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Canadian doctors brace themselves as cannabis becomes legal

David Spurgeon Quebec

Canada’s new regulations on the medical use of cannabis have drawn criticism from both its medical profession and current users.

The new regulations, which allow cannabis to be used by people with a terminal condition and serious medical illness, came into effect at the end of July and make Canada the first country to take such a step (14 July, p 68).

Peter Barrett, president of the Canadian Medical Association, said that most physicians were reluctant to participate in the government’s programme for the medical use of marijuana because they worry about recommending a drug that has not been subjected to rigorous testing and whose full side effects, interactions with other drugs and correct dosages are not known.

"We’re really unhappy," he said. "This is the first place in the world where this is being allowed to happen, and we’re the ones who have to take the responsibility for it," he said.

Under the new regulations, a doctor must sign the application form, and the patient applies for permission to use cannabis. A doctor must also set the dose.

In an "Info Capsule" posted on its website (www.cma.ca) the association said that the government’s new cannabis regulations do not adequately reflect four principles that the association put forward during the federal health department’s preparation of the regulations, which it considers paramount. Nor do the regulations "address outstanding concerns," it said. The association therefore strongly opposes the regulations.

The four principles the association believes paramount are that regulations should be based on safety, quality, and efficacy; should use the same evidence based standards as for pharmaceuticals; should incorporate clinical research; and should not undermine the patient-physician relationship.

Until the new regulations came into force, anyone wishing to use cannabis for medical purposes had to apply for a special exemption from prosecution under the law, which required detailed submissions from doctors. About 250 people did this. But some of these say that the new regulations will not make things easier.

Steve van de Kemp, who heads the 50 member Ontario Compassion Club, which supplies marijuana at low prices to people in medical need, said that red tape and doctors’ reluctance will prevent many sick people from using the drug legally. He has depression and anxiety and thus will have to reapply within six months for the exemption he received last summer and will require the signatures of two specialists, he said.

A recent BMJ editorial (7 July, pp 2-3) commenting on two studies in the same issue concluded that "on current evidence cannabinoids can be recommended only for use in controlled clinical trials in carefully selected conditions for which there is no effective treatment."

The American Medical Association’s House of Delegates recently voted to rescind its 1997 position opposing a particular type of "compassionate use" programme for the medical use of marijuana, but it failed to pass a new position explicitly advocating access on compassionate grounds.
 
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