New ruling will protect doctors, say College of Physicians and Surgeons of Alberta 

Marijuana buds

Some medical marijuana users and advocates are being forced to choose between the treatment of their symptoms and their freedom. However, Dr. Janet Wright, assistant registrar of The College of Physicians and Surgeons of Alberta (CPSA), says she has no idea if the College's new rules will limit patient access to medical marijuana. 

The College introduced new rules on March 7, 2014 that would make marijuana less accessible to those who need it.

The new rules would allow physicians to cite moral or religious objections to treating a patient’s medical condition or symptoms with marijuana.

 

As well, these new standards would require physicians wishing to prescribe medical marijuana to register with the College as an authorizer of marijuana for medical purposes.

On April 1, the federal government implemented the Marijuana for Medical Purposes Regulations program.

Under the new federal regulations, physicians can no longer authorize patients to grow their own marijuana. Instead, physicians can authorize patients to purchase marijuana from a licensed producer.

In a memo obtained by the Calgary Journal, The CPSA — which regulates physicians in the province — raises concerns over the federal government's new system stating, "Health Canada regulations should not ask physicians to provide patient access to a substance with limited evidence of clinical efficacy or safety."

Wright, the assistant registrar with the College, says Health Canada's new regulations, put physicians in the position of administering a treatment that not only lacks conclusive scientific proof and has the potential for misuse, but may produce side effects.

"What (the College) wanted to do is provide a framework that would allow physicians to consider the use of marijuana in appropriate patients," says Wright in a phone interview.

According to Wright, the names of physicians registered with the College to provide medical marijuana will not be publicly available. The College will track physicians' authorizations to use that drug in a way similar to the province's Triplicate Prescription Program.

Under this program, certain groups of medication deemed to have the potential for misuse or "double doctoring" are required to be written on a special prescription form. Wright says that this information is entered into a database, so doctors can track their own prescribing as well as their patient's habits.

Drugs currently tracked by the prescription program are mostly opioids, stimulants and benzodiazepines and include oxycodone, morphine, fentanyl and methylphenidate.

Philippe Lucas, a researcher with the Centre of Addictions Research of British Columbia, says those specific rules would make medical marijuana less accessible to Albertans, and further stigmatize sick people.

Marijuana plantSome physicians say the science behind medical marijuana is not solid enough, and introducing new rules may better guide physicians on prescribing medical marijuana safely and appropriately.

Photo courtesy of Mark Ray

Lucas says extra rules and paperwork act as a disincentive for physicians to work with medical marijuana.

"I think anything that increases obstacles to access for this critically and chronically ill population is unacceptable in this day in age, with the amount of information, research and knowledge we have about the therapeutic potential of cannabis," says Lucas, who is also vice president of patient research and services at Tilray — one of Canada's biggest medical marijuana cultivating companies.

Aaron Bott, who operates Alberta's only medical marijuana dispensary, says he shares that view.

Bott says physicians in Alberta are already reluctant to approve access to medical marijuana, and the rules proposed by the CPSA will make it even more challenging for sick people to access their preferred medicine.

"We don't help anybody get connected with Alberta doctors, because no Alberta doctors come forward to say you can refer patients to them," says Bott, whose organization — the Mobile Access Compassionate Resources Organization Society (MACROS) — assists people in obtaining authorization to use medical marijuana.

"The standard of practice is not meant to prohibit that," Wright says.

The College did not consult The Canadian Consortium for the Investigation of Cannabinoids, The International Cannabinoid Research Society, or the International Association of Cannabis Medicine when drafting their new standards of practice regarding the use of marijuana for medical purposes.

The College's lack of consultation with these authorities concerns Dr. Arnold Shoichet, medical program director with the Medical Cannabis Resource Centre in Vancouver.

"Based on my experience supporting 2,000 patients in the use of cannabis for medical purposes, there is no doubt that cannabis can make a significant difference in the quality of life for patients suffering from a number of serious medical conditions," says Shoichet, in a telephone interview.

Shoichet says there is considerable evidence that medical marijuana is "more effective, better tolerated and safer" than conventional treatments.

Medical marijuana user, Travis Donald, says that marijuana is a "massively effective" treatment.

Donald, who uses marijuana to ease pain associated with kidney and spinal disease, says that doctor prescribed opiates almost gave him a drug addiction.

Donald says medical marijuana, allowed him to cut down his consumption of pharmaceuticals from 30 pills a day to 26 a week.

"You can't tell me that's not medically effective," Donald says. "I've cut my doctors visits in half."

Donald, like Lucas, Bott and Shoichet, is concerned that patients in Alberta will not be able to find medical support for the care and treatment they need under the College's new rules.

However, Dr. Lori Montgomery from the Calgary Chronic Pain Centre says the rules proposed by the CPSA are not intended to limit access to medical marijuana, but rather bolster the rights of physicians. She says the impending MMPR program puts physicians at risk by asking them to prescribe an "unproven treatment."

"I think that part of the intention behind the standard of practice is to clarify that the science behind using marijuana for medical purposes isn't solid enough to require physicians to prescribe it," Montgomery says.

She also says the proposed rules will establish boundaries to better guide physicians on how to direct the use of medical marijuana safely and appropriately.

"Does that mean that fewer patients might end up with the medical document signed?" Montgomery says. "That is possible. But, I would hope that would mean the ones that do end up with the documents being signed by a physician in Alberta are chosen appropriately and are using it safely."

Other portions of the proposed rules range from making physicians assess patients' risk of addiction before authorizing access to marijuana, to prohibiting physicians from dispensing marijuana.

Editor's note: This story has been updated since its original publishing date to reflect the April decision.  

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What do you think about the rules surrounding medical marijuana? 

 

David Grant 07.03.2014 11:13  
Marijuana truth   This stands in stark contrast to the death of a patient every 19 minutes from prescription drugs. Marijuana is the only substance we currently have that stops the progression of diseases like (A.D.) (ALS) and Parkinsons. Marijuana reduces inflammation systemically, all chronic illness begins with inflammation. http://www.ncbi.nlm.nih.gov/pubmed/15837565?dopt=Abstract. For the sake of being brief on a subject that deserves better I'll conclude that unless the assumptions being used to make the decisions are truthful, then the outcome will be useless. Cannabis was in the formulary and comprised an active ingredient in 40% of medicine prior to 1942. It was only removed because the supply was interrupted, not because of inefficacy or unacceptable side effects. It was American Medical Assiciation that protested the 1937 tax act that took cannabis away from medicine. Continuing the "shows no efficacy and could be dangerous" is disingenuous if not an outright lie.
 
   
       
David Grant 07.03.2014 10:59  
Marijuana truth   We have had the unintended consequences of finding benefit through those studies, but we'll make sure to obscure them in our fearful state. Last year Boston U, Dept of Medicine published a study indicating that they can find no increase in emergency room visits or increase in hospital use due to use of marijuana. http://link.springer.com/article/10.1007/s11606-013-2605-z Dr Donald Tashkin has completed a 10 year study of chronic use of marijuana and its affect on COPD http://healthland.time.com/2012/01/10/study-smoking-marijuana-not-linked-with-lung-damage/ and in his conclusion states"Whatever the cause, it seems that those who argue that marijuana is harmful because of its smoke are going to have to find a different line of attack." These are only studies published in the last 6 months, they are not unique, they support the existing documentation that marijuana in beneficial to many patients. Cannabis has no measurable lethal dose LD-50. It has never killed anyone.  
   
       
David Grant 07.03.2014 10:39  
College and access to marijuana   With any decision it is important to make sure that we deal with the facts, the truths. For 75 years we have been told and for the most part accepted that marijuana is bad. Considering that this is the fundamental argument shouldn't we explore whether this assumption is, in fact, truth. For 7 decades the best and brightest scientists have explored the dangers of marihuana to the tune of a few billion dollars. I say explored the dangers because the statistics show that science funding for the negative effects of marijuana received 96% of the funding vs the 4% to explore anything except the dangers. Clearly, as a society we have done our due diligence. What have we found from the science?...nothing. Seriously, no study will conclude that marijuana caused harm to its subjects. The always included standard quote will read "We have yet to understand the mechanisms of the plant, further study is required yada, yada,yada. this quote will ensure your future funding.  
   
       

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