Under new rules being phased in by Health Canada, physicians will arguably have an even bigger role in the process than they had under previous regulations, writing prescriptions that patients can then take to a licensed marijuana producer, with no need for a government permit.
At the same time, though, professional organizations like the Canadian Medical Association and regulators like Ontario’s College of Physicians and Surgeons are alerting doctors to the potential pitfalls of prescribing dried pot, as opposed to approved medications that contain cannabis.
Without good scientific evidence around the proper dosages, safety and efficacy, it is unclear how doctors can fulfill their duty to ensure patients get safe and effective treatment, says the college.
“We would advise physicians to exercise caution,” Prithi Yelaja, a spokeswoman for the regulator, said in an email response to questions.
Since the federal government first allowed medical use of marijuana in 2001, a smattering of physicians have been willing to assess whether patients suffer from one of the conditions eligible for the plant. Those include cancer, severe arthritis, multiple sclerosis and epilepsy.
In Vancouver, the Medicinal Cannabis Resource Centre helps people with therapeutic-pot applications, its non-physician staff referring eligible patients to affiliated doctors, Dr. Arnold Shoichet being the most prominent among them.
Dr. Schecter’s proposed clinic, which originally was supposed to open this summer in north-end Toronto, would appear to go a step further, operating as a physician’s office staffed by him and a colleague. Patients who secured a prescription could seek out an independent producer — though none have been licensed by Health Canada yet — or pick up their cannabis at the clinic, the website says. The new rules allow doctors to “transfer” marijuana to patients, but not actually produce and sell it.
The details of exactly what the clinic would do, however, are in flux, said Dr. Schecter. Lawyers have suggested they must be careful of the “optics” around the practice, he said. But to limit revenue by relying solely on medicare billings for consultations with patients may not be a sustainable business model, admitted the physician.
Dr. Schecter said the key is to assess patients with proper diligence, noting that he has seen some of Dr. Kamermans’ former patients and would not have prescribed marijuana to them.Looming over the plan is the case of Dr. Rob Kamermans, the rural-Ontario physician who signed 4,000 medical-marijuana approvals in little over a year — charging fees on top of medicare billings — and now faces fraud, forgery and other charges.
“He went about it in the wrong way,” argued the physician. “I respect the fact he really put himself out there and tried to help people … [But] it’s too bad he didn’t take better care of himself.”
The CMA states bluntly that there is “no clinical evidence” to back up the medical use of marijuana, though that view appears arguable. According to the Mayo Clinic, for instance, there is class-A scientific evidence — including randomized clinical trials — that suggests it is effective against chronic pain and some symptoms of multiple sclerosis.
Dr. Schecter said he is working closely with Canadian Consortium for the Investigation of Cannabinoids, a network of academic researchers and physicians who want to build a base of scientific evidence for cannabis as a treatment.
National Post
