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Canadian doctors say it is inappropriate for them to prescribe marijuana

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8623 (Published 21 December 2012) Cite this as: BMJ 2012;345:e8623
  1. Charlotte Santry
  1. 1Toronto

Canadian doctors have rejected plans to allow them to write marijuana “prescriptions” and provide the drug directly to patients.

The federal government proposes transferring the responsibility for prescribing marijuana from the public health agency Health Canada to individual doctors in March 2014. But medical associations have warned that the proposals could have adverse consequences for doctors and patients.

The Federation of Medical Regulatory Authorities of Canada and the Canadian Medical Association have voiced their concerns in a letter to the health minister, Leona Aglukkaq.

It states, “At present, given the lack of scientific-based evidence of the product, there is insufficient information on correct dosage, specifics of patient monitoring and measures of efficacy, possible side effects and interaction with other medications or pre-existing conditions.”

The federation’s president, Heidi Oetter, told the BMJ, “Physicians who refuse approval, and by extension their families, could be in some danger.” There have been cases of threats against doctors who refused to approve access, said the federation.

Canada became the first country to introduce a formal regulatory system for medical marijuana in 2001, after a Supreme Court ruling.

Under the Marihuana Medical Access Regulations, some patients with conditions such as severe arthritis, AIDS, cancer, epilepsy, and spinal cord injuries can grow their own marijuana or buy it from the federal health department, Health Canada.

To do so they must ask their doctor to sign a form which describes the patient’s symptoms and specifies the amount of marijuana that the patient intends to use.

In some cases this is then sent to a specialist for approval. Authorisation is granted by Health Canada, which also provides the marijuana through a single producer and distributer.

But the government department no longer wants a role in approving access to or providing medical marijuana, which it says should now be treated “as much as possible like any other narcotic used for medical purposes.”

Under proposals out for consultation, authorised doctors and potentially nurse practitioners would be able to sign “a medical document similar to a prescription” for patients to take to a licensed independent supplier of marijuana, which could be the clinician. Doctors would no longer have to declare that they were aware that dried marijuana was not covered by drug safety regulations or to state that conventional treatments have been ineffective.

Aglukkaq said that the changes would remove “red tape” and reduce the risk of fires caused by marijuana cultivation in people’s homes.

But the federation has argued that the lack of clinical evidence made it “inappropriate” to make doctors the sole “gatekeeper” to the drug. The Canadian Medical Association said in a statement this week that the government was “dumping” its responsibilities on to doctors.

The association’s president, Anna Reid, said that expanding the role of doctors in providing access to and asking them to write “prescriptions” for a drug that had not been clinically tested would “fly in the face of a physician’s training and ethics.”

Canada has around 22 000 registered users of medicinal marijuana. However, many doctors refuse to approve it.

Rade Kovacevic, president of the Canadian Association of Medical Cannabis Dispensaries, said that doctors in urban areas were more sympathetic than those in rural areas, creating inequalities.

The impact assessment of the new proposals said that the number of registered users of medicinal marijuana would be 30% lower by 2024 than would have been the case had the proposals remained unchanged. A Health Canada spokeswoman said that this was because the subsidised price of medicinal marijuana is predicted to rise from the current $C5 (£3; €3.8; $US5) a gram to $8.80, and thus some users would grow plants illegally or choose different treatment options.

The spokeswoman added that doctors’ responsibilities over “what to prescribe their patient” had not changed. An expert advisory committee would provide advice to support informed decision making.

Notes

Cite this as: BMJ 2012;345:e8623