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do not get involved with medical marijuana. there is enough problems out there as it is, creating just another problem
Medical marijuana is a fact of life for physicians despite the lack of research evidence for it’s use in the most common conditions for which it is being prescribed. The risks of endorsement of such a treatment by the medical profession has been significantly underestimated for both patients and physicians. I suggest that the prescribing of this agent be limited to physicians trained with expertise on the subject rather than treating it as a simple new drug requiring prescription by any licensed physician. An uncontrolled approach has serious potential for abuse and error as well as physician intimidation by patients. We need strict control from the outset, as we establish the scientific basis for judicious and appropriate use.
Judiciously it is being explained to the SCC in the Cannabis Buyers’ Club of Canada trial coming up. It is giving you the basics of understanding what the Eastern Pharmacopeias seem to know but you know apparently do not
There is a complete lack of education and awareness to the medical benefits of marijuana.
The was a great 2 day convention on Medical Marijuana this week. The first thing I noticed was the was not one doctor from Ontario there. Besides the guest speakers of course.
Heath Canada declined an invitation to speak or even attend the event. I was the only member from the CPS and Action Ontario there.
If you post a comment you should back it up or its just ignorance.
I am a surgeon who has been practice for 30 years. One year ago I was diagnosed with metastatic melanoma to the brain, lung, and bone, and been treated with whole brain rads, chemo, and immunotherapy. The vast majority of the time I have felt lousy (not a medical term but the best way to describe it). During my whole brain radiation, I was prescribed a short course of high dose dexamethasone which made me feel good, but I did not want to take the high dose for long (because of potential side effects), and now limit myself to 2 mg of dexamethasone once or twice a week, along with two Percocet once or twice a day.
Twice over the summer (despite using the above meds), I left so lousy that I succumbed to one of my daugters offers of marijuana, and it was the only two times in the last year that I have felt 100% good (physically, and emotionally) if only for four hours at a time. So, it does work very well for the symptoms of malignancy, and I can also appreciate that would be widely open to abuse. Most of what I have read up on it is full of bias – the chronic recreational users claim they have illnesses which it is mandatory for, the manufacturers downplay the side effects to make a profit, and most doctors that I speak to feel uncomfortable ordering it because they are not all that familiar with it. I think the CPSO needs to get as much information of the “prescribing” of it to the doctors as possible before its widespread use.
The simple fact is that marijuana is the number one abused drug in places where such statistics are kept (meaning the US).
Another fact is that marijuana has humdreds of different chemical compounds, many of which are currently under study by the pharmaceutical industry. Health and Welfare Canada mentions 489 different chemicals in 18 different chemical classes.
Different groups propose different ways of use od this mostly unproven. And the burden to youth is potentially life derailing.
So the situation is that marijuana is like snake oil. And use of prescribed marijuana can be liiked at as witchcraft medicine.
I will not prescrine it. Undoubtedly there is potential for big money to be made on marijuana. But, as a physician my first duty to my patients is to do no harm.
As a side note, the argument that marijuana is an old and effective remedy does not cut it. Other ‘old and effective’ remedies included arsenic treatment and flagellation in te middle ages.
I disagree with the statent that ‘medical marijuana is a fact of life’. Marijuana is a fact of life. Now it has been made political. Lets keep the ‘medical’ out of it, unles and until there is reliable evidence for its use.
Marijuana does not have good evidence, and the risks far outweigh the benefits. The increased access to marijuana is only going to make access easier. We are naïve to believe that that won’t put more marijuana in the hands of our teenagers, people with addictions, etc. By making all physicians able to prescribe this untested and commonly abused substance, physicians are being put in a very difficult position of being pressured by patients to do what the patient wants (allowing autonomy) rather than what is in the best interest of the patient (beneficence). The changes in legalization have put the physician in a difficult ethical position, and further, are making the health care system more of a “give me what I want not what you believe to be in my best interest” system.
It’s no different than prescribing opiods, except there is no deaths associated with taking the herb.
The patients have a legal rights allowing them to advocate for themselves as they are the patient.
It’s all about education and awareness!
I fail to see the ethical dilemma here. Can you please elaborate?
Can you please lists these “risks” you speak of?
Can you further comment on easier access to kids? Because there is absolutely no evidence to support this claim anywhere in the world.
You certainly can’t overdose on marìjuana.
I wholeheartedly disagree with you;
Please provide proof of your assertions of perceived risks. The LD50 = ZERO. So, with no deaths attributable to overdose, I fail to see what risks you speak of.
DO NO HARM = encouraging EDIBLE use by patients, and discouraging SMOKING, as Health Canada strangely mandates.
I am completely opposed to this. There is not enough evidence to provide solid guidance to properly prescribe and we are having enough trouble with proper prescribing of available drugs with potential for abuse.
Reality is darn near every thing is abused at some point. Focus should be on harm reduction
In a free & logical society, all natural plant & plant materials from based or derived form, should be considered as part of the Pharmacology for physicians. It has no logic nor holds no merit to exclude a Natural substance, used for thousands of years as a remedy for an exponential amount of ailments to both Human and animals
I feel that as physicians, we are being asked to regulate or be gatekeepers of this drug and I find that it isn’t fair that we are being put in this position. Patients are definitely putting pressure on us and it is difficult at times to justify witholding an available treatment even though there is mixed evidence and I think the risks outweigh the benefits… People who want to use it will use it regardless so why in essence should I be the one to allow them to do it legally? I think this issue is still way too controversial at this point and should be debated by the legal system – not by medicine!!!
The Cannabis Buyers’ Club of Canada trial will give you enough time to change before the SCC sees you haven’t , and then you will be forced to know. The justic system is changing the way it does and it will be due diligence that forces you to sites like ccic.net
It will force curriculum to the Inflorecence Monogram from the American Insurance Co’s
Aren’t you just so lucky to be in a position to complain that something you could so easily do to help patients isn’t fair to you. Think about the patients FIRST, which is your medical duty. How fair is it to them that they have found relief for their disease or symptoms with this natural plant that cannot kill by overdose (ie. LD50=ZERO), and the bulk of Dr’s refuse to prescribe so they STAY OUT OF JAIL for getting the much needed relief to get back into productive society.
I agree that the plant should not be illegal, but in the meantime, you are part of the problem.
The evidence is weak thus far for the widespread use of marijuana. I would not trust the distributors that are officially endorsed – would we know the strength of the plant? I would far rather wait for formulations from pharmaceutical companies after more indepth studies support the use.
I question how you can reconcile this:
Pharmaceutical companies appear to regularly get caught falsifying data, or bribing for Rx.
Many, if not all, marijuana patients distrust pharmaceutical companies. Why are phyiscians so trusting of them?
I personally welcome new regulatory changes and hope they will help to regulate both access and availability of marijuana to patients. While helpful in some cases to relieve pain and decrease anxiety, recent research shows its potential harmful effects for children and adolescents if used frequently and in largely quantities. Given that the long-term effects of marijuana use are still unknown and evidence is still in the developing stage, we cannot confidently comment on its effectiveness and safety at the current stage.
Moreover, given the commonly acceptable ‘culture of use’ in North America, I believe clear regulations and rules should be put in place around marijuana use and prescription to protect the public, and those most vulnerable among us, such as youth and adolescents in particular. While a lot of proponents of marijuana use argue that this is a matter of personal choice and individual rights, I do believe public good and well-being of nation override possible individual benefits for a limited group of people.
Physicians are in best position to exercise clinical judgment and use the most current to date evidence to assess the necessity of marijuana use to relieve particular symptoms. Limiting growing of potentially harmful substances to licensed growers is a great step towards increasing safety and protecting public.
Overall good document but I feel that marihuana should be handled like methadone, and physicians should be required to have the expertise to prescribe it in order to have that license. So far, I haven’t even seen CME on the subject.
Marijuana is a useful drug for pain relief and poor apetite. LIke everything (even water) it can be dangerous, so control methods and accreditation of prescribers are essential.
I am practising in arizona- the medical marijuana is out of control. Every loser is on it and there are no controls on drivers! The crooked drs who write the cards are making a fortune!
The losers who are on it lol i am glad your not my doctor.. I wonder how you feel about patients with other addictions as u feel this is a drug obviously and not a medicine so you must think any body addicted to the countless other medicines u prescribe are losers aswell and u sir as a dr ahould not be speaking in such a way about sick people.how do you feel about natural products because they help a whole lot..to call other drs crooked or people losers cause they have differant beliefs in what medicine is disrespectful. What have you for knowledge on cannibinoid receptors i will bet you have read nothing and just assume instead of look at the countless studies and proof. You already have your mind made up with no knowledge at all cause if you actually took the time to read then you qould not feel like people were losers and crooked. You obviously dont care about patients but the money from big pharma instead
I just read the document in hopes that it would give guidance on this issue. I think that it does not. It seems the Federal Government has downloaded the decisions to the CPSO and the CPSO has downloaded to individual physicians. The section that says we have to explain material risks, benefits, indication,contraindications etc is inappropriate given that the college documents fails to identify with any certainty what the facts actually are.
I have no interest in prescribing it unless there is an end of life issue at this stage and this document does not give me any confidence to stray from that thought process. It may to patients complaining to the college that I would not give it to them and the CPSO better be sure how to handle those kinds of complaints when there is a paucity of evidence to guide us it seems.
Your suggested policy requires:
“ Demonstrating professional competence, which includes maintaining the medical
knowledge and clinical skills necessary to prescribe appropriately”
While the above is excellent policy for any drug that has quality control and consistent bioavailability and dosage, these are not the attributes of marijuana and so I feel that the CPSO standard will be impossible to meet, setting us up for problems.
Great idea instead of crossing the border
Marijuana can be grown by a person in a greenhouse. Narcotics are from pharmacies. How can you treat it like any other controlled drug. It is very different. I can’t monitor for abuse and diversion. It is very difficult with narcotics and impossible with marijuana.
One comment so far.
A request for clarification of line #53:
“submitted directly” -by whom? patient and /or physician? Would you consider adding a clarifying phrase?
The guideline does not address the accepted indications for dried marijuana. What is the available evidence in support of dried marijuana against other available options including oral cannabinoids? Other than good record keeping and screening for risk of addictions, it does not provide much as a supporting guideline.
The policy document seems to be duly cautious however where are we as physicians to find the information necessary to provide to patients (re benefits, material risks, etc) so that the patient can give a truly informed consent? It is particularly difficult to know where to look for unbiased information as to the potential benefits of marijuana for medical purposes.
I disagree with the CPSO policy that an authorization for medical marijuana should be considered a “prescription” and therefore be controlled by the Prescribing Drugs Policy of the CPSO.
An authorization for medical marijuana is not a prescription. It is simply an procedural form filled out by the physician stating that the patient may obtain and use medical marijuana for a legitimate medical purpose to be determined between the physician and the patient in the setting of a therapeutic relationship. This authorization cannot be considered a “prescription” as there is no single “drug” being prescribed (marijuana is a mixture of several hundred different compounds) and thus the physician cannot know the exact amounts and quantities of the various substances being authorized.
The authorization should be considered the same as that given for any complementary or alternative medication and should be governed by the already existing CAM Guidelines.
The CPSO policy on Prescribed Drugs also states that
Physicians must not prescribe drugs that have not been approved for use in Canada, that is, drugs for which Health Canada has not issued a Notice of Compliance (NOC). 69 However, there are two circumstances when access to an unapproved drug can be obtained for patient use. The first is when drugs have been authorized by Health Canada for research purposes as part of a clinical trial. The other is when drugs have been authorized under Health Canada’s Special Access Programme.
As marijuana has not been approved with a Notice of Compliance, is not being used in the setting of a clinical trial and is not being authorized under a Special Access Programme, it must not be considered a “prescription” unless the purpose of the CPSO policy is to ban its use.
From the Health Canada website comes the following:
Dried marijuana is not an approved drug or medicine in Canada. The Government of Canada does not endorse the use of marijuana, but the courts have required reasonable access to a legal source of marijuana when authorized by a physician.
In the interest of the many patients who get considerable benefit from the use of medical marijuana, please do not pass this repressive, regressive policy as it currently stands.
Fed Tax Court if I recall it correctly, just went over the exact word “prescription” when it comes to CANNABIS!
‘Hedges v Appeal bla bla…@ fed tax court web page.
Hedges dealt with an ATP not being a prescription. It doesn’t address the medical document under the MMPR
This is so far the most appropriate feedback I have seen thus far.
This policy is not appropriate.
While we should be in a position to provide authorization for access, there is insufficient criteria to qualify these authorizations as prescriptions.
I think the draft policy is fine and comprehensive. My only concern is your requirement that we not charge for the documentation as I do not believe that it is just like any other prescription that we write. First we write a normal prescription for the patient. Then we get a fax from the grow company the patient chooses (rarely has a patient come ready with the name of the company and the forms). Then we fax their form back. Then we get a call from the company to confirm. For all this work, I feel that we should be able to charge. Thanks for considering.
When you compare Cannabis to the plethora of other oriental-medicinals I start to see a consistency in your statements that begs the question
How do YOU accommodate the differences to your therapy to oriental medicine ?
Are you really a Dr or a Pharmacutical Representative?
I completely agree the physician doing this work should be paid a reasonable sum in proportion to time spent and possibly also level of expertise. It takes time plus the cost of an office and staff. Certainly the patient should not be required to pay for completion of a request for this medication anymore than for request for a lab test or x-ray.
It is far more time-consuming than competing a sick note yet we are allowed to bill privately for this.
The next thing is: who pays? Recommending treatment for an Illness that can be helped by a prescription is covered by OHIP as part of the visit fee. The same should be true of this. But is the fee for counselling appropriate? I have never done it but assume it should take about 1/2 hour for all the information gathering, warning and advice in addition to completing the form.
I have heard some docs charge $400 for this! That’s disgusting! Let’s have a fair fee that does not ask the suffering to suffer more.
1) the completion of the extensive documents is not like a prescription and either needs a billing fee or a set amount
that can be billed as this is far from the amount of work equivalent to producing a prescription-No other profession such as lawyers,accountants would submit or agree to such an unequal job value
2) The college should provide written or copiable electronic risk lists that should be presented and signed
by users at least annually-I foresee lung cancers and lung disease as being expected outcomes that will be denied by
users as ever having been listed-we need a consolidated
list of known and anticipated possible risks listed so the physicians and indeed the college does not end up as the
named parties in future lawsuits as the tobacco drug companies did as a known precedent. Although their suits
were compromised by lies and suppressed evidence the
physicians and their College could be likewise compromised by variable “risk and consent” practices
“extensive documents”? Have you even seen the one Health Canada provides? My doctor put his stamp with all of his info on it on my form and signed it. That’s all that was required. It took 2 seconds.
Yes, and your doctor is an example of someone who is not practicing professionally according to this draft policy of the CPSO.
Precisely why may physicians don’t want to do it.
Physicians should explore every viable opportunity to treat their patients including the use of cannabinoids.
However, prescribing of “medical marijuana” is problematic for most Ontario practitioners.
For what conditions is “medical marijuana” a drug of choice? By this I mean not the patient’s choice but an option based on reasoned and informed decision making. Is marijuana a cure for any condition? Has it been demonstrated to be consistently equal or superior to other options?
If a substance does not qualify for a “Notice of Compliance”, how can it be considered a medicine? Isn’t it premature to consider marijuana for any medical purpose? There can be little doubt that marijuana is far be established as a recreational drug than a medical one.
The legislative framework of this process is ill-conceived. It denies patients, and the wider public, the protections inherent in the conventional path to drug approval. The assessment of treatments where the outcomes are subjective symptoms rather than objective physical phenomena like blood pressure or glucose levels poses unique challenges.
While the risk of near-term serious adverse reactions such as death appears to be small, the long-term risks need to be better established. This is especially so because the conditions for which marijuana is considered are usual chronic and incurable.
I agree with and endorse the proposal of one of the contributors above; medical marijuana should be limited to those who have a special marijuana license based on approved training and a qualifying examination, (similar to a methadone license). There should be regular audits to ensure continued compliance with the guidelines.
Chronic Pain TorontoThis person is in the know and is obviously doing g his job for all the right reasons.
Are u in Toronto?
email@example.com if we could talk outside this forum.
I guess the new policy would bring to an end, the hopes of some doctors to privately bill large fees (in the 100s) to do the form. This is a good thing.
If not for charging this fee, I think there will be no incentive for doctors to promote and “prescribe” this weed.
I think doctors should not have anything to do with pot. If lawmakers want people to smoke cannabis, they should just legalize it, not encourage people to go to MDs to make up lies about symptoms they don’t have to get this recreational drug.
Morphine is a prescribed drug; opium isn’t. Aspirin is a prescribed drug, willow bark is not. Warfarin is a prescribed drug; sweet clover is not. Same should be with cannabinoids. Nabiolone/cessamet are prescribed thc, but weed should not be a prescribed drug.
Excellent comments from Anonymous.
There is a large pro-marijuana lobby favoring legalization for recreational purposes. Some prominent politicians are avid marijuana users. Even one former Ontario health minister stated that he had once been a user of “party drugs.”
Many regard “medical marijuana” as a segue to full legalization.
Doctors should have special concern about any substances that is smoked.
Certainly smoked tobacco must have some positive effect otherwise there would not be so many addicted to it. Will there soon be a companion policy on “Medical Tobacco?”
Someone seems to feel that there is an opportunity in marijuana prescribing. The Standard in St. Catherines reported the opening of the city’s first clinic dedicated to marijuana prescribing.
Canadian Cannabis Clinics plans on opening ten offices across Canada. Their business model was not disclosed.
The former health minister? You must mean George Smitherman.
Considering his party is already smeared in the gas plant scandal, I certainly would not want the government to regulate the distribution of dope. Giving the government a say of distribution and production, is a money grab, and is an opportunity of patronage.
We can not trust the government to run this thing. They will turn it into a cash grab and a make-work project. Nor do we want the use of dope to be regulated by the inflated medical surveillance state.
This is another fee the doctor can bill the government debt. What a joke.
As a low-level street drug, it provides revenue to distributors, as well as a source of work the the police who harass producers, distributors and users. Through legalization, I would expect we will end up robbing Canada’s marginalized groups of their dope-dealing revenue. Then we end up giving the revenues to a more politically & ethnically enfranchised class.
This is just the kind of proposal by an inflated government looking to butt further into peoples lives and make itself needed through regulatory actions. We shouldn’t have to submit ourselves to a medical bureaucracy to smoke dope, a God given plant.
This is also a bandaid solution towards the promotion of health care instead of the promotion of health. Adding dope to the medication driven health care system, isn’t going to promote health.
Health not health care.
You will be adding the fees to run this onto the tab of Canada’s younger population I assume? The younger population will soon get tired of looking after the aging population and watching them rack up bills to keep them aging comfortably. The new generation will not be able to afford the lavish health care and are waking up to the enormous debt we will soon inherit. They are waking up to how our aging population has been swindled by a bunch of medical charlatans.
The young are angry because they’ll be too busy paying off the aging population’s government debt/medical bills to age comfortably themselves.
gee this response makes the most sense yet
It may make sense, but it’s way off-topic. The issue here is that the doctors are being given a responsibility and the college is developing a protocol on how that responsibility is to be exercised. What any of us think about the Ontario government is a tale for another day.
I am opting out of prescribing it. How can I prescribe a drug that doesn’t have a monograph? Not approved by Health Canada. Don’t know concentration, interactions with other drugs etc. This is just a way to make physicians be the gatekeeper for a drug. We have enough trouble distinguishing the legitimate vs. illegitimate users of other drugs of abuse. The gov’t should either make it legal like tobacco alcohol etc or maintain the status quo.
Sounds like a cope out! You have a duty to treat.you can’t opt out once the new best practices get implemented next year.
Go to a conference and educate
I cannot see how the CPSO can tell physicians not to bill for doing work involved in “prescribing” marijuana?
My accountant and lawyer can bill for every minute working on my case and we physicians should work for free
While I am commenting as a member of the public, I was employed in public health for 30+ years before retiring 3+ years ago. Since then, for reasons too long to detail here, I have been studying the issue of cannabis and its health/medicinal impact. My research suggests that cannabis is more benign than many here appreciate (in act, it was legally prescribed as a med, in the US, from the mid 1800s to 1937. Its removal from the US Pharmacopeia in 1942 had nothing at all to do with it being seen as dangerous by the doctors of the day, but that is another story … in fact, the doctors of the day did NOT want it removed as it was used for many ailments). Further, few appreciate that the US government actually holds patents for the medical use of cannabis, as a neuroprotectant and anti-inflammatory.
While it is not perfect, when measured against many of the meds prescribed by many of you on a daily basis, I would dare to say cannabis is in fact much safer. All that said, I agree that you have unfairly been made the gatekeepers of cannabis and wrongly so.
It sounds to many of you would love to attend something like this:
Scroll down. Most of those names are not new to me, but I suspect many are to you.
One of the most exciting fields of study of cannabis as a nutraceutical. Many do not know that cannabis as the raw, unheated plant is NOT psychoactive and can be consumed in salads and smoothies. One researcher has seen some remarkable results in is practice (last I heard they had over 7000 patients) … and about 70% get clinical benefit from this use of cannabis for a very wide range of diseases and, that included in one case, the eradication of a brain tumor. Cannabis has about 80 cannabinoids that are ONLY found in cannabis and they are EXTREMELY beneficial to the human endocannabinoids system. Most who have looked at cannabis as a med, and I agree (whether raw or activated), comment that its real benefit is via what is called the “entourage effect”, i.e., all the cannabinoids, terpenes and flavonoids working synergistically — hence the reason synthesized versions of THC will never have the full benefit that the whole plant has.
For those who might be interested, there is an excellent book called: Marijuana — Gateway to Health. It has over 200 references and contains some very interesting material.
In any event, I hope there is something above that is helpful. In my own personal opinion, we’d be better off just legalizing and controlling it like alcohol, and tobacco. There are many reasons — just too much to detail here. But interestingly, since cannabis was legalized in Colorado, use among young people has apparently gone down … very early in that experiment, but it does reflect what has happened in other areas of the world where there is a more lenient cannabis policy (Netherlands) … one thing is certain, prohibition has been a dismal failure and we are never going to “jail” our way out of drug use … and the billions that have been spent trying to do so, has been a huge waste of $.
I can’t dispute one fact here. Any one who puts in 20 minute’s of research on this topic can verify all the above.
I have to ask these simple questions to physicians.
Don’t you feel it’s your responsibility to always be educating yourself on new and alternative treatments.
If yes, why is there such an unwillingness to educate yourself on medical marijuana?
Most of the naysayers on this form can’t even to back up their “professional opinions”
I feel disappointed and let down as a tax payer, professional, and member of our society that the people we trust and hold in such high regard for our health won’t even make an effort to educate themselves before even giving their “professional opinion”
Everyone should check out the confernce report. The papers presented give evidence that marijuana can be extremely helpful. Unfortunately our society seems to be a drug company controlled society and if no money can be made by investigating the value of marijuana we will never have the “science” to back up what we know is true.
I am a biological scientist who finds waht we call science to be a great disappointment.
The real problem here is that most doctors don’t know anything about most of the drugs they prescribe to begin with (see GPs rxing anti-depressants and benzos en masse to people better served by a mental healthcare professional) and they’re just annoyed that this ignorance will be greatly highlighted when their patients know more about the medicine they’ve researched back to front and have risked jail to obtain because IT IS IMPORTANT.
The ignorance in these comments astounds and I’m really glad none of you are my doctor.
The licenced producers test their product for the 2 known cannabinoids effective for various ailments and diseases: THC and CBD. Every single batch is tested and every single patient knows this information before they order. It’s not rocket science to inform patients new to the drug to start with a low THC strain or, if their condition warrants it, such as epilepsy, a high CBD one. All of the producers in Canada – again – have this information available on all product. If you talked to any of them or did any actual research into this subject, you would know this.
There is so much information out there and you all just seem too lazy to look for it. You want it to fall in your laps.
You know it’s okay to change your mind based on new information, right? It’s not against the law.
Educate yourselves and be better physicians!
There’s a good reason doctors are lazy and expect information to fall in their laps-that’s what the pharmaceutical companies have been doing for us for years. Our Colleges don’t forbid us from reading drug company literature or attending pharma-sponsored educational events, but they do warn us against any association with Licensed Producers, who meet industry requirements! A double standard indeed. Unfortunately its the patients who are left holding the short stick.
For open-minded doctors who want accurate information on the safety and efficacy of cannabis as a preventive medicine when compared to pharmaceutical anti-depressants and relaxants, check out stressedanddepressed.ca
Public servants and medical proffesionals do not have the right to prohibit citzens from possessing and even abusing natural agents in any form. That they do is a violation of individual natural rights. Dr.s should not be gatekepers of anything more than a patients medical information NOT their patients choices. It is fine and even right for Dr.’s to advise patiets about the risks involved in smoking dried Cannabis but that does NOT translate into the right to prohibit.In fact it is absurd to even be refering to smoking and dried cannabis, it is the Cannabinoids (resin glands) that is the medicine. Why on earth would people be prevented from removing the plant matter from the medicine and be forced to smoke it. Surely if Dr.s have the patients best interest in mind they would speak out against this. In fact the courts have ruled against this policy. The comments by Dr’s very much need to be taken with caution as they are in a serious conflict of interest due to their conections and dealings with Pharmacuetical companies who see the repeal of cannabis prohibition as a threat unless they can monopolize the distribution and prevent individuals from growing their own. Cannabis after all is a herb and people deserve the right to grow and use herbs and food as they desire. The risks of Cannabis abuse are grossly overstated here and do not come close to the risks associated with any other thereputic agent. Rather than putting a patient at risk of mental diorders from abusing Cannabis, Cannabis is an extremely effective anti-deppresant and anti- anxiety medicine ( it must be stated that some strains are helpful and some strains can be counterproductive). To site an increased risk of Schizophrenia for example is to be ignorant of the lack of correlation between increeased Cannabis consumption since 1970 and rates of Schizophrania.To maintain that Cannabis should be aproved only after all other agents have failed is irresponsible and completely wrongheaded as Cannabis is much less toxic and risky than the other “drug” alternatives, it should be tried first.(You can see why big pharma is scared) For Doctors to threaten to close the gate on a patient for accessing this herb through other than a LP is again a gross violation of the doctors oath and the rights of citizens, I do agree that Dr’s should educate themselves about the theraputic value of Cannabinoids and the Endo-cannabinoid system but they should not be party to prohibition.
NORML CanadaIt’s just possible that cannabis will displace — to some degree — more potent pharmaceuticals with which physicians are more familiar and comfortable. That would be an interesting outcome on many levels.
It’s interesting to see concern about addiction though there is no support for it in the literature. The persistence of ‘demon drug’ mythology has to be regarded as one of the triumphs of the war on drugs.
My prediction is that physicians will eventually be comfortable prescribing cannabis and the sky won’t fall.
your prediction is wrong.
pot is not a medication and will not be prescribed.
pot-smokers should focus their attention on legalizing marijuana instead, like alcohol and tobacco and not on a back-door way from doctors, by having to make medical symptoms.
and now with this new policy, there will be no financial gain to do the form, so many doctors who were planning on doing it, will not.
What an insult to legitimate medical users of cannabis
I find it so sad, that Health Canada is in the wrong here, and they are succeeding in pitting Doctors against patients.
Patients report they derive successful treatment of their condition using a natural plant that the Dr. signs a piece of paper to allow him/her to use so they DO NOT GO TO JAIL for using.
Yet, Health Canada, whom has been MANDATED BY THE COURTS to proved ACCESS to it, warns Dr.’s not to prescribe.
So, who is wrong here?
Chronic Pain TorontoCheck out Chronic Pain Toronto Facebook on how to protect yourself legal if your understanding the MMAR program
I just see a lot of complaining,ignorance and laziness.
Look to Israel for the testing and to the 50000+ patients that use medical marijuana.
There is lots of information if you look for it.
I’ll send u some links that might be helpful.
I will be partnering with pain clinics to hold lunch and learns on chronic pain so A GPS can get the tools to make that call
Chronicpaintoronto@gmail.com if you want more info
Ironically, physicians of an earlier era would have known quite a bit about cannabis, how it worked; who it worked for; and so forth.
I commend you for publishing this consultation but I suspect that physicians will be among the last to accept the inclusion of cannabis as a therapy.
Mtn Goat ToursA profound thing might happen here, if we want.
The knowledge-base of this is not in the Professionals
Dr.21 Your insurance Co is from the States.
Your Monogram is found there also
AHP American Herbal Pharmacopeia;
Cannabis Inflorecence* .
PUBMED just key one-word searches ;
THC. 7,676. “studies”
Cannabis. 13,234. “studies”
Marihuana. 13,534. “studies”
Marijuana. 20,579. “studies”
In a free & logical society, all natural plant & plant materials from based or derived form, should be considered as part of the Pharmacology for physicians. It has no logic nor holds no merit to exclude a Natural substance, used for thousands of years as a remedy for an exponential amount of ailments to both Human and animals.
I have mixed feelings on the issue of Fee’s. On the one hand it would be great if we could all get our papers free of charge, on the other, how often is the Dr. going to request to see you for renewals if he can only charge his allotted fee set up by the CMA for prescription writing? It could translate to more monthly visits in order for the Dr. to receive his originally charged extra billing fee that was for licensing for 1 year.
Again, this leave’s the door open for unnecessary repeat visits, to recoup fee’s unattainable via “extra Billing” for paperwork & document filling. The extra billing allows for patients to have their prescription for 1 year, rather than monthly. This is a problem especially for those who are in Rural area’s, & must travel far distances at great expense. Such as myself. I would have to visit Toronto, from 7 hours away in the Kirkland Lake region. To do this monthly, would be unsustainable.
We do need guidelines for Physicians to follow so there is a more uniform practice for all patients to access. This first draft is good, but still has much room for improvement.
There is much to be desired here. Patients who cannot or do not wish to grow their own ought to be supplied with the appropriate strain of cannabis. But this is different from ailment to ailment and from patient to patient. Are doctors going to have a range of cannabis strains for patients to try until they find the most optimally effective? Are doctors adequately educated in the benefits of cannabis over other pharmaceutical products?
Why the restrictions on oils, tinctures and edible products? Cannabis oil cures cancer. It was effective in helping me beat squamous sarcoma.
Why the scare tactics regarding dangers from abuse? These have been greatly exaggerated, as there are none. Cannabis is Not a narcotic and should not be treated as one. It safer than aspirin and should be freely available over the counter.
Cannabis producers ought to be treated in an equal manner to producers of alcohol and tobacco. There should be no regulation of private production and use, only those producing for commercial purposes should be regulated. Prescribed cannabis ought to be insured and supplied as oils, edibles, and dried marijuana as best serves the patient’s needs. This should be covered by insurance the same as antibiotics are.
There is NO DEMONSTRABLE JUSTIFICATION FOR PROHIBITION, Therefore prohibition of cannabis is unconstitutional and the expense is unnecessary. Doctors have been trained with a lifetime of misinformation about the so-called hazards and dangers of cannabis that Simply do not exist. To date the only hazards and downsides connected with cannabis and its use are all resulting from the unjust prohibition of the substance.
Every citizen of Canada has the right to determine their own health and treatment under Section 52 of the Constitution Act of Canada and its Charter of Rights.
While the College of Physicians and Surgeons is only concerned with the body of doctors that it covers, who is going to supply people prescribed by naturopaths, ministers of religion, etc., and or those who choose to use recreationally and should have a right to safe access to their cannabis also?
In short, it is my thought, belief and opinion that every citizen of Canada should have the right to have safe access to cannabis and all of its products as there is NO credible evidence, that is demonstrable, of any hazards or downsides associated with it, and a great many benefits including life saving ones.
There are large breweries in Canada making billions of dollars a year bottling beer for mass consumption, much as the college is envisioning suppliers of medical cannabis supplying to patients.
There are also microbreweries and home brewers that are less regulated or not regulated at all. Like the tens of thousands of Canadians who grow fruit in their backyard to make wine there should be the same opportunity for people to produce cannabis and cannabis products for the private use of themselves and their friends. If they choose to sell their products commercially, then of course they ought to be regulated and taxed just like producers of wine or beer for health and public safety reasons.
Your draft regulations are myopic, short sighted and displaying a large concentration of idiocy and ignorance surrounding cannabis use and it’s production including the various strains and the fact that growing cannabis is amost as much art as it is a science; just as brewing beer in a microbrewery is an art or making wine is an art, but they are also sciences as any brewmaster or oenologist will tell you.
In much the same way cannabis production is very different than most commercially produced crops and should not be left to large corporations to mass produce it it like soda pop or Canadian beer, without opening it up to the smaller producers that produced the higher quality that will drive the market and develop better and better strains which the big companies do not do.
The foregoing comments notwithstanding, there should be free access for medical patients and safe commercial access for recreational and users, anybody who wishes to grow their own should be allowed to do so unmolested by the state.
given your comparisons to Beer and microbreweries, you should address your concerns to your politicians, not to the College. The College is only for the regulation of physicians, not for the regulation of substances in Canada. That is the responsibility of the government.
And unfortunately the politicians are listening to the Tobacco and Pharmaceutical lobbyists instead of the PEOPLE. The COURTS, however, have MANDATED Health Canada to PROVIDE ACCESS to Cannabis for patients.
Health Canada is in the wrong here!
I think that your policy is fair and far more complete than others. The use of telemedicine is particularly astute. People in remote areas need help too.
I am not shy, nor ashamed to prescribe medical cannabis and in fact, have had a clinic for the past three years dedicated to the challenge. I lecture regularly around Ontario, and I am an academic physician. The draft policy, which looks quite familiar to me, is comprehensive and fair. I am impressed that the CPSO has put so much effort into dealing with the topic of medical cannabis and recognizes two sides of the discussion. My concern for the future, is that it will repeat the past of not that long ago, where unscrupulous individuals/industry/quasi educators using “bro science” will take advantage of enthusiastic physicians and patients. And on the flip side, physicians will sign prescriptions without being properly educated. Cannabis has some very big potentials and robust literature on its lack of harm, not to mention a two thousand year old documented track record (with an astonishing lack of piling bodies for the negative attention it receives) and should be taken very seriously. Proper education of interested physicians in the clinical setting is key to successfully implementing the program. Clinically, it is very easy for one to close their eyes, cover their ears and stomp their feet and say “not my problem”, yet said physicians find it easy to prescribe opioids (which are responsible for 1 in 8 deaths in young adults and have severe side effects in 1 out of every 6 elderly patients)for indications that are weak at best. In my clinic, over 85% of my patients prescribed Cannabis have decreased their opioids by 50% in the past year. That’s huge! and the burden it lifts off of them and society is just as massive. So, before knocking a non toxic, low side effect rate medication (yes .1% of the population will have an adverse reaction, you can see Grant et. al. if you don’t believe me)please take the “hard” road and get educated. It is after all in your patients best interest and will save a life, that I can assure you (specifically monitoring patients and informing them not to drive while acutely using cannabis for example can potentially save a life. Considering, it is very difficult to convict an impaired driver for anything other than ETOH, after they have killed someone, as just one example, will make a difference). In the meantime, I’d like to see how the college is going to monitor physicians who do prescribe cannabis. Opioid prescribing failed miserably for years and playing catch up has proven difficult and unfair in many situations. Hopefully, the same situation can be avoided with Cannabis. —
That would be .001 percent – my mistake. Not .1%
This guideline seems quite reasonable in its approach to the use of Cannabis for managing chronic pain. I would like to point out that a significant number of chronic pain patients will not have an indication for medical marijuana, as they typically present with nociceptive pain ( such as chronic mechanical back pain , OA, etc ). Moreover, medical marijuana is not recommended for fibromyalgia. At present, medical marijuana is indicated for managing NEUROPATHIC PAIN conditions.
I strongly suspect that marijuana /
” chronic pain clinics ” will not follow the recommended guidelines. It is also likely that the watchful dose of 3 grams per day will be exceeded. I suspect this, as I have seen patients with Fibromyalgia on very large doses of Cannabis and yet have failed to demonstrate analgesic benefit ( known as chasing the tail phenomenon ).
The above issues may result in CPSO audits.
Although 0.1 % of your patients may have “side effects”, approximately 9 % of users will experience a very significant problem with this substance ( known as Cannabis dependence , a DSM V diagnosis ).
General comment for phyiscians…I frequently see the claim that marijuana as medicine is based on anecdotal evidence. Physicians claim to be uncomfortable prescribing medication based on anecdotal evidence.
Yet, off-label prescriptions are based entirely on anecdotal evidence. Pharmaceutical companies routinely encourage physicians to prescribe their medications for conditions that were not tested under the rigourous testing that many physicians are demanding.
As a sufferer of chronic migraines, I know a few things:
1. From aproximately 3000 BCE until 1942, marijuana was the recommended treatment for migraines.
2. There are no studies of any kind for marijuana as a treatment for migraines. There will be no studies because there is no possibility of return on investment.
3. Marijuana acts as a treatment that helps relieve migraine headaches, and as a prophylactic in significantly reducing the frequency of migraines.
4. Not all marijuana is effective. Some cultivars will trigger headaches, others are more effective at eliminating them.
This is my reality. The simple fact is that when consuming marijuana on a regulated basis, it is an effective treatment that does not impair me. When I am without medicine, I am severely impaired. (I do not drive so no need to worry there)
What is the charge for other prescriptions now or in the future?
Canada is way behind both Israel, http://www.jewishjournal.com/cover_story/article/green_gold_israel_sets_a_new_standard_for_legal_medical_marijuana_reasearch
and the Netherlands.
Physicians do not apparently have any issue with writing millions of scripts for untested drugs ( vioxx & paxil being two), whereas Marijuana has been used medicinally for eons. I find this hypocritical.
Some doctors were getting or planning to get into the marijuana business, because of the lucrative idea of doing the forms for $200-400 each.
With this policy, which is commendable, this will stop. There will be little incentive to for them to “prescribe” marijuana for cash.
To the physicians and members of the public who claim to say they know that marijuana is bad for you or that try to argue how to prescribe the doses… Are you serious?? After all these years that smoking cigarettes and weed and the only one coming back with any negative effects on the human health is tobacco. Dont you think we should have found something wrong with it by now? And people, EDUCATE YOURSELVES BEFORE YOU POST IDIOTIC AND UNPROVEN FACTS! I smoke it, it’s the only form of pain relief I can get. So ask yourselves, if you were in my place, wouldn’t you fight for the one thing that makes you better? Stop trying to make our lives hell just because you are too afraid to self educate or even try it to experiment with it. We live in 2014, decriminalization or just legalize with an age limit like cigarettes and alcohol. if it helps me and you don’t like it, that’s your problem, not mine. As for the children who might experiment… Who doesn’t? Its all on the parents and how well they do their parenting. Such a big problem for nothing….
It is different for everyone. Marijuana has no effect on me as Percoset and over-the-counter painkillers don’t either, however aspirin seems to work for me! Don’t tell my liver!! It’s different for all. I’m talking about canibus as a pain killer, now. And it’s already easy to get off the streets at the moment, so whether it’s legalized or not is irrelevant.
I just don’t like the “smoking” part of it! Smoking is SMOKING and nobody’s an expert on how to do street drugs. THEY kill too!
I strongly object to the use of “medical marijuana” as a CURE for anything. Studies are ALWAYS BIASED and drug side effects are reprehensible! Physicians should NOT hand out pharmaceutical drugs all willy-nilly if there are ANY side effects! Doctors should not be so naive as to believe whatever the Pharmaceutical Rep tells them! Especially if the doctor wants to be TRUSTED by the public still.
I have concerns that clinics are being set up to capitalize on prescribing medical marijuana and to make a profit on it and to prescribe when it is inappropriate
it is alarming that on a regular basis I receive faxes from such clinics promoting marijuana for conditions such as anxiety where not only is there no evidence it is not effective but in fact makes things worse.
The guidelines need to be clear that like other prescriptions there need to be clear indications for marijuana for which such indications are very few or we will end up like other jurisdictions where the common reason for prescribing are for conditions where there is no evidence of efficacy
in California some of the commonest reasons for prescribing marijuana are sleep disorders, anxiety and depression even though there is no evidence that they are effective
I believe the college policy needs to discourage that happening in Ontario.
I agree that there is a lack of education for prescribing physicians. I really don’t know what I am doing if I prescribe it. Where are the CME programs to help us understand?? The draft policy was not specific regarding the knowledge needed to prescribe.
Physicians have expressed concern about the lack of scientific resources for prescriping Cannabis.
This is an article in the JAMA:
Here is an article on the NCBI:
Physicians are essentially prescribing medications that have been subject to much less testing than marijuana.
maybe, but none of those substances are delivered by hot smoke from a burning plant.
How would the College react if a doctor used marijuana for ‘anxiety’ and was under the influence whilst treating patients? I wish the College was more transparent about where they really stood.
Putting this in the hands of physician makes it more likely for them to get into trouble with the College for both prescribing and not prescribing it?
Don’t prescribe it, patients complain.
Prescribe it and you’re a drug dealer, money hungry, unethical etc.
Please don’t dump this on doctors. If the public wants to smoke marijuana let the law enforcer and monitor it just like they do alcohol.
Chronic Pain TorontoIf I could get an approved curriculum for continuing education credits and further support in the area of pain management, from the Royal College of Physicians.
Format: lunch and learn.
Focus on early diagnosis, The referral process to pain physicians.
If I held 6 lunch in various pain clinics every 2 months How many would be interested in attending?
Inhaled marijuana is not medicine. Except for its antiemetic effect, the medical benefits of inhaled cannabis are restricted to its euphorigenic effects – hence its addictive effects. Any substance that generates immediate euphoria can be said to have analgesic and anxiolytic properties. Addicts have said the same of cocaine, heroin, and alcohol. By the same token any substance that creates immediate euphoria and reward is also highly addictive.
THC is available in the form of standardized tablets, e.g. dronabinol, in the same way that morphine is available as medicine but not opium. Morphine is medicine which is standardized in terms of dose and effect, but smoked opium is not. An addict may and will claim that smoked opium is more “effective” than control release tabs of morphine , but that is mainly because any euphorigenic substance when inhaled gives faster reward, and is thus more addictive in that form. hence fentanyl when smoked is much more rewarding and addictive, than when it’s worn as a patch on the skin.
marijuana is not a medication. Many medications in modern medicine are derived from plants. doctors don’t prescribe the plants, but the standardized and processed extracts. No other raw substance is prescribed in Western medicine, especially with a route of delivery of inhaling its burnt smoke.
If society really wants to make marijuana legal, as it did with alcohol or tobacco, then that is a political issue and out of the scope of this discussion. Otherwise, this substance when burnt has no place in medicine, and no amount of lobbying, and twisting and turning the issues by the “advocates of medical marijuana” should change that.
The following statement occurs in Volume 10, Issue 3, 2014 of Dialogue: ” positions are reminded in the draft that they must always practice within the limits of their knowledge, skills, judgment, and clinical competence.”
This requirement is virtually in possible for most physicians ( except those with personal experience using the drugs) to comply.
The problem with the legislation and our draft policy is that nothing is clear-cut, prescription or recommendation? Are they the same? Then call in a prescription and give it a DIN number.
Hold physicians accountable for recognizing addiction potential with marijuana, but ignore the epidemic of addiction and drug abuse from medically prescribed drugs which have filled our newspapers for the past several months.
The draft policy in my opinion reflects the college of disapproval of this development and appears to hold positions recommending marijuana to a standard which is impossible given the level of experience and knowledge positions not possess.
The result is then will be fear on the part of physicians to remove barriers to access to legitimate substance which could help a significant number of their patients with an alternative method of dealing with chronic pain, fibromyalgia and other conditions were medicine has proven unable to deal adequately with the condition.
Thank you so much for tackling this thorny topic and attempting give guidance. I think the guideline is well thought out and presented as it stands.
By way of introduction I am a physician working in Ontario in addiction for the past 13 years. I have worked at various methadone clinics and am certified by the American Board of Addiction Medicine.
As stated the guideline are excellent although I would suggest a few small changes. At or around line 84 I would add:
“Any patient with moderate to high risk of addiction ( Hx of addiction, mood disorders, ADHD, family hx of addiction (including alcoholism or smoking), young age (less than 30) or positive urine drug screen) should be referred to an addiction specialist or psychiatrist before prescribing cannabis.”
I would also add a small disclaimer that “because there is only scant medical evidence of positive effects in only 3 recognized diseases no doctor should feel obligated to provide a prescription. Doing so will NOT be considered withholding treatment.”
I would like to believe the majority of physicians will read these guidelines and act properly but the reality is that some physicians see an opportunity to fill a niche. Already there are dozens of “Cannabis clinics” where up to 90% of people who present get prescriptions for cannabis ( often at many fold the required dose). I don’t want Ontario to become like California where doctors roam the beaches giving out prescriptions and the average cannabis patient is 25y/o male with vague pain complaints. I really can’t imagine the number of people on chemo or with multiple sclerosis who can’t convince their neurologist, oncologist or GP to give them a prescription for cannabis. I’m sure it happens but it is extremely rare and certainly not enough to warrant the establishment of so many clinics.
I don’t see anyway of banning such clinics but requiring them to delve into addiction risks and take it seriously may decrease the toll both on the population and on the respect doctors have earned over the centuries.
My suggestions are based in solid science and are within your purview to mandate. Even with such demands there will be a lot more cannabis around and more of our youth will be exposed to it. The results can be catastrophic and it could be another blight on the medical profession. In the midst of dealing with prescription drug abuse, the worst iatrogenic illness in history, we are doing the same thing with cannabis except this time there is very little data to support its use.
This is an excellent document. I have 3 comments:
line 72 should read “oral or buccal pharmaceutical forms”. This is because in Ontario we have both oral nabilone and sublingual nabiximols. I wonder also if it is important to say that these medications (if used for anything other than their specific indications) would be considered off label and patients should be made aware of that.
line 91: using the words “interactions” and “contraindications” implies that medical cannabis has undergone the same rigorous testing that is applied to pharmaceutical products. this is simply not the case. Health Canada did not evaluate cannabis with the same level of evidence requirement that pharmaceutical products require. Perhaps the wording can be changed to “potential interactions, and adverse reactions”. Though we believe that cannabis should not be used in patients under the age of 18, and that a personal or family history of psychosis should cause the practitioner to Not prescribe cannabis, these are cautions and not true contraindications.
Finally, I greatly appreciate your stance that charging for these prescriptions is not allowed. I am very concerned about the Cannabis clinics which have sprung up, many restricting their practices to just marijuana prescribing. AS a physician with a focused practice in chronic pain, I can’t imagine offering my patients just one option out of all that are out there.
LOTS OF MY PATIENTS TELL ME THAT THE NEW LEGAL GROW-OPS WILL BE OFFERING BROWNIES AND COOKIES – WHY ARE WE JUST TALKING ABOUT DRIED MARIJUANA ?
WHAT ABOUT VAPORIZED MIST THAT MANY PEOPLE USE TO AVOID THE DANGERS OF SMOKING ?
I ALREADY PRESCRIBE CESAMET FOR NAUSEA OF CHEMOTHERAPY FOR MY PATIENTS – THIS IS NOT A NEW ISSUE FOR PRACTICING PHYSICIANS .
The draft policy number 3-06 “Marijuana for Medical Purposes” is appropriate in my opinion.
It provides more of a gate than a doorway.
I deeply resent the fact that the federal government’s MMPR was formulated and released without full prior consultation so that the Colleges’ policies could have been prepared IN ADVANCE rather than having them prepared in reaction to ironically coercive forces: the populist movements towards freer access to marijuana in general (spearheaded by the liberal media) and the business interests of marijuana producers (championed by the conservative government). Both of these groups are gung-ho on the “benefits” while barely considerate of the risks.
The draft policy is emphatically risk-oriented.
In my opinion our profession has already become far too willing to prescribe substances rather than to take the time to engage our patients in efforts to work on their health maintenance and to work on their recovery from various illnesses they may encounter. Forwarding lifestyle choices and lifestyle changes seems to take a back seat to the issuing of pharmaceuticals.
I find it telling that in the article in the MD Dialogue that the clause “physicians can ENABLE patients to access a legal supply of dried marijuana” . Certainly that particular word speaks to unhealthful dependency rather than better outcomes!
Hopefully the next years do not see our profession pressured to move beyond “a pill for every ill” to “weed for every ‘need’”!
I have read a lot of well done review articles on marijauna and believe that we are opening ourselves up to producing a lot of schizophrenics. The truth is that if you smoke enough marijauna you will have a psychoic episode as marijauna ia an hallucogenic drug. 40 to 60% of First Time Psychosis (FTP) will have used cannabis in some way, whereas only 10% of population will have FTP. Half of all patients who are treated for cannabis-induced psychoses go on to develop some form of schizophrenia. Psychoses does not always appear right away, it may take years for psychoes to develop even after the use of cannabis has stopped. I view of this the Medical profession must take extreme caution about prescribing marijauna.
Why are not telling patients who use medical marijuana not to drive? Until we know usage levels and driving ability and are able to measure blood levels this seems to be a no brainer.
I am a 3rd year Physiatry resident with interest in pain management (intervention based and chronic).
My questions to you’re draft are the following:
1) Would there be any guidelines for dosing of the Marijuana? And if yes, how would they be generated (from habitual users?)?
2) How will you monitor the quality and quantity (percentage) of the active substances in the drug (THC content / Canabidiol content), given the numerous amounts of legal suppliers possible?
3) Finally, will you determine which strand with what percentage of active substance (THC/CBD content) would be best used to treat a particular disease?
(example: high CBD content for seizure as opposed to higher THC?)
I ask this since the available suppliers advertise mostly high THC content strands of marijuana, however, trials are uncertain if the therapeutic effect of the drug is indeed a result of the THC or other active substances …. (with I believe the exception of epilepsy ).
I am writing to voice my opinion as to the CPSO marijuana for medical purposes draft policy.
Firstly, let me state that I am a gastroenterologist practicing in the community for more than 15 years in Ontario.
I have many concerns regarding the issue of physicians getting involved in this issue:
1. The draft considers the medical document authorizing patient access to dried medical marijuana equivalent to a prescription. Drugs that are prescribed by physicians are approved by health Canada after rigorous, peer reviewed large scale trials are done to prove not only the efficacy but also the safety of the drug in question. New drugs must go through phase I, II, and III testing and subsequently phase IV ongoing monitoring. There is no such data for marijuana. If doctors are to prescribe it, we should demand large scale studies showing its benefit and safety in the condition it is being prescribed for. If this is not possible, it should not be considered a medical prescription.
2. Given the lack of medical grade evidence of the kind required for a new drug submission, I don’t think that physicians should be asked to be involved in any way in regulating its use. Without quality evidence, the term “medical marijuana” is a misnomer. I find it similar to the use of alcohol for medicinal purposes during prohibition. If there is some holistic benefit to be gained by using marijuana in certain situations, this falls beyond our mandate as physicians and prescribers. I think it is unfair to put physicians in this situation. It would be more fair to grant/sell a pharmaceutical company the potential prescribing rights to medical marijuana but before being able to sell the product, demand the same level of study required of any new drug so we know the true benefits and risks.
3. I fear that the “medical” designation for certain conditions will negatively impact on the physician patient relationship. Physicians will be pressured by patients to prescribe the drug by patients in situations where they do not feel this is the best treatment for them. I can tell you that nearly everyone of my young Crohn’s and Ulcerative colitis patients asks me to prescribe them marijuana and it is my impression that this is mostly for access to the drug for recreational use. It takes away time from the physician encounter, sometimes creates hostility between physician and patient when the request is denied, and takes time away from patient care.
4. As gastroenterologists, we are seeing cases of refractory nausea and vomiting secondary to habitual marijuana use. (see American College of Gastroenterology (ACG). “Marijuana use may cause severe cyclic nausea, vomiting, a little-known, but costly effect.” ScienceDaily. ScienceDaily, 22 October 2012.) This is becoming a more frequent problem and the only effective treatment is marijuana cessation. This and other side effects of marijuana use need to be studied more carefully before it should be licensed to be “prescribed” by a physician.
5. We are being asked more and more as physicians to practice evidence based high quality care. Should we as physicians not ask the same in this setting? This is essentially a new drug submission. We do not really know the benefits and risks of prescribing marijuana. If we as physicians are expected to prescribe this product, it must be formally tested in the same way as any new drug before it is licensed for use.
I do have to admit that in addition to the concerns above, I am skeptical about the motivation for medical marijuana. It seems to me to be a convenient way for legislators to skirt the issue of legalization. I have no problems with legalizing and regulating marijuana for recreational use. I simply feel that Doctors should not be pulled into this issue without evidence that it is truly a safe and beneficial treatment for our patients.
Perhaps you should review the diagnostic criteria for cannabis dependence and refer these patients to an addiction medicine physician.
Doctors are still afraid to prescribe it, even though there are no hazardous effects compared to other prescription meds. These doctors have been brainwashed by government with false info on the dangers, little to no info on the health benefits, and most are very aware of CPSO’s willingless to pull medical practice liscences for stepping outside their box. As for the hazards of smoking and driving, I would bet other prescription drugs cause far more motor vehicle accidents. Many seniors are obviously overmedicated behind the wheel! Besides, if other forms of medical marijuana were legally available i.e. leaves for juicing, cannabis oil, that could also decrease the amount of patients driving stoned. One last comment… Cannabis medicine extracted with olive oil seems to be even more effective for many medical conditions and has no psychoactive effects, especially if the plant strain used is high in CBD.
Am concerned re:
1. limited evidence re: safety and effectiveness
2. issues relating to prescription/dispensing of specific concentration of drug (I have the impression that the prescribing physician does not actually have control over the concentration of product dispensed. I wouldn’t be comfortable prescribing an NSAID, or narcotic, or any other drug, without being assured that the medication would be dispensed in the dose I’d requested. Why is the CPSO expecting a physician to do so with dried medical marijuana?)
Question about written treatment agreement. I have never had a patient taking narcotics or any other controlled substance sign such a document. Is marijuana being held to a higher standard or am I ignorant in the prescription of narcotics?
There are opiate contracts that you are supposed to be using as per cpso guidelines.
1. Re no charge to patients to complete document: Until there is an appropriate OHIP fee code .I think it reasonable to charge the patients a modest fee.Prior to the change of regulations in April 2014, I was charging a modest fee of $30.00 to complete the associated paperwork.The other service provided was education re medical marijuana, ingested products vs smoked vs vaporized. My usual MJ talk takes about 20 minutes with time allowed for questions.With the expectation of signing an agreement the service could take 25-30 minutes. There is no fee code that adequately remunerates this time.
No-one complained about the fee. Many doctors were charging $250 to do this, and more, because there was no regulation.To my knowledge there is no fee code yet. It does require that you respond to either an email or a phone call from the distributor to confirm you have written the document, and for the amount stated. THis take a few minutes to check.
2. Re written treatment agreement: Are there any templates for such an agreement available or should we write our own?
I want to draw your attention to the fact that the University of the West Indies has created a group to actively investigate possible medical uses for marijuana. There is no need for the CPSO to re invent the wheel. It would be a nice gesture for the CPSO to investigate the research of the UWI. It might make the College more sensitive to minority ethnic groups. I am thinking especially of young Jamaican immigrant men for whom ganja is a mainstay. These may well end up as patients.
The policy is admirably brief and does offer the perspective of balancing benefit with risk. I think it is very important that use of medical marijuana be confined to those patients who are likely to have benefit and not be used in patients in whom there is likely to be harm. There is emerging data on this and, as with any drug, medical marijuana use should be guided by evidence. Unfortunately there are patients seeking medical marijuana for conditions in which benefit is very unlikely and also for conditions in which harm is very likely. In this case the physician has in my view the duty to inform in a candid and nonjudgemental fashion what is known and not known. As well, there are groups of patients such as children and adolescents at special risk of harm related to developmental issues and this should probably be at least mentioned in the policy.
I have used medical marajuana for two patients with great success.
If used judiciously, a valuable tool.
The only thing I like about the draft policy
is that it mentions chronic bronchitis schizophrenia as the two illnesses which may be exacerbated by marihuana use and driving.
Obviously any mind altering substance such as ethanol or THC obviates driving.
So anyone who smokes marihuana or drinks alcohol must lose their driving privileges.
O tolerance for any marihuana or alcohol in the blood above natural levels as we know that there is a minimal ethanol level even in non drinkers as there is an endocannabinoid level such as anandamine.
Both cause cognitive impairment and as such is incompatible with driving or the use of any other electric or internal combustion motor or engine. People even chop their toes and fingers if they use an axe when drunk or fall off ladders and scaffoldings.
Being high on marijuana is equally dangerous.
BTW there was the same nonsense during Prohibition when medicinal brandy was prescribed for the non existent condition of cardiac neurosis. This mysterious disease of course disappeared after its repeal.
There is no illness or disease which marihuana would cure or even help manage.
So why is it being called medical? when it isn’t.
One of the most offensive comments by marihuana advocates – are they advocati diaboli? – is that MDs should get educated and it the education isn’t available and that they are happy that opponents of this addictive poison are not their doctors. Let me assure you that the feeling is mutual.
Nonsense. For everyone MDs and others a website is available and it is 95% accurate and true. TBFTB The Brain From Top to Bottom. It covers all psychoactive drugs and substances. The most beautiful thing about it is that it has levels of understanding elementary intermediate advanced and of organization from sociological to psychological to organismic to cellular to molecular. It has very extensive coverage of everything from heroin cocaine alcohol caffeine to marihuana.
You can also read the endocannabinoid articles on wiki as well as thousands of articles on molecular biology neurology
There is simply no excuse for anyone to claim ignorance.
And if you have read enough it becomes clear that the so called medical marihuana is a hoax a lie a political football.
No sane person would advocate for alcoholism
or opium dens or gambling which is also falsely renamed in the newspeak of the age gaming as healthy wholesome activities or as therapeutic.
So why the nonsense and the lies about marihuana?
Addict promoting addiction. As if we didn’t have enough problems with drugs and other major addictions already.
The College or should not consider the marijuana “recommendation” equivalent to a prescription. Marijuana has not been approved by health Canada is a pharmaceutical and does not have a Drug Identification Number (DIN).
The current requirement for a recommendation for medicinal marijuana is simply a political expedient to limit and regulate the supply for people with sufficient need.
Why should the College put fear in physicians or prescribing us of the which may help, but certainly has less potential for harm than the narcotic medications which are prescribed so freely and cause such damage in our society.
The College should be regulating the marijuana recommendation document as a bureaucratic document permitting patients who already benefit for their conditions illegally to continue without becoming a criminal.
For weeks we have been reading about the damage caused by medically prescribed narcotic analgesics in our society. The federal health minister has expressed serious concern about physicians prescribing habits in this area.
The risk reward when comparing medicinal marijuana for pain therapy compared to narcotic analgesics favors medical arrow on a significantly. There is no risk of death from her Sparta recompression. The addiction potential is equal or less than that of alcohol and a fraction of the addiction potential of cigarette smoking.
The College should be giving doctors assistance in meeting the needs of their patients rather than becoming a non-legal barrier to people with legitimate concerns and needs.
I believe that marijuana should be decriminalized and that physicians should not be prescribing it.
This is a political/societal issue ,and not a medical issue
We do not know much about cannabis but we know less than ideal about other psychoactive substances that we prescribe.My grandmother grew the plant and claimed it was good for a number of conditions including chronic pain. I agree with her.We need more research but in the meantime let the physicians who choose prescribe it.The government should establish a monopoly on its production and sales and make it legally available to all adults as is the case with alcohol.
As a psychiatrist I agree the use of marihuana for management of pain symptoms and seizure disorders,how ever if it is smoked we are giving double message about smoking which can cause cancer and copd.hence the method of using marihuana is important. Genetic vulnerability can increase the dopamine in the brain thus leading to psychosis and mood instability. Thus people with diagnosed or family history of psychotic and mood disorders should not be prescribed
I am absolutely totally against the prescription of so-called Medical Marihuana. As Ontario Representative to the Assembly of the American Psychiatric Association for 8 years, I saw this issue come up a number of times, and eventually it was approved for one main reason, the repeated highly emotional appeals of one elderly psychiatrist.
But each time, reputed clinicians and researchers with much experience in this area stood to express their rejection of the proposal, and gave their very knowledgable reasons for doing so.
I do not believe there are no other alternatives for chronic pain or the pain associated with terminal cancer.
I also believe that not only are there no good medical reasons for prescribing it, and not only are the possible harmful effects considerable, but I also believe that it will be very easy for less than scrupulous doctors to “collaborate” with ‘potheads’ – for a fee – and write such unnecessary prescriptions.
Dear Physicians and Surgeons,
Thank you for allowing a member of the public to post on your boards.
Firstly, I want to say that I have the utmost respect for your profession, and can appreciate the difficulty that many are having in accepting the idea of herbal cannabis as a medicine. Without any basic education in the endocannabinoid system (ECS), and the modes of action by which the phytocannabinoids in the plant resin interact with the human body, it is understandable that you would reject any attempt to convince you about why you should be willing to prescribe herbal cannabis.
Even if you do not take the time to learn about the ECS, I think that you owe it to yourself to learn just how benign and safe herbal cannabis is. This is easily proved in any number of ways, but I will give you two. The first is that it is almost impossible to have a fatal overdose. The number of deaths in any year you care to examine that are due to cannabis overdose is zero. The second reason is simple common sense. People have been ingesting and inhaling cannabis for thousands of year. Currently WHO estimates somewhere around 150 million people around the world use it, and in great quantity. If there was a serious problem, wouldn’t we know it by now?
Once you are convinced that cannabis is safe, then prescription becomes a no-brainer. It is obvious that inhaling cannabis (preferably through a vaporizer) seems to benefit some, but not others. Compared to almost all other medications, its safety profile is remarkable moderate. My point being; let those patients of yours who want to try it, try it. It won’t hurt them, it might make them feel better, and there is an outside chance it might actually do some good.
What do you have to lose?
This should be by cpso guidelines just like the methadone program. Physicians should have to do a course in order to be able to prescribe and also have regular audits of charts.Should also ensure that ER docs cannot prescribe otherwise we’ll end up with creation of inappropriate use just like when many ER docs prescribe opiates by the truckload and never get audited. I am a ER doc and former methadone prescriber.
I am a pain physician at a tertiary care Toronto centre. 95% of the patients who ask for MM are not eligible for it (similar to the numbers of those I see ALREADY on MM by other physicians). The vast majority have been recreational pot smokers from before. A syst lit review on MM and CNCP shows a modest effect on neuropathic pain but trials are very short lived and can’t advise on long term effectiveness. Please use UNIVERSAL precautions and make sure you know what the diagnosis is. Lets not duplicate the opioid disaster
Line 69: not sure how “most appropriate” will be determined. Many patients for whom medical marijuana will be considered are on multiple, synergistic therapies and all my be appropriate in the circumstances.
I would like to see something in the proposal to protect physicians who refuse to prescribe Marijuana, that even if all alternatives have been exhausted there is no expectation for the physician to prescribe an unproven and clearly harmful substance.
The issue is not whether dried marijuana is a good thing or whether dried marijuana is as effective as its supporters claim.
Dried marijuana is becoming part of the panoply of pain control medications. Like all the others in this broad class, it has limitations and possibilities for abuse.
Doctors are not being asked to endorse marijuana use but to be gate-keepers in its distribution for medical use — just as they are gate-keepers in the distribution of all prescription drugs.
Perhaps in time the view of dried marijana will change against its use — just as it turned against the use of the opiates that were so popular 150 years ago. But, for now, people believe that its effectiveness is worth the risks associated with it, so the physician’s duty is to deliver it to patients who will apparently benefit from it.
I think dried marijuana might serve as a potential last line option for patients with very specific medical conditions. With that being said, there needs to be very clear regulations and guidelines with respect to this medication equivalent.
As well, one of my concerns is how do we deter diversion with this drug? Patients who will be using this medication chronically will have urine tests that could potential show cannabinoids in their system for up 30 days. Definitely a lot harder to detect diversion or comliance issues when compared to somethinf like methadone or othet medications that have potential abuse.
The use of marijuana is discussed on an almost weekly basis in our pediatric chronic pain clinic – but after
Reading through the draft, the pediatric patient is really not specifically taken into account. I would suggest
that this should be considered.
I grew up in BC in the 1970s, and like most BC teens, I heard tell of marijuana.
Me personally, I don’t smoke it, but it seems to me the Greater Good comes from legalizing it… it’s harm-reduction thing.
But “medical marijuana’? Largely a farce, I think. My read of the science leads me to think it’s not first- or second- or third-line for much of anything. But I suppose it serves a useful political purpose on the road to legalization (which I support).
You’re putting good thought into the whole issue — it makes me proud to be a member of the profession.
Inasmuch as marijuana, medicinal or otherwise, causes altered sensorium, somnolence, blurred vision, dizziness ,.. the College should perhaps make it mandatory for prescribers to notify the ministry of transportation for the patients who are still driving. When renewing their driver’s license patients should be made aware if the fact that they too have an obligation to inform the MTO that they are on medicicinal marijuana on the medical information questionnaire we all fill out when we renew our license . It goes without saying that the same applies to the operation of heavy machinery/ tools at home or at work.
There has been a recent report of an increase of fatal car accidents in Colorado since the legalization of marijuana. I would suggest that once a physician prescribes MM for one if his patients a monitoring of reflexes by regular neurological examination should be part of the follow-up with any change fully charted and documented; changes in ocular accommodation should also be documented (our ophthalmologists do warn us to wait before driving after they had used atropine to trigger mydriasis ).
I would be extremely cautious..although I am semi retired I would not prescribe unless there were clear and very definite criteria for this use……in the past I had requests for the drug for the most (in my view) the most inappropriate reason…
Why not make it similar to tobacco and cigarettes
Your description of adverse effects did not include the evidence of cognitive impairments. This can occur in adults, but is very significant for the developing teenage and early 20’s brain.
There is a rapidly increasing literature on this. Even Health Canada has started putting public health messages about this on TV.
I suspect that many physicians are not aware of this emerging literature, as I have discovered when I send copies of recent journal articles even to my psychiatrist colleagues.
One of the concerns which we have experienced is patients self-referring to physicians that are recognized as being willing to provide the required authorization form. These physicians do not necessarily provide information to the patients primary care physician that they have provided this authority to have marijuana for medical purposes. Many of these patients will already be on other medications to treat their condition, and the use of marijuana may reqr these to be changed/stopped. I would like to see the policy provide some guidance regarding the physician who is not the primary care provider to advise the patient to report this to their primary care clinician, ideally they would request that the patient permit them to obtain the medical history and current treatments from the primary care provider and/or to provide consent to send a note to their primary care provider.
New Brunswick does have some language in their policy that somewhat addresses this issue regarding physicians that are not the patient’s primary care provider providing these authorization forms.
Thank you for the opportunity to provide comment.
Thank you for the opportunity to comment on the Draft Medical Marijuana policy.
It is not likely that I will be prescribing marijuana. However, I may, from time to time, refer a patient to a physician who is. As I am not fully aware of the indications for Medical Marijuana, my referral will come as a request for consultation. As such, I would like to see the Policy include a statement that for patients referred to a “Medical Marijuana Clinic” a consultation report will be sent to the referring physician. This is important so I may know exactly what the indication is and what the treatment plan is moving forward.
I would like to make a few comments about this policy.
I was the leader of the research team that developed the NOUGG Canadian Opioid Guideline for the CPSO in 2010. I am aware of many bad opioid prescribing by Ontario doctors. My main concern is that this policy is very liberal and open for any doctor to prescribe medical marijuana in Ontario, without proper and strict criteria of the appropriate patients or appropriate products.
First, making it a prescription is a good idea, but there are other conditions that need to be met to fulfill the criteria of a prescription: indication, dose, contra-indications, patient selection, dispensing and monitoring. I don’t see these details in this policy document.
Second, when physicians started prescribing opioids for chronic non-cancer pain 20 years ago, there were no boundaries and monitoring for good prescribing habits, and that is why we are in the mess we are today with opioids. I would like to see the CPSO more proactive and restrict with what constitutes a good prescription habit for doctors. And it is essential that these prescriptions be captured by the current Ontario Narcotics committee.
In Quebec, their College has set a standard that all medical marijuana prescriptions need to be tied to a central database that will continuously monitor the outcomes, doses and complications. I think we should do the same in Ontario.
Thank you for allowing me to provide feedback. I hope someone is listening.
With all due respect to those who wish to prescribe and use this agent, there should be limited physicians , at least initially, to have the privilege to prescribe this. This would help format the problems in administration , but also allow experience in the use of this agent, since there are few scientifically executed studies. This, the lack of these studies , runs against the the guidelines for other drugs.
As a physician prescribing to Ontarians, I have the expectation of consistency in bioavailabilty of the active ingredients of the medications I prescribe. As of now, health and welfare Canada doesn’t seem to have approved of any standardisation of THC/ cigarette or oral form. Notwithstanding the draft policy, which I think lays out the basic principles around which medical marijuana can be utilised by medical practitioners for patients, the lack of predictability of the ‘strength’ of the drug and any guidelines as to dose is worrisome
I just got back from the CFPC forum in Quebec where I attended a couple of sessions on marijuana
Then tonight I read the latest summary from the CPMA
Then the draft guidelines
The guidance from various colleges across the country are all over the place and that is a problem.
Why would we have such different guidelines? We all live in Canada.
Each college has some different unique and useful provisions I think the CPSO should look at before finalizing the Ontario version
Let’s make Ontario’s the best!
I don’t think that the “medical document is a prescription and won’t think even if the CPSO does because unlike all other prescriptions for medications we write:
1. Health Canada has not approved marijuana as a medication as they have for everything else we prescribe
There is slim to no evidence of effectiveness for most conditions it is being used for and that is why Health Canada has not approved it, also there is ample evidence of harms
2. A usual Rx for a medicine is sent to a pharmacy
3. Although the amount and the product strength and the dosing can be specified, the suppliers are not obligated to fill it as prescribed and we heard in Quebec numerous examples of this happening
4. The method of taking it cannot be controlled (vapourization vs smoking vs ingestion) , therefore the harms cannot be controlled
I think the liabilities are potentially huge
Patient has a car accident, drug testing is positive for THC, they have a prescription from me ………..
I think the doctors of Canada as represented by their colleges and associations should push back and send this back to the drawing table
We were not consulted about it and we don’t have to comply and if our associations advise us not to that will have a much more useful effect in terms of this being better thought out with MD input and legislation re-done
We don’t have to jump when the government suggests we do
If all the above is ignored at least please be explicit about giving us language around the right to refuse to provide the documentation with no ability of patient to make frivolous complaints.
The following are my comments on the proposed marijuana policy
In its document “Cannabis (marihuana, marijuana) and the cannabinoids Dried plant for administration by ingestion or other means”, Health and Welfare Canada specifically states that:
“ marihuana (cannabis) can be considered a very crude drug containing a very large number of chemical and pharmacological constituents, the properties of which are only slowly being understood.”
More specifically, it also states that: “Cannabis plants contain at least 489 distinct compounds distributed among 18 different chemical classes, and harbor more than 70 different phytocannabinoids”
And furthermore, when smoked, which apparently is the only legal way of doing it: “pyrolysis transforms each of the hundreds of compounds in cannabis into a number of other compounds, many of which remain to be characterized both chemically and pharmacologically.” In that document Health and Welfare Canada specifically states that “Cannabis is not an approved therapeutic product”. So indeed, from the government point of view smoked marijuana is akin to snake oil.
The College is legalizing the act of medical prescribing to smoked marijuana. It is formally endorsing a prescription for a substance that is not an approved therapeutic product. This in effect could be seen as retrogression to the times of the Wild West and the sale of snake oil by physicians.
The College is making a statement in its policy that certain groups of ‘patients, physicians, and researchers have voiced support … for the use of … marijuana” Just exactly who are those individuals? What evidence has been proposed that this indeed is beneficial? Why is the College yielding to pressure of certain groups when the evidence for the beneficial use of this substance is weak and contradictory? Why is the College guiding the profession to endorse the prescription for a substance that is not a recognized therapeutic product?
In considering legalizing a prescription for marijuana, which is not a recognized pharmaceutical by Health and Welfare Canada, the College is indeed putting my professionalism into question.
Professionalism values are clearly stated in the College document. However, I do not see professional knowledge mentioned as a key value of Professionalism in the College document.What did I go to medical school for so many years for? Professionalism definition in Medicine includes base knowledge component according to most sources. At this stage the base scientific knowledge about the “medicinal” effects of marijuana is weak and conflictive. However, looking at the emerging trends the burdens of marijuana on the patients and society is considerable. Certain age groups are more vulnerable to long term adverse effects of marijuana use.
The College is not setting any clear cut guidelines in its proposed policy. Some facts are left understated despite the fact that the quoted reference papers in the proposed policy clearly mention these. This makes the proposed policy akin to an official statement simply endorsing the government law in regards to the “medical marijuana”. Nothing is done to guide the profession and protect the public other than stating that from now on the marijuana document is going to be treated as a prescription, with all its attending professional responsibilities.
I am sure that the college is aware of the recent College of Family Physicians Guidance document. It is clear cut and practical. It provides the levels of evidence. Unfortunately, the levels of evidence quoted show that the evidence for using smoked marijuana for medical purposes is weak.
In that document fifteen recommendations with 27 comments citing levels of evidence are presented. Only 1/27 recommendations (4%) is quoted as level 1 recommendation (supported by randomized controlled trials or meta-analysis). That recommendation specifically states that: “Authorizations for dried cannabis should only be considered for patients with neuropathic pain that has failed to respond to standard treatments (Level I).”
Furthermore, in that document 12 recommendations (44%) are defined as level 2 (observational studies) and 14 recommendations (52%) are defined as level 3 (expert opinion) recommendations. With all the respect to my professional colleagues, snake oil indeed!
In writing a prescription for the patient I have to consider the 2 B’s – the benefits and the burdens. Unfortunately the benefits are weakly supported by the emerging medical literature. The burdens are high, particularly among the teens. This aspect in particular is totally omitted in the College Policy proposal. Do young people not smoke marijuana?
From medical malpractice point of view, when writing a prescription for marijuana I risk both errors – of commission, that is willing fully prescribing substance that I know, as a professional, is potentially harmful, and of omission, that is prescribing a substance about which full effects I am professionally ignorant.
Given all of the above, if the College policy is approved, as a professional I will pass on writing a prescription for marijuana. I believe that, given the current level of evidence, any prescription for marijuana clearly puts the prescribing physician at risk for malpractice. If this substance is prescribed serious side effects may occur precipitating a lawsuit against the prescribing physician, which may not be defensible in the court of law.
I would respectfully suggest the College carefully reconsider approval and publication of this particular policy. I would respectfully suggest that the policy be redacted and reformulated to reflect the College Mission Statement in order to truly guide the profession and protect the public.
I have some serious concerns:
There is no mention of the fact that minors under the age of majority are particularly vulnerable to the physiological risks associated with regular marijuana use, including cognitive changes as well as the increased risk of subsequent psychosis. The policy does mention onset of psychosis but there is no mention of the increased risk among youth.
The policy describes measuring the dried marijuana but there is no mention of restricting the THC content of the dried marijuana. We know that the THC content of marijuana has increased dramatically through the years, partly because the strain used for hydroponically grown marijuana (ideal for North American climate) generally has higher levels of THC content then the “weed” grown in the Southern hemisphere. THC content is the psychoactive component associated with psychosis and cognitive changes – the higher the strength of THC the higher the risk of psychosis. The THC content is also associated with the addictive risk of the strain of marijuana. The proportion of THC varies by strain and so simply weighing the dried marijuana does not necessarily predict the strength of THC content. Physicians should be setting limits on the THC content of the weed to protect patients from harmful effects on the brain. At the same time, it is incumbent upon licensed growers to disclose the THC content of the marijuana they are producing for medicinal purposes. I suspect the supply of low THC content marijuana may be limited, although I am not sure.
The policy is fuzzy about the need to monitor the mental state regularly of those prescribed medical marijuana. I have had a patient under the age of 21 who was prescribed medical marijuana by a physician who never actually met the patients in person. The assessment was over Skype (not OTN) and in fact the physician provided several repeats without ever re-assessing the patient. The patient would not reveal their name. Unfortunately, the patient became psychotic and required an emergency admission and was discharged to my care.. The patient had legitimate and severe chronic pain but the physician was not actually monitoring the patients mental state or monitoring how much of the marijuana the patient was actually smoking. The patient was not just using the marijuana for their chronic pain, the patient was also was using large amounts every day to escape from emotional pain. It is incumbent on the College to ensure patient’s mental states are monitored carefully, including concerns about work functioning and operating a motor vehicle.
Finally, has the Health Protection Branch approved this substance as a medication without phase II randomized control trials? I think it needs to be clarified in the policy what the HPB standards have been for evaluating this substance, so that physicians are aware that the standards may not necessarily be the same as other HPB approved drugs. How are physicians to know whether this substance interacts with other medications and what the harmful effects are without data from large randomized clinical trials?
I had a chance to take a look at the proposed Medical Marijuana policy, and it seems sound to me: I particularly like the recommendation for a a signed, written agreement with patients, but I would prefer if this were a requirement.
Also, I think the recently released “Authorizing Dried Cannabis for Chronic Pain or Anxiety: Preliminary Guidance” by the College of Family Physicians of Canada should at least be cited as a reference. It’s a concise, well organized statement with many helpful suggestions for safe prescribing.
some physicians are getting into this for the kickback incentives given to them by the marijuana growers to “prescribe” it.
I think the College should specifically add in the proposal that such an act is conflict of interest and unethical.
I don’t feel the burden of “prescribing” Medical Marijuana should fall only on doctors. I think that the regulations regarding its prescription should be relaxed to include Alternative medicine practitioners.
Let’s be honest for a moment. While the ultimate benefits for medicinal marijuana are unclear and yet to be fully determined, I believe that its benefits greatly outweigh the risks of its use. My personal research on marijuana leads me to believe that it is fairly benign in terms of side effects and health risks for long term use. Much less so than many other classes of drugs.
The problem with medical marijuana is that research is in its infancy. There are many factors to consider when prescribing marijuana and most doctors do not have the time to keep up to date on recent developments and changes. Doctors tend to be uncomfortable prescribing courses of medication that they don’t fully understand.
Perhaps it would be a good thing to consider allowing Alternative Medicine practitioners, as well as doctors, the ability to prescribe this substance. Those that choose to research and prescribe it will be in a far better position to assist their patients in terms of dosage, types and methods of ingestion.
Yes, there are concerns for abuse and diversion. This applies to many different drugs. However, my opinion of medical marijuana is that since its risks and side effects are so low, this is less of a concern than that of opiates. Lets also be honest again for a moment. Marijuana use and abuse is widespread as a recreational drug and has been so for a very long time. Even in cases of abuse, the harm is relatively low in comparison to say, alcohol or crack cocaine. My biggest concern would be to keep it out of the hands of young, developing minds. Sadly, no amount of regulation is really going to change this.
I would like to address this policy with some facts and then give my opinion at the end. I have chosen to leave out the crucial and I think somewhat obvious notions that physicians should weigh risks and benefits, advise against smoking, start low and go slow, include patient contracts and follow up regularly.
1) The MMPR is a federally mandated policy.
2) The MMPR specifically does not call the medical document a prescription
3) Marijuana is not approved by Health Canada for medical use
4) Long and short term safety profile of marijuana has not be clearly elucidated
5) Dosing of marijuana is not precise given the variability of different strains
6) The CPSO intends to change the definition of a prescription in order to include only one product that has not been approved by Health Canada – marijuana.
7) The CMPA’s legal stance is that the medical document is not the same thing as a prescription: “While it is widely stated that physicians issue “prescriptions” for marijuana, the medical document issued by physicians is distinct from a prescription. Prescriptions are required to access drugs approved for use and regulated by Health Canada. Health Canada does not currently approve nor regulate medicinal marijuana. Therefore, the medical document provided by physicians to allow patients to access medical marijuana can only be considered to be analogous to a prescription in limited ways.” (https://oplfrpd5.cmpa-acpm.ca/-/medical-marijuana-new-regulations-new-college-guidance-for-canadian-doctors)
It is my opinion that the CPSO is trying to fit a square peg into a round hole. As physicians we are used to dealing with prescriptions and products that have been approved by Health Canada. Marijuana is not one of them, so treating it as if it is can set a dangerous precedent. Why is marijuana being singled out as the one unapproved product that gets treated as if it has been approved? How can we as physicians purposely speak out of both sides of our mouths when we warn of the dangers of products that have not been properly tested and then completely ignore our own advice when it comes to marijuana? This reverse-engineering of what is defined as a “prescription” is politically motivated and seems to run counter to federal law.
A product is either approved by Health Canada or it is not. What is so wrong with calling marijuana what it actually is? – An unapproved herbal product that can be used by patients with a physician-issued medical document, but which has not been properly studied for risks and benefits. We should respect the Health Canada approval process and not just ignore it because it makes our lives less complicated.
Response in PDF format.
It is my opinion and that of the majority of my colleagues at our hospital, that to further expand
the use and supply of this drug is inappropriate.
I have practiced medicine for over 50yrs as a General Surgeon treating patients of all ages with a
wide range of surgical problems including trauma and multiple different cancers, from primary
diagnosis and surgical management to, and including, palliative care of those who are or have
become inoperable (or otherwise terminal).
I have never seen, or know of, any indication to prescribe or use marijuana (incidentally, nor
have I seen the necessity to prescribe Percocet or its other combinations).
Twice I have been requested to condone the use of marijuana. On both occasions , in
unfortunate individuals habituated to marijuana who had inoperable, terminal cancer (possibly as a consequence of their addiction) I concurred with the on going use of the drug.
Already in this country we have an inappropriately high addiction rate to narcotics. Many of
whom have been unnecessarily prescribed narcotics for minor aches, pains, depression or quality
of life issues.
Over the last few years there has been a very significant increase in the death by overdose of narcotics particularly in the young.
It is my considered opinion that the “medical use” of marijuana in some approved manner will expand these problems in society, for very little if any benefit. We should be practicing evidence based medicine. If the “side effects” out way the benefits of treatment, the treatment should not be advocated.
I work in an area of Ontario with a focused practice in Palliative care. This area has one of the highest rates of prescription IV opioid addictions. Regularly I see young adults with endocarditis and other life- limiting infections from this. Many started with a legal prescription of opioid from a physician and most on the street is diverted from a legal prescription. Our opioid prescribing is killing our youth!! I have yet to see a patient die from infection, organ failure or overdose from recreational marijuana. Medical marijuana is NOT recreational. It provides a much higher level of safety than opioids when prescibed properly. I recognize that it must be used wisely, 1-3 grams per day and for appropriate indications but it can be a viable and safe alternative. Many countries, Switzerland, the Netherlands, Israel, have excellent experience with it.I can absolutely accept that medical Marijuana should be prescribed by Physicians with experience and should be monitored. I also think that physicians who have told their patients that as long as you are in pain you can’t get addicted to opioids, or there is no ceiling on opioids should be required to take mandatory addiction training. The evidence indicates that the greatest risk of marijuana is in daily use greater than 5 grams. This should never be prescribed. Greater than 100 mg of morphine equivalent per day increases the risk of accidental overdose and greater than 200mg increases the risk of hyperalgesia, yet physicians still prescribe these doses. Medical marijuana has risks including addiction and should not be used indiscriminately but it is not putting our children in their graves.
College of Physicians and Surgeons of AlbertaResponse in PDF format.
1. I support the legalization of marijuana.(like physician #80 who “heard tell”of marijuana).
2. We now have a new problem of so-caLLed “synthetic maiijuana”, whereby patients are presenting to ER with seizures. This now generates expensive toxicology screens because it is none of the ususal suspects.
3. I would go so far as to say if your patients have seizures , then it is NOT marijuana. (which has been studied by documentaries & it is seizure reducing, if anything.) CNN Charlotte a 5 year old Colorado girl.
4. The number one concern I have is that we will legislate ourselves into a corner.
Nothwithstanding court descisions, the College can write guidelines that hold doctors liable for the standard of a prescription drug & then turn around 180 degrees and go after individually prescribing physicians for failing to meet the prescription standard!
I hope and pray this is not the College’s motive.
5. What I’m about to write next is sort of like writing about being gay in a time when homosexuality was illegal. (I’m not gay but the analogy is similar)
I lived near a major airport, many years ago & long before I got into medicine, I did not drink a drop of alcohol, never smoked cigarettes, never wore cologne, aftershave or scented deodorant. I not only tried it, I graded it, like a tea taster or a whisky blender, my senses had to be sharp.
6.Canadian marijuana was weak at the time, worse than Baby Duck 1/10. I had no time for it. While THC content has risen in recent years, I fail to see the College’s logic banning hashish. For me a vehement non-smoker of tobacco, hash was the drug of choice. It is more stable in THC content, not changing much in thirty years, stores better, & marijuana gets moldy (with aspergillus). That is why hash has been made for about 800 years.
I was a seasoned expert (if you’re going to do something…do it well)
Second sifting red or blond Moroccan was the standard most consistent method of delivery of effect. dose =1.0
Afghanistan Black dose =1.8
Afghanistan Black “coil”=1.6
Red & Blonde Lebanese 0.7
Indian Black Ganja sticks =1.8
as above with 3% opium = 2.5
Weed : Acupulco Gold = 0.6
Jamaican Blue Mountain Bombshell = 0.5
Jamaican white lightening 0.6
Note this is dated material. The pre-1973 hash friendly Afghan King was deposed; now it”s “banned”….guess what ….replaced by poppies!
7.History: 1937 marijuana laws introduced by Roosevelt were found unconstitutional breaking 1st amendment, since in order to pay the marijuana tax, you had to produce a handful for which you would be convicted of possession. Law repealed 1969, Nixon made it a class one drug (which it is not in terms of addictiveness, but paradoxically the more highly addictive cocaine is class two!)
8.We are incarcerating people for marijuana, and frankly we need the tax dollars for hospital beds.
We are also encouraging the making of still supposedly legal substances called synthetic marijuana. As I alluded to earlier the stuff is more harmful.
9. I do not prescribe drugs or work in psychiatry or pain management. I studied a great deal about medical imaging. Here’s why I went completely “straight”.
10. In 1971, orange single barrel acid had about ten times today’s doses of LSD.Double barrel self explanatory. Hashish and acid ….very synergistic, I’d say triple the hallucinations.So, the pharmacological equivalent is sixty hits of acid!!! My friend went insane & so did I.Pharmacological psychosis was manifested by disruption of sleep wake cycle, profound visual hallucinations, and subsequently PHPD post hallucinogen perception disorder.( 5 psychiatrists missed the sleep deprivation induced organic disorder in yours truly) My friend permanently is in an insane asylum; I went totally straight.
PS . Psychiatrists are right about taking 8-10 years to recover from a psychotic break. I totally found psychiatry to be a more than average stress (about six times worse than normal med students) I had no counselling at the time. I got through it and was no star. But here’s what I studied from imaging. Of course standard CT is negative.
Neuro: After visual impulses go past the optic chiasm, they go to the lateral geniculate nucleus. This structure affected by LSD when tested on cats. The white fibers in the brain after lat. gen nuc.are affected as well all the way to the second decussation prior to going to the optic cortex. Since THC was fat soluble as in crossing the BBB, it potentiates the LSD.
PHPD (post hallucinogen perception disorder) is a separate entity, a disorder of binocular vision + accomodation. It persists for up to one year, but usually 6-8 months. Basically if you look at your arm it is deformed because binocular vision is disrupted & you can’t accomodate properly. How I wish I’d had a doctor that told me this!!! No you are NOT schizophrenic!!! Schizophrenia is typically auditory hallucinations….I cannot overemphasize this as a practice point. 98% of LSD is visual not auditory, and since I spent some time with someone recovering from methamphetamine psychosis, they have no more than 20% auditory hallucinations. I don’t do psychiatry because for me it is like war vet going back into battle.
11. After all these experiences, why would I advocate marijuana?
a) migraine sufferers (pt#36)is correct.
A homeopathic amount is two puffs of red Moroccan with 3 x 325mg ASA (chew up tablets), not just swallow them. It got rid of migraine after scintillating scotoma warning. (but only 5% pts have a warning)
b) Never prescribe marijuana in a setting of thyroid storm, functioning thyroid nodule, LSD stone or ACUTE psychotic episode.
c) It has uses in decreasing spasm, has been used in Israel for tremors.
d) The vasodilation that stopped migraine probably helps in Prinzematal”s angina, but we need to investigate this.
d) Finally as a non-smoker of tobaacco (tar and nicotinic brochoconstriction)……why when I smoked two puffs of hash did my asthma get better?…no kidding! ( bronchodilation )
The reason I didn’t like weed was tar and leaves +stems (less carbon footprint, so to speak) I demand a drug trial, unbiased & we need to know if it’s cannabinoids or THC or both that bronchodilate. I swear on a stack of Bibles, my “asthma” got better!
We need to do proper research since it could be used as an adjunct to puffers, not causing steroid induced hip fractures is paramount in an aging population. (yes I know Astra-Zeneca (Symbacort)doesn’t like it)
We have been lied to by scare tactics from DEA FDA, biased funding in favour of “harm”papers. (remember coffee & pancreatic cancer!!!) I’m still drinking my coffee.
e) It is like anything else, its a herb, 98% of people don’t get into trouble.
f) The current paper says “harmful in children < 16 years. We shall see how Charlotte of Colorado turns out, only time will tell. Maybe even the current children's precaution needs to be revised.
12. The College needs to recognize the lawyers still haven't figured out what happens in an MVA, patient +ve for THC , prescribed by Dr such+such.Infinite liability!!!!
Even patients reading this blog will have to realize that I busted my rear end to extricate myself from a drug ridden past……..just to have some lawyer take away my house my car and everything I've ever worked for….just so they can make a new high legal award for "personal injury"! (which seems to be the new legal thing after governments capped auto accident premiums) It's all about "personal injury".(civil suits) Maybe the College is protecting itself.
13. We need a proper non biased trial, before recommendations.My pseudoguidelines are 1-2 puffs, qid, not more than 2 otherwise it affects appetite/coordination.
FYI: 5-6 puffs, "munchies" there goes the weight loss programme! (impaired ++)
10 puffs (impaired +++)
15 puffs no able to walk;soporific effect
Note: I have NOT used Cannabis while being a doctor. Those guidelines were for moderately weak hash.
I have not tried the current product.
Oh I forgot, a true chronic user can take two puffs and drive. Now we need a blood test that tells us.oF COURSE YOU ARE NOT SUPPOSED TO DRIVE; BUT 2 PUFFS USED LIKE A PUFFER, doesn't do anything to a chronic user…possibly mild photophobia, change of accomodation like eyedrops one third to one half strength.
Physicians remember : Do NOT prescribe with functioning thyroid nodule, thyroid storm, acute psychosis or LSD stone.
Hope this helps.
It occurred to me that many colleagues need guidance as to what their patients may experience.
I am not a pharmacologist but though I’d write some points.
Hashish was always for me far more predictable for effect. From a doctors post of view, I shall describe my findings for a 70kg man. Of the 5 levels of analgesia, only the first two are medically useful.
Level 1 1-2 puffs , level 2 5-6 puffs, the later for appetite stimulation & mild pain analgesia.
After inhaling 0.2gms, there is about three minutes for effect, and includes a mild increase in heart rate which may cause anxiety in 1st time users, but it soon passes.
The desired effect in 3 minutes, peaks in about 20minutes, lasts for three hours.
Mydriasis much less than atropine, photophobia about like half strength weak eye drops.
Per oral doses (po); for desired effect of 0.2gms it takes 1gm. About 5x the expense and effect of inhaled & and depending on whether you have a full stomach or ingested something like ice cream, can really delay absorption further. Average time to effect =45mins. Mild bloating and very slight nausea which soon passes occurs.
It may stimulate histamine but I don’t know this & any gastritis is more likely from an associated ingested beer!
I suspect it increase FEV1, something I desperately want an unbiased drug trial with certificate of compliance and a real respirology opinion. Remember any drug trial would have to EXCLUDE smokers of tobacco from the study, since they already have tar + bronchoconstriction! It would pretty much have to be hash smokers only! (not an easy group to find)
Hash is expensive to produce but to me as a doctor, the more measurable, weighable drug. Growers would have to take 100kg of marijuana just to get only 900-1000gms of the best first sifted hash. At most, 2kg of “bad hash”. Since they can sell more as dried marijuana, they propose it.
From a dose in mg/km of effect, hash is the better drug!(stores longer, less mould as well)This maybe les profitable, I suppose.
From an advertising point of view,the TV commercials about the THC rising is only true of weed (because of more flower tops), but the problem with the whole campaign is that once youth who try weed and find out that the sky doesn’t fall…..no longer believe anything the College of P&S
has to say.
The real danger is that we should concentrate the ad on the three white powders, heroin, methamphetamine & cocaine along with it’s crack analogue. These are really addictive. Heroin with an 82% recidivism rate and I think cocaine might even be higher at 90%.
Hash even with 3% opium changed the effect from 4% American beer to 13.5% Chilean red wine, wasn’t addictive, had the morphine equivalent of one half of a Tylenol#3,and was less addictive than the average early am quest for a Tim Horton’s!!
I’m sure you will agree that one half of one Tylenol#3 pill in one week, doesn’t lead to a habit.
As for “brain damage” the TV ad is in danger of becoming a modern day “Reefer Madness”. Youth are wise ….they know BS when they see it.
Brian damage …let’s see…I understand Feynman’s acoustical equation for which he won the 1965 Nobel Prize in Physics. I heard of diffusion tensor imaging in CT scanning, am self taught in Levi-Civita tensor calculus and understand Einstein’s field equations. Does this sound like brain damage to you? Please tell the Government of Canada to stop wasting my tax dollars on nonsense TV commercials.(42% tax paid by Canadians according to the Fraser institute) May as well keep up the anti-tobacco campaign.
On the matter of fees…well….that depends on how much of a telephone book you want family doctors to document.
In imaging, the ever increasing paperwork, now means I have to take an entire day off of work to prepare for inspection & even that’s not enough, more like 2 days!! Don’t get me wrong, I like charities
I can’t imagine what the paperwork would be for 100 AIDS patients on complex drugs, marijuana included!!! Nobody will take on these patients without proper funding……what on earth are you smoking????Better go & get a THC test!
Even though I advocate marijuana, I probably wouldn’t use it much…..the greatest deferral of all is time & I can’t spare the four hours to waste.
Professional Association of Residents of OntarioResponse in PDF format.
Marijuana is an illegal herbal product in Canada, although the Federal Government has approved it for medical purposes. The medical research studies are so few, have such small cohorts, and many may not have been double-blinded, so that it is doubtful that it would ever receive HPB approval as a drug.
The CPSO‘s policy should be guiding the profession with a greater degree of caution than outlined in the current draft statement. The CPSO policy should provide the profession with a high standard level of guidance on a number of aspects to lower the legal risks involved to the patient, the profession, and the public at large.
The Federal Government’s previous eligibility for a marijuana licence had a physician’s statement that all conventional treatments had been tried and failed. This concept should be considered as a recommendation under the new guidelines before a prescription is issued. It should be recommended that marijuana not be prescribed in conjunction with narcotics or other controlled medications. If a patient is deemed eligible, the policy should recommend that a weaning process off of other medical treatments be required before initiating marijuana. Does it make sense for a patient on regular narcotics for the medical condition in question also be allowed a marijuana prescription? This concept should be contained in the portion “Before prescribing” (Draft line 65, lines 71-73).
There should also be very specific guidelines on screening patient for eligibility or denial. In addition to the usual factors which include addiction risk, history of past illicit drug use, there should be a separate cautionary clause (beyond the statement in lines 69-70) regarding those patients who have a history of recreational marijuana use in the past, perhaps even outright denial of a prescription for those individuals. There will be the obvious people out to “scam” physicians for a script.
I strongly agree that a treatment contract (Draft lines 105-111), not only be recommended (line 105) as for narcotic prescriptions for non-cancer chronic pain, but should clearly be a requirement for marijuana prescription. The treatment contract should also include patient acknowledgement and recognition of adverse effects, in detail, both psychological and respiratory. Due to the risk of pulmonary disease by inhalation delivery, the eligible patient should be required to take their marijuana by vaporized form only, and confirm this in a statement included in the treatment contract. The policy should state that a prescription should not be issued until the patient proves proof of possession or purchase of such equipment. Failure to use it resulting in cancellation of the prescription should be a statement of acknowledgement included in the contract. Possession of oral or edible forms for consumption, although potentially safer, is not legal for medical use unfortunately. The contract should also state that the patient will not drive nor operate any machinery or equipment for a period of at least four hours from taking the marijuana.
However, it addition, the CPSO policy should also require an additional document, namely a release signed by the patient, absolving the prescribing physician from any legal and medical liability pertaining to the patient’s possession, use, health risks, and any other consequence of having marijuana in their system or on their person (including driving infractions). Such a release should be developed by the CMPA on the advice or request of the CPSO, and this policy document should not be released to the profession for use until such a document is completed and made available to the profession.
Remember, as soon as the CPSO passes this policy, the door is open for any patient to come to their physician for a marijuana prescription. Without definite guidelines for the members, consider the possibility that persistent patients will use the CPSO complaints process as a means to get what they want. Physicians will not necessarily be aware of which other physicians in their community are prescribers, if required to direct their patients to as an alternative source. Any statement in the policy that says “may” or “could” is open to interpretation by all; whereas, any statement that says “must” or “should” is a requirement. So, in finalizing this policy, PLEASE BE MORE SPECIFIC!
In conclusion, I feel that the CPSO could consider adopting all the above amendments in order to protect the patients, the public at large, and the physicians of Ontario.
I would like to suggest the inclusion of language that limits a physician’s duty to provide marijuana prescriptions. I’m basing this on the precedent of patient’s rights to challenge physicians who fail to respond with narcotic prescriptions to adequately treat pain. Does the physician bear the burden to suggest and / or prescribe marijuana for pain refractory to routine narcotic regimens? At what point would a physician be required to offer marijuana to a patient ?
I would be in favor of language that :
1) puts the burden on the patient to request marijuana treatment
2) language that generally protects physicians from being responsible to respond to these requests – ie. language that notes that this is a specialized problem and that many practitioners may not have the knowledge or experience to respond to these requests
3) that also there may be personal or other reasons why practitioners may not want to or feel comfortable to prescribe marijuana treatment and
4) a general disclosure notice that physicians could post in their offices that refers patients to the College for a directory of practitioners who have experience and knowledge to prescribe marijuana
5) information for patients about their alternatives & recourse if their physician is unable or unwilling to prescribe marijuana
6) information for practitioners on their medical and legal responsibilities and guidance on how to respond to a patient request when they are unable or unwilling to prescribe marijuana
7) a list of risks and disclosures that physicians should provide to patients if they do prescribe marijuana to protect physicians from liability if patient themselves suffers, or causes someone else, serious injury as a result of the prescribed marijuana; perhaps this should be a universal document distributed to all practitioners that the patient must sign to receive the prescription
The Medico-Legal Society of Toronto Response in PDF format.
CANNABIS is non-toxic, LD50=0. As such, it should always be considered as a front line treatment, over and above harmful pharmaceuticals with serious side effects. It can be successfully used to end opiate dependance. It should be covered under drug plans. Dr.’s should not be charging FEES to prescribe.
There is plenty of evidence, testimonials and research that has been done to prove efficacy. More studies need to be done by the CPSO to determine best dosages of strains for patients conditions, to make it easier for more physicians to prescribe more.
There is ZERO liability to be of concern for the Dr’s, since there has NEVER been a documented death from overdose of Cannabis.
It was not a prescription, which intimates liability on the part of the physician. It is more of a notice that the Dr. is aware of the patient’s use and acknowledges that the patient reports they gain medical benefit from Cannabis.
It should not be limited to DRIED, because that assumes, and almost forces patients to smoke it for the most part. Patients should be allowed, and even encouraged to EAT other forms…ie. oil, tincture, budder, edibles, infusions, etc that DO NOT require smoking.
In NOT authorizing patients to use a natural plant that has no LD50, they have lost patient trust and patients feel Dr’s no longer have any compassion. Since over 40,000 patients have been authorized to use Cannabis, realistically over 1 million are using them without authorization for fear of reprisal. Having the College advise Dr’s against authorizing patients to use this non-toxic, non-lethal, non-addicting medication is against the original basis of the Medical Profession…..do no harm. They are doing their patients harm when they insist that they must use dangerous, addictive narcotics, rather than this natural plant.
So, why is the College not doing studies, or relying on current studies that are freely available even to the general public online? This is a disservice to the physicians you represent as well as the well-being of the many patients that Cannabis helps.
I strenuously object to the College referring to CANNABIS as a slang, derogatory name that was invented during initial prohibition to cloak it’s true medical name from physicians from objecting to the banning of the most widely used and prescribed plant in the medical pharmacopeia of the time.
The ‘oral pharmaceutical forms’ of Cannabis, are NOT from the real plant, they are synthetic, and do NOT have the same entourage effect, nor anywhere near the beneficial effects of the natural plant. The majority of patients that have tried the synthetic versions report that it makes them vomit, extreme dizziness and is only 10% as effective for their condition as the real plant.
Cannabis use does not cause schizophrenia. In an extremely low number of people that have a strong family history of it, and were going to get it anyway, extremely high usage can simply bring it on slightly earlier in life than it would have. People would not have to worry about bronchitis, if they were not forced to SMOKE IT. If they were allowed (encouraged) to use EDIBLE, TINCTURES, OILS, BALMS, etc, it would be much safer and actually have stronger, longer lasting medical use. There is no such thing as ‘addiction to Cannabis’. No PHYSICAL addiction is possible. In less than 9% of heavy users, it can become ‘habit forming’…no more. It CAUSES NO MENTAL ILLNESS. Prove these false claims or do not spread the rumours!
CANNABIS is NOT an OPIOD, and does not work on the same part of the brain, nor in the same manner. The College had best research ENDOCANNABINOID SYSTEM. It is an integral part of the IMMUNE SYSTEM.
There would be no ‘risk of diversion’ if it was Legalized and Regulated as it should be.
There is only 1 good thing about this new policy, you finally stopped Dr’s from charging a fee to allow a patient to use Cannabis.
Canadian AIDS Society Response in PDF format.
I have been HIV+ and developed several other conditions as well as dealing with chronic pain from a 1976 accident. Spring of 2013 I was taking over 120 pills a day and convinced my Doctor to allow me to use and get licensed to use Cannabis. I started using it and today I am down to ten pills a day with six more to be stopped soon. I also went from 200 lbs to a much healthier 150 lb and feel far less toxic and more alive thaan I have felt in decades. My arthritis is under control, my COPD has disappeared and chronic diarrhea for over 25 years is healed. My onset dementia has started to reverse and I have had a third degree burn treated topically that two months later is invisible. Please help your citizens refind relief in this wonderful plant.
In regard to drugs and abuse, I”m sure that many physician’s are aware of the many drug overdoses and attempted suicides that occur with such legal drugs as tylenol, gravol, insulin, morphine, dilaudid, and everything else that teenagers can get their hands on.The potential overdose effects of these drugs are often very damaging and sometimes irreversible . Who’s monitoring these drugs.In all my years as a pediatric nurse not once have we had an admission for a marijuana overdose. Interesting yet this is a drug that is so harmful to EVERYONE. PYSICIANS take heed-until you’ve walked in someone’s shoes who suffers from chronic pain and is allergic to all pharmaceuticals available-do not judge. Your job is to heal and to provide appropriate care as indicated.Compassion and ongoing education is all part of the job as is relieving suffering.Listen to your patients-KINDNESS AND COMPASSION csn go along way !
Ontario Medical AssociationResponse in PDF format.
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Toronto, Ontario, M5G 2E2