The Fall 2013 Newsletter
contained an article on medical marihuana. The first part of this article repeats the information from that article. The last part of this article summarizes the requirements imposed in the College bylaw which establishes standards for physicians who authorize the use of marihuana by their patients.
Information regarding the new College bylaws was further updated in the Winter/Spring 2014 Newsletter
The system for medical marihuana prior to June 19, 2013
On June 19, 2013, the Government of Canada published new regulations which changed how patients are authorized to possess marihuana for medical purposes.
Under the previous system, physicians would complete a document which was provided to Health Canada. Health Canada would then decide whether to grant a patient an exemption to allow the patient to possess or grow marihuana. There were listed conditions for which a family physician could support a patient’s use of marihuana. Other medical conditions required a specialist be involved in the decision to support a patient’s use of medical marihuana.
The effect of the marihuana access regulations
1) Until March 31, 2014, patients who have been authorized by Health Canada to possess or grow marihuana continue to be able to possess or grow marihuana under the previous regulations.
2) Until March 31, 2014, physicians can complete renewal forms for patients who were previously authorized by Health Canada to possess marihuana for medical purposes. Those authorizations will expire, at the latest, on March 31, 2014. Health Canada will no longer accept renewal forms for patients after March 31, 2014.
3) The only form of authorization physicians can provide for new applicants is a “medical document” provided to the patient which authorizes the patient to obtain marihuana from a licensed producer. After March 31, 2014 the only form of authorization for existing users of medical marihuana will be a “medical document” provided to the patient.
4) The decision whether to provide a “medical document” to the patient is now solely that of the physician. There are no longer any categories of medical conditions for which it can be prescribed, nor any requirement to involve a specialist for any of the medical conditions for which it is prescribed.
5) A patient who receives a “medical document” from a physician will provide that document to a licensed producer of marihuana. The licensed producer will ship the marihuana to the patient’s address in accordance with the requirements of the regulations.
6) After March 31, 2014, Health Canada’s only role will be to license producers to grow and sell marihuana for medical purposes.
The College’s Concerns
The College is concerned about potential for abuse under this new system. The system does not permit the College to track the prescribing of marihuana, unlike what is available for drugs of possible abuse under the Prescription Review Program.
The College is concerned that physicians are being placed in a difficult position by being expected to make decisions whether to provide a “medical document” to patients when there is insufficient information available about risks, benefits, dosages, strengths, etc. to allow physicians to practice evidence-based medicine. Marihuana is a substance which is not subject to any of the regulatory controls which are required of all other drugs to become approved for medical use in Canada.
The College is also concerned about potential conflicts of interests for physicians who are involved in authorizing the use of marihuana by patients.
The College’s concerns are similar to the concerns which have been expressed by the Canadian Medical Association, the College of Family Physicians of Canada, the Federation of Medical Regulatory Authorities of Canada and other organizations.
The College’s Bylaw
The College’s bylaw which regulates physician authorization of medical marihuana is now in effect. A summary of the bylaw follows:
1. The bylaw begins with a statement that there has not been sufficient scientific or clinical assessment to provide evidence about the safety and efficacy of marihuana for medical purposes. The bylaw begins with an acknowledgement that federal government regulations have authorized the use of marihuana for medical purposes.
2. A physician cannot authorize the use of marihuana for a patient unless the physician is also the treating physician
for the condition for which the patient is authorized to use marihuana. For example, if a patient is to be authorized to use medical marihuana to deal with symptoms of MS, the physician must also be the treating physician for the patient’s MS.
3. A physician must review the patient’s medical history, review relevant records pertaining to the condition for which the use of marihuana is authorized and conduct an appropriate physical examination before authorizing the patient’s use of marihuana.
4. The patient must sign a written treatment agreement which contains the following:
A) A statement from the patient that the patient will not seek a prescription for marihuana from any other physician during the period for which the marihuana is prescribed;
B) A statement by the patient that the patient will utilize the marihuana as prescribed, and will not use the marihuana in larger amounts or more frequently than is prescribed;
C) A statement by the patient that the patient will not give or sell the prescribed marihuana to anyone else, including family members;
D) A statement by the patient that the patient will store the marihuana in a safe place;
5. The physician’s record for the patient must include the requirements for all medical records and, in addition, contain the following:
A) The treatment agreement signed by the patient;
B) The diagnosis for which the patient was authorized to purchase marihuana;
C) A statement of what other treatments have been attempted for the condition for which the use of marihuana was prescribed and the effect of such treatments;
D) A statement of what, if anything, the patient has been advised about the risks of the use of marihuana;
E) A statement that in the physician’s medical opinion the patient is likely to receive therapeutic or palliative benefit from the use of marihuana to treat the patient’s condition.
6. The physician must retain a single record, separate from other patient records, which can be inspected by the College, and which contains:
A) The patient’s name, health services number and date of birth;
B) The quantity and duration for which marihuana was prescribed;
C) The medical condition for which marihuana was prescribed;
D) The name of the licensed producer from which the marihuana will be obtained, if known to the physician.
7. Physicians who prescribe marihuana will be required to provide the College with the information referenced in paragraph 6:
A) Every twelve months if the physician has prescribed marihuana to fewer than 20 patients in the preceding 12 months;
B) Every six months if the physician has prescribed marihuana to 20 or more patients in the preceding 12 months.
8. The bylaw prohibits physicians from diagnosing or treating patients at the premises of a licensed producer;
9. The bylaw prohibits physicians who prescribe marihuana from having an economic or management interest in a licensed producer;
10. The bylaw prohibits physicians from storing or dispensing marihuana from any location where the physician practices medicine.
The bylaw is numbered Bylaw 19.2 of the regulatory bylaws of the College and is available at the College’s website.
Sample treatment agreement to comply with the College Bylaw
I __________________________ understand that I will be receiving a medical document from Dr. _______________________ which will authorize me to purchase marihuana for a medical purpose. I agree to the following:
A) I will not seek to obtain a medical document to authorize me to purchase marihuana from any other physician during the period for which the marihuana is authorized;
B) I will utilize the marihuana as authorized in the medical document and I will not use the marihuana in larger amounts or more frequently than is authorized in the document;
C) I will not give or sell the prescribed marihuana to anyone else, including family members;
D) I will store the marihuana in a safe place;
E) I understand that if I break any of these conditions, Dr. _________________ may refuse to provide any future medical authorization to purchase marihuana.
Patient’s signature Date
Health Canada has published new Marihuana for Medical Purposes Regulations (MMPR) effective October 1, 2013.
The Canadian Centre on Substance Abuse has released a guide to facilitate discussions about marijuana and its effect on youth and families. It is available in both English and French.
Guide to Facilitate Discussions about Youth Cannabis Use in Your Community (English)
Guide pour faciliter les discussions sur la consommation de cannabis chez les jeunes dans votre communauté (Français)