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Sessions helps clear air on medical marijuana

They heard firsthand from a doctor who prescribes and his patient who uses marijuana for medical purposes, and ultimately delegates expressed their appreciation for a “balanced” presentation.

The Monday education session at General Council featured a physician pain management expert and one of his patients who uses the drug, as well as the head of Canada’s medical regulatory authorities.

Use of medical marijuana has been a hot-button topic for Canadian physicians and CMA since regulatory changes that took effect last April made physicians responsible for deciding who should legally have marijuana to treat medical conditions. The CMA opposes the use of marijuana for such purposes because of the lack of rigorous scientific evidence supporting its efficacy and safety.

A survey conducted by the CMA this summer found that about a quarter of its members are sometimes or often asked to prescribe marijuana for medical purposes. Of those who receive requests, a third sometimes or usually provide authorization to allow the patient to obtain marijuana.

Three-quarters of respondents said there is insufficient information on the risks and benefits of marijuana to justify its use.

Polls conducted during the session indicated a majority of delegates said they felt they weren’t able to have meaningful consent discussion with patients about medical use of marijuana, and 44% said doctors should not be placed in the position of deciding who obtains marijuana for medical purposes. Asked whether marijuana should be legal in Canada, 50% agreed and 11% abstained.

“It’s time we begin to speak this language of cannabis, and discuss this with patients,” said Dr. Mark Ware, executive director of the Canadian Consortium for the Investigation of Cannabinoids.

Mark Nixon, a paraplegic who is Ware’s patient, said using marijuana made his life easier by helping control intractable pain. It also helps him sleep.

“Medical marijuana can help. It does help me feel a lot better,” he said. “It’s not about having fun with your friends.”

Ware said there are no guidelines for screening or monitoring patients who use marijuana for medical purposes, nor indications for its use or how to select which company or product should be used.

Under current regulations, Ware noted, the Canadian Medical Protective Association has advised physicians should only sign medical documents when they have sufficient knowledge about marijuana and can engage in informed discussions with patients about the drug.

There have been randomized controlled trials to show proof of concept for using cannabinoids in treating certain conditions. Ware said if he can find a role for helping a patient through the therapeutic use of marijuana he is open to doing so.

“Clearly this isn’t going away,” he said, but added there’s a need to better monitor patients.

Responding to the presentation, Dr. Trevor Theman, president of the Federation of Medical Regulatory Authorities of Canada (FMRAC), said he agreed with the emphasis Ware had placed on authorizing marijuana medically only in the context of an established physician-patient relationship.

He discussed the colleges’ concerns about making physicians the gatekeepers for use of the drug for medical purposes, and the relative lack of supporting evidence. For the last decade, he noted FMRAC has stated physicians should not prescribe drugs for which there is little or no clinical evidence of efficacy.

“You are not obliged to provide marijuana for patients,” Theman stated.

He said proposed amendments to Health Canada regulations would call for licensed producers of marijuana to provide information about patient and physician clients to provincial regulatory authorities.
During question period, physicians raised a wide range of issues on the subject. While some delegates said they still felt there was insufficient evidence to support the use of medical marijuana others asked technical questions about how to prescribe and properly bill for this.

CMA president-elect candidate Dr. Cindy Forbes, from Nova Scotia, talked about being visited by a detailer marketing medical marijuana to her practice. Theman said Health Canada officials told him this type of marketing is totally inappropriate and will be prohibited.

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