Marijuana for Medical Purposes – Update: New Policy Approved

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    Stakeholder feedback

    View the feedback we received to our online survey

    View the comments posted to our online discussion page

    Our Process

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    The College’s Marijuana for Medical Purposes policy received final approval from Council on March 6, 2015, and is now an official policy of the College of Physicians and Surgeons of Ontario.

    We would like to thank all those who submitted their feedback and contributed to this policy review. While not every comment or suggested edit was incorporated into the final policy, all comments were carefully considered in light of current practice issues, the values and duties of medical professionalism, and the College’s mandate to protect the public.

    Below is a brief summary of the policy review process, including an overview of the feedback received and revisions undertaken:




    Who we heard from

    • 284 submissions were received in response to this consultation.
    • While the majority of feedback we received was from physicians, we also heard from a number of other important stakeholders, including members of the public and key organizations, including the Ontario Medical Association, the College of Physicians and Surgeons of Alberta, and the Professional Association of Residents of Ontario.
    View the feedback: Survey reportWritten Comments

    What we heard

    Other important considerations

    • Generally speaking, respondents expressed support for the draft policy.
    • Of those who were complementary of the draft, many believed that it was clear, concise, and struck and appropriately balanced tone.
    • Respondents were most divided on whether the draft was comprehensive and whether it articulated reasonable expectations for physicians.
    • Of those respondents who provided constructive criticism or suggestions for how the draft could be improved, the following are representative comments:
        • References should be added to direct readers to current evidence with respect to the safety and efficacy of dried marijuana as a medical treatment.
        • Alternative methods of consuming dried marijuana, such as edible products and oils, should be addressed.
        • Guidance should be added with respect to establishing a safe and effective dose.
        • Guidance should be added with respect to prescribing dried marijuana to younger patients.
        • The policy should permit physicians to charge patients directly for prescribing dried marijuana, and for providing education around its use.
    • In addition to the feedback, we considered a wide range of other information while developing the final policy. This included:
        • Relevant legislation.
        • Policies and guidelines of other medical regulators within Canada and internationally.
        • An extensive literature review focusing on the full range of issues related to the medical use of dried marijuana, including the best available evidence regarding clinical indications, and risks and benefits.
        • The expectations contained in the final policy are grounded in the best available evidence regarding clinical indications, risks and benefits.

    How we responded to your feedback


    • A number of revisions, additions, and deletions were made to the final policy in response to your feedback. The majority aim to improve the overall clarity of the policy and provide additional guidance in key areas of practice.
    • Two of the more significant revisions are highlighted below, as are two important instances where revisions were not made:
    Policy decision Rationale
    • A section has been added to the final policy to assist physicians in establishing a safe and effective dose of dried marijuana.
    • Broadly speaking, these expectations recommend that physicians proceed cautiously, by initiating prescriptions with small quantities of dried marijuana and using strains that are low in the psychoactive compound tetrahydrocannabinol (THC).
    • Evidence suggests that the risk of harm associated with dried marijuana may increase with high doses and strains that are high in THC.
    • Physicians are permitted to incrementally increase the quantity prescribed and/or substitute strains that are higher in THC if the initial prescription proves ineffective.
    • A section has been added to the final policy which sets out specific expectations for prescribing to younger patients (all patients under 25 years of age).
    • These expectations require that physicians first attempt all other conventional treatment options before initiating treatment with dried marijuana, and be satisfied that the risks associated with dried marijuana are outweighed by its potential benefit.
    • Current evidence suggests that dried marijuana may have a harmful effect on the developing brain.
    • Until these effects are better understood, all patients within the normal period of neurodevelopment, which continues from the prenatal period until the mid 20′s, must be considered high risk for marijuana-related harm.
    • The final policy has not been revised to address the consumption of marijuana in a non-dried form (such as edible products, oil, and tinctures).
    • Current regulations only permit  physicians to prescribe marijuana in a dried form. 
    • The final policy has not been revised to permit physicians to charge patients for writing a prescription for dried marijuana.
    • The College considers the medical document authorizing patient access to dried marijuana to be equivalent to a prescription. 
    • As prescriptions, together with the activities associated with prescriptions, are insured services, physicians must not charge patients a fee.

    The final policy


    • The Marijuana for Medical Purposes policy received final approval from CPSO Council on March 6, 2015. It is now a formal policy of the College of Physicians and Surgeons of Ontario. 


    Read the Final Policy

     Key messages of the final policy:

    • It is the College’s position that the medical document authorizing patient access to dried marijuana is equivalent to a prescription. As a consequence:
        • Physicians must not charge patients or licensed producers a fee for prescribing dried marijuana or for services associated with the prescription;
        • Physicians who prescribe dried marijuana must meet the same legal and professional requirements that apply when prescribing any other drug.
    • As with any treatment, physicians are not obligated to prescribe dried marijuana if they do not believe it is clinically appropriate for their patient.