Cover Photo by RAFAL GERSZAK/THE GLOBE AND MAIL

Dr. Ellen Wiebe focuses her work on Abortions and Assisted Dying, procedures that she says are very similar in that they are basic human rights that people are denied access to.

Through her work and research she has done some incredible work for women and is globally renowned for killing off sexual health myths with science. A lot of her research involves cannabis – initially she wanted to find out if it could help with period pain and then medical abortions.

She then wanted to find out if cannabis really enhances sexual pleasure.

We interviewed her about her studies and experiences in the medical field.

Tell us about yourself, your field of study and experience?

I’ve been a family doctor for many years and have enjoyed doing research over the last few decades – most of it in women’s health. I’ve been doing abortions and contraception in my work and also in my research. In the last three and a half years my work and my research has been in assisted dying.

Abortions and assisted dying are amazingly similar, and in many ways they are basic human rights for which there is problems with access. The reason I got involved in marijuana research was because I was looking at pain control for medical abortions. I started looking at how marijuana was used for period pain and and then in medical abortions.

I had also been doing some other research on contraception with sexual side effects of hormonal contraception. So I had been doing both work on sex and on marijuana and my research associate Allie said, let’s put them together and research how people use marijuana for sex. And so that’s how we came to do this particular project.

What Were The Overall Goals of the Study?

My focus was more on the issues around sexual pleasure and marijuana than as pain and symptom control for abortions. But together we decided that there was a lot of general knowledge or belief that marijuana made sex better and no science, none.

When we looked into the science, it was the exact opposite – marijuana shouldn’t make sex better. When you look at the biochemistry on endocannabinoids and how are they related to sex hormones, you would predict that marijuana would make sex worse, that it would interfere with sexual pleasure.

We knew that the common belief around it was that it made it better. So this made a real interesting puzzle. Why does the biochemistry around cannabinoids make you believe that it should interfere with sexual pleasure and then people are specifically using it for that? So I just wanted to understand more.

Who did you study? Male, female?

What we wanted was people who had experienced using marijuana with sex, that’s all I needed. We used social media and we had an online questionnaire that we designed with some other people. We promoted it through various social media through organizations that promoted marijuana use and through the marijuana shops at that point.

At the time we did the study, we had a legal medical marijuana in Canada but not recreational. But it was widely used and widely sold openly in shops without being prosecuted. So it was socially acceptable enough and we just got whoever we could regardless of demographic.

What did you find out?

It was fascinating because we wanted to know how people use it, whether they use it specifically to enhance sex or whether they just happened to have sex when they happen to be using marijuana. We wanted to know what effects they found were good ones, what bad ones, and what worked, what didn’t.

What we found was interesting and it helped explain the answer for why people felt it was helpful when it shouldn’t have been. The issue was that marijuana specifically increased sensitivity to touch, which is not specifically a sexual thing, but it is a general thing that one is more than sensitive to touch. And, it causes relaxation. Those were things that enhanced sex for people.

The negative things around when marijuana interfered with a sexual experience had to do with getting too sleepy, which of course would be a dosage related issue. If you have a little bit, you don’t get sleepy, you smoke a little bit more, you can get sleepy.

If they were too sleepy, then they’d lose interest in sex, or wasn’t as a as good. Another bad side effect is if they became agitated in some way, which some people get from marijuana. Usually a too high dose might cause some agitation. Those were negative things.

The heightened sense of experience, people found to enhance sex as well as other experiences. Also cannabis provides a feeling of closeness and bonding with their partner.

Most of these things are not specifically sexual – a closeness and bonding with a partner. You can naturally see what improved the quality of your sexual experience, even though it isn’t specifically related to sex hormones or the nerves around sex organs.

It’s a general feeling of heightened sensation and intensity. So then it made sense that you could have a substance that shouldn’t work if you’re looking at the actual effects on a endocannabinoid system – but somehow does.

Because these are other aspects of sexuality. It’s not just nerves in your sexual organs and you know that give you sexual pleasure. It’s a whole lot of stuff.

How hard is it to do Research Like this in Canada?

Cannabis is federally legal in Canada and there’s still roadblocks to research. This kind of observational study, no problem. I could get approvals for that. But when I was trying to do some randomized controlled trials, I could not get the substances – even though it is legal for recreational use.

It was also very complicated because, for a randomized controlled trial, I didn’t want to use fire and smoke. I wanted to use something easier to manage in a research study. So I wanted oral, oil drops. but I could not get them because for a research trial it had to be standardized and, approved through various levels and I couldn’t get it.

Every time you see a scientific or medical paper on the effects of marijuana, they say more research is needed. But it’s really hard to do. I only wanted to study legal substances that people have access to. I didn’t want to study these synthetic versions that are prescription drugs used in cancer patients. I wanted to use the stuff that you can buy in Colorado shops and in Vancouver shops – stuff that people can buy.

We need randomized controlled trials as well as observational trials.

Tell us about Cannabis and Menstrual Pain?

I wanted to get a hold of women who had used marijuana for menstrual pain. And what I found was that 80% of the people who responded to my survey had extreme severe menstrual pain. The kind that makes you rive on the floor and vomit, that kind of menstrual pain.

They had lots to tell me about how they use marijuana successfully for it and how they had tried everything else and nothing worked. Clearly an important issue that we need to know about. This is one that it’s a little scary to talk about because who has the most severe moments for pain? Teenagers. Are we going to recommend marijuana to teenagers when it might be affecting growth and developing brains? Highly unacceptable.

You talked also about Medical abortion pain?

What all we did with abortion pain, what we were looking at was what people were using. So we asked hundreds of women who had medical abortions, what they used other than the prescription drugs that were given to them. Marijuana was one of them. It was being used but not filed by a high percentage.

Medical abortions feel like a really, really bad period. And it’s very, very painful.

I wanted to study it properly and know if it was something that we should be recommending.

When I provide medical abortions, all of our patients are asked what drugs they use, both recreationally and medically. When I see that they are marijuana users, I will then recommend it but never to somebody who doesn’t say that they are already using it.

So if they say that they’re using it, then I will talk about it and say marijuana also helps. But I know I can’t ever truly recommend it until somebody does the trial that I was wanting to do. A randomized controlled trial to say if cannabis works for medical abortion pain.

Would a Cannabis and Medical Abortion Pain trial be a “Bucket List’ Trial for you?

No, I have veered around and do most of my clinical research activities on assisted dying.

Weren’t You Almost Convicted of Murder for Your Work in Assisted Dying?

No criminal law charges of any kind. Just formal complaints of various sorts because I work on the edge. I stayed within the law all of the time, but work right up to the edge of the wall.

If you Could Research Anything with No Government Restrictions, What Would It Be?

Exactly what I was trying to do a few years ago, which is a randomized controlled trial on how cannabis could help the symptoms of medical abortions. The reason is that medical abortions include pain, which is caused by the muscle contractions of the uterus and nausea which is a direct medication effect as well as the effects of the pregnancy hormones.

There’s a lot of stress involved. Women are scared, they’re worried – it’s just an upsetting time. Even if they know for sure that they don’t want a baby at this time, there’s sadness involved and there’s difficulty. It’s a really tough decision.

So it seemed to me that marijuana, takes care of nausea better. That’s why we use it in cancer patients who are vomiting from their chemotherapy. It works better than most of our other anti-nausea methods. It does something special about pain relief, particularly in uterine contraction pain which is what we learned from the menstrual period.

In addition, it causes some relaxation if it’s at the right dose. If you can give one medication that is short acting and doesn’t have long term effects, yet it could handle the nausea and the pain and some of the anxiety involved in a medical abortion, we could get people through more easily.

That’s what I really would like to have somebody do. It’s, it just makes sense that this is what we would want to use.

Now that I’m working in end of life care more than abortion care, I see cannabis being used all the time. It’s being used for people who’ve never used it recreationally. My 95 year olds are getting relief from terrible symptoms.

With cancer we’re talking about the combination of nausea and pain and distress. Many people find cannabis more useful than anything else that they try.

One five and 10 year prediction, what would your predictions be?

Well, I’m sure that people will do some real research. Both in the Biochemistry realm as well as the more practical realm of what should be used in arthritis and in cancer and Epilepsy and those things. Preferably with plant as opposed to some synthetic versions.

10 years from now we’ll have answers to all these questions that you and I have.

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