top Canadian universities and hospitals, cover the most up to date information about research into medical cannabis, including its use for a variety of disease states, » said Catherine Thomas, spokesperson for Loblaw Companies Limited, which owns the Shoppers Drug Mart chain.

In September, Shoppers Drug Mart received a licence from Health Canada to purchase and store pre-packaged cannabis products from existing licensed producers.

« This is the first step in our journey to provide medical cannabis to our patients, » Thomas said in an email.

Health Canada confirmed that Shoppers Drug Mart pharmacies cannot sell cannabis even through the mail, until the company receives a second Health Canada licence.

« There is no licence under the Cannabis Regulations that would allow Shoppers Drug Mart, or its subsidiary companies, to sell cannabis in its stores, »  Health Canada spokesperson Tammy Jarbeau said in an email.

With files from Manjula Defresne in Vancouver.

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