On February 2020, at my request, I was referred by my family physician to the Centre for Addiction and Mental Health (CAMH). I was seeking therapy for some minor mental health issues (anxiety, depression, chronic fatigue, and sleep issues).

During the intake call, I was asked some questions, one of which was regarding my alcohol/drugs use. As I always did, I answered all the questions honestly. I disclosed that I use cannabis to cope with anxiety and for sleep.

A few months later, I received an email from CAMH informing me that I have an appointment scheduled with Dr. Nitin Chopra.

Because of the COVID-19 lockdown, the appointment was set to be conducted online.

On the day of the appointment, when I connected to the online platform, Dr. Chopra wasn't available. Instead, a student informed me that he will be the one conducting the assessment interview.

The student asked me a series of questions he read from his notes.

The internet connection he was using was so slow, the call kept dropping every 2 minutes. He then told me that he will discuss with Dr. Chopra, and he will call me over the phone instead.

An hour or so later, the student called and said that he consulted with Dr. Chopra, and that they will report me to the Ministry of Transportation of Ontario for substance use disorder. He added that my driver's licence will be suspended.

He then told me that if I accept to get screened for cannabis every 2 weeks, and if I continue going to CAMH, then they will NOT report me to the Ministry of Transportation. Finally he said that they will prescribe me a safer alternative to cannabis called gabapentin.

That was it!

It sucked the air out of me. I was shaking. It was surreal. I couldn't believe what just happened. I was in total shock and panic.

I told him that I don't own a car and I rarely drive. I told him that I use my driver's licence only as an official ID. But he didn't care.

It's only a few hours later that I realized that what just happened had nothing to do with how medical exams are usually conducted. I never experienced anything remotely close to a situation like this.

I was threatened and coerced to take a medication I never asked for. I had no say in MY treatment. I wasn't given any other treatment options or alternatives. It was all about taking gabapentin instead of cannabis.

I was treated like a criminal and thrown away! Actually no! Even criminals have rights. They have the right to stay silent, they have the right to a lawyer and they also have the right to a fair trial. I had none of that. I was convicted without proof or trial.

But there was no turning back. Either, I take gabapentin and I get screened for cannabis every 2 weeks during the first COVID-19 lockdown. Or, I will lose my driver's licence.

That same day, I sent an email to Dr. Nitin Chopra where I complained about the way the initial appointment went, and the threats I received from his student. I clearly and repeatedly told him that I do not want to continue any treatment at CAMH.

To my surprise Dr. Chopra never answered to my email. Instead, the student sent me a short message saying that on our next appointment he will clarify to me again their legal obligations to report cannabis users to the MTO.

Despite the fact that I repeated many times that I do not want to continue any treatment at CAMH, Dr. Chopra and his student continued to dangle the driver's licence suspension if I keep refusing to take gabapentin.

I did everything I could to cancel the upcoming appointment. But a few weeks later, I received a call from Dr. Chopra's office administrator asking me to confirm the next appointment which was scheduled that same day in the afternoon.

Considering that I never met or spoke with Dr. Chopra, and that I didn't know if my driver's licence was suspended or not, I decided to keep the appointment.

As soon as I hung up, the phone rang again, but this time it was Dr. Chopra himself. Despite the fact that my appointment was scheduled 3 hours later!

I asked Dr. Chopra why do I have to take gabapentin? His answer was: 'Because you have a heavy cannabis addiction'.

But this makes absolutely no sense as I am legally allowed to use cannabis for medical purposes. The quantity I disclosed using is half of the quantity allowed by my medical cannabis prescription. Why did Dr. Chopra decide that I have a heavy addiction?

Why is it that my family physician who met me in person so many times, never said that I have a 'heavy cannabis addiction'?

Why is it that no other doctor or healthcare professional think that I have a 'heavy cannabis addiction' or that they had to report me to the MTO?

Moreover, according to the Ministry of Transportation's own regulations, medical cannabis users are not even subject to Ontario’s zero tolerance drug requirements.¹ Why did Dr. Chopra threaten to report me despite the fact that he knew that I wasn't driving at all?

During our one and only phone call, Dr. Chopra turned out to be the most dishonest person I ever spoke to. When he realized that I wasn't going to be an easy prey, he changed his mind and said that he will discuss again with the student regarding the reporting to the Ministry of Transportation.

Now, Dr. Chopra doesn't think anymore that I am putting other peoples' lives at risk. All this was just scare tactics to take my right to informed consent. At this point, I could have let go and kept my driver's licence.

Instead, I decided to look for more information about gabapentin. What I uncovered still boggles my mind.

In Canada, there is a silent dirty war being waged against medical cannabis patients. Since the legalization of cannabis, Big Pharma lost billions of dollars to the medical cannabis industry.^{2 3}

Follow the money as they say...

According to FortuneBusinessInsights, the cannabis market was valued at $20.47 billion in 2020 and is projected to reach $197.7 billion by 2028. Over 30 countries have already legalized its medical use through various national programs.⁴

This rapid adoption of medical cannabis for various medical conditions such as pain management, sleep disorders, and anxiety is anticipated to expand even more in the coming years.

As cannabinoids have shown higher potential in pain relieving experiments than opioids, these are showcasing an upsurge for chronic pain treatment. Medical cannabis is also noted to replace opioids for the pain management applications owing to numerous side effects of opioids.⁵

In 2018, a prominent Democratic U.S. senator slammed pharmaceutical companies for opposing marijuana legalization.⁶

"To them it's competition for chronic pain, and that's outrageous because we don't have the crisis in people who take marijuana for chronic pain having overdose issues," Sen. Kirsten Gillibrand of New York said. "It's not the same thing. It's not as highly addictive as opioids are." ⁷

"What I see is the opioid industry and the drug companies that manufacture it, some of them in particular, are just trying to sell more drugs that addict patients and addict people across this country." Sen. Kirsten Gillibrand of New York said.⁸

In Canada, pharmaceutical companies are fighting back to keep their market share by turning physicians into predators. These shameless doctors are conducting a witch-hunt against their own patients.

In my case, I was coerced to take gabapentin because allegedly it's a safer alternative to cannabis. Let's see if that's really the case.

The drug Neurontin (gabapentin) was approved by the FDA solely for adjunctive or supplemental anti-seizure use by epilepsy patients.

Since then, gabapentin became the 10th most prescribed drug despite the fact that there is little data to justify how this drug is being used. ⁹

This was the result of an aggressive, illegal and fraudulent marketing scheme designed to promote unauthorized off-label uses of gabapentin.¹⁰

An investigation was conducted in 2004 by the Health Care Fraud Squad in the Boston Office of the FBI, when a former medical liaison for Warner-Lambert filed a whistleblower suit on behalf of the U.S. government.¹¹

Warner-Lambert, the manufacturer of the drug Neurontin at the time, agreed to plead guilty and paid more than $430 million to resolve criminal charges and civil liabilities in connection with the illegal and fraudulent promotion of gabapentin. This was the second largest criminal fine ever imposed in a health care fraud prosecution.¹²

According to the settlement (found here), Warner-Lambert used a number of tactics to achieve its marketing goals, including:

• Encouraging sales representatives to provide one-on-one sales pitches to physicians about off-label uses of Neurontin without prior inquiry by doctors.

• The company’s agents also made false or misleading statements to health care professionals regarding Neurontin’s efficacy and whether it had been approved by the FDA for the off-label uses.

• Warner-Lambert also utilized "Medical Liaisons," who represented themselves (often falsely) as scientific experts in a particular disease, to promote off-label uses for Neurontin.

• Warner-Lambert paid doctors to attend so-called "consultants meetings" in which physicians received a fee for attending expensive dinners or conferences during which presentations about off-label uses of Neurontin were made. These events included lavish weekends and trips to Florida.

• The pharmaceutical company implemented numerous teleconferences in which physicians were recruited by sales representatives to call into a pre-arranged number where they would listen to a doctor or a Warner-Lambert employee speak about an off-label use of Neurontin.

• The company also sponsored purportedly "independent medical education" events on off-label Neurontin uses with extensive input from Warner-Lambert regarding topics, speakers, content, and participants.

• Warner-Lambert misled the medical community beforehand about the content, as well as the lack of independence from the company’s influence, of many of these educational events. In at least one instance, when unfavorable remarks were proposed by a speaker, Warner-Lambert offset the negative impact by "planting" people in the audience to ask questions highlighting the benefits of the drug.

• Warner-Lambert paid physicians to allow a sales representative to accompany the physician while he or she saw patients, with the representative offering advice regarding the patient’s treatment which was biased towards the use of Neurontin.

• Warner-Lambert directly promoted off-label drug uses to Veterans Affairs physicians and pharmacists on a nationwide basis, in direct violation of FDA laws. As a result, from 1994 to 2002, sales of Neurontin to the Department of Veterans Affairs jumped from $287,000 to $43.2 million.

These tactics were part of a widespread, coordinated national effort to implement an off-label marketing plan. At the same time, Warner-Lambert decided not to seek FDA approval for any of the new uses because it was concerned that approval for any of the non-epilepsy uses would allow generic competitors of Neurontin, which was expected to go off-patent soon, to compete with a "son of Neurontin" drug that Warner-Lambert hoped to have approved by the FDA for both epilepsy and non- epilepsy uses.

Pfizer, Warner-Lambert’s parent company, has agreed to comply with the terms of a corporate compliance program, which were supposed to ensure that the changes Pfizer made after acquiring Warner-Lambert are effective in training and supervising its marketing and sales staff.

Unfortunately, doctors are still prescribing gabapentin in record numbers.¹³ Furthermore, the two major sources of gabapentin were physicians (52%) and drug dealers (36%), and street costs were reported to be less than US$1.00 per pill.¹⁴

As a result, a large number of jurisdictions took action to track gabapentin's use through prescription monitoring programs.

Table 1 - International regulatory status, amendments or monitoring of dispensing for pregabalin and gabapentin.¹⁵

Year	Month	Country	Measure
2005	July	United States of America (USA)	Pregabalin: Drug Schedule V Controlled Substances (Federal law).
2015	May	Saoudi Arabia	Pregabalin: Limited prescription, dispensing only in state health-care structures and use of a prescribing register.
	October	Russia	Pregabalin: Listed as controlled medicine
	December	United Arab Emirates	Pregabalin and Gabapentin: List of Controlled Medicines and Medications, Narcotic and Controlled Prescriptions. Limited prescription to 3 days for general practitioners, 2 weeks for specialists, 4 weeks in hospital. Prescription validity: once (no possible renewal). Register for prescribers and pharmacies and specific prescription support provided by the Ministry of Health.
2016	August	Minnesota (USA)	Gabapentin: Mandated reporting to a PDMP
	December	Argentina	Pregabalin: Listed as Other Substance for Special Control
		Ohio (USA)	Gabapentin: Mandated reporting to a PDMP
2017	February	Virginia (USA)	Gabapentin: Mandated reporting to a PDMP
	May	Wyoming (USA)	Gabapentin: Mandated reporting to a PDMP
	July	Armenia	Pregabalin: Listed as controlled substance
		Kentucky (USA)	Gabapentin: Drug Schedule V Controlled Substances with mandated reporting to a PDMP (State law)
		West Virginia (USA)	Gabapentin: Mandated reporting to a PDMP
	August	Massachusetts (USA)	Gabapentin: Mandated reporting to a PDMP
		North Dakota (USA)	Gabapentin: Mandated reporting to a PDMP
	November	Turkey	Pregabalin: Prescription validity for 1 year. Specialized opinion (neurologist or psychiatrist) for chronic prescription. Electronic prescription since January 2018.
	November	Jordan	Pregabalin: Listed as controlled substance, second table (Drugs, Psychotropic substances and Precursor chemicals appended to the Narcotic Drugs and Psychotropic Substances Law no. 23 of 2016). Limited packaging to 64 tablets. Prescribing and dispensing register.
2018	January	Nebraska	Gabapentin: Mandated reporting to a PDMP
	April	Norway	Pregabalin: Schedule B (alongside benzodiazepine)
	May	New Jersey (USA)	Gabapentin: Mandated reporting to a PDMP
	June	West Virginia (USA)	Gabapentin: Drug Schedule V Controlled Substances (State law)
	July	Sweden	Pregabalin: List of substances to be considered narcotics under the Penal Law on Narcotics.
		Tennessee (USA)	Gabapentin: Drug Schedule V Controlled Substances
		Kansas (USA)	Gabapentin: “Drug of concern,” mandated reporting to a PDMP
2019	January	Michigan (USA)	Gabapentin: Drug Schedule V Controlled Substances (State law)
	April	United Kingdom	Pregabalin and Gabapentin: Category C
	June	Washington (USA)	Gabapentin: Mandated reporting to a PDMP
	July	Virginia (USA)	Gabapentin: Drug Schedule V Controlled Substances (State law)

In Canada, the situation could not be more different. Not only Canadian health authorities are extremely slow to react, as gabapentin is still considered a safe medication. It is also being prescribed off-label for many conditions like anxiety, migraines and even sleep. More importantly, patients get reported when they REFUSE to take gabapentin.

This was made worse by laws and regulations that have been amended to make it possible for physicians to report their patients for basically any reason.¹⁶ As Dr. Chopra himself put it: 'I can report you just for anxiety if I want to'.

There is no legal mean for vulnerable patients who can't afford a lawyer to defend themselves. As a result, doctors in Canada are above the law — literally.¹⁷

This led to a situation where patients are forced to take unnecessary, harmful and addictive drugs without their consent. Some of them ended locked up in psychiatric hospitals only because they dared to complain, while others committed suicide.

I refused and I continue to refuse to take gabapentin. I paid the high price, I was stigmatized, traumatized, treated like a criminal and thrown away. My only mistake is that I was honest, and I disclosed that I use cannabis for anxiety and sleep.

Because of this, I had the choice between taking a harmful and addictive drug or losing my rights as a citizen. I became a collateral damage of a dirty war between pharmaceutical companies and the medical cannabis industry.

This situation is very reminiscent of Project MK-ULTRA and the bloody history of psychiatry in Canada.¹⁸

Therefore, it is of paramount importance that Canadian psychiatrists understand that they are medical doctors, not drug dealers. And that their patients are human beings, not preys or guinea pigs.

I do not know if there is any chance that someone in Canada has the authority, the moral integrity, and the courage to step up and investigate these abuses. But my hope is that other patients, especially immigrants and vulnerable people, who are the main victims of this fraud, realize that their doctor is not as trustworthy as they may think.^{19 20 21}