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As new marijuana rules take effect, CMA preaches caution

Although new regulations governing the use of marijuana for medical purposes are slated to take effect across Canada April 1, the CMA remains adamant that it will not throw its support behind medical use of the drug until numerous questions about safety, efficacy, dosage and delivery have been answered.

“The new regulations do not address physicians’ long-standing concerns,” CMA President Louis Hugo Francescutti said following the February meeting of the CMA Board. “It remains just as we said when the new regulations were published last June — asking physicians to prescribe a substance that has not been clinically tested runs contrary to our training and ethics.”

The new regulations will require that all marijuana used for medical purposes be purchased through licensed producers — previously, medical users could buy it from Health Canada or seek permission to grow it for personal use.

Francescutti said the CMA has been raising physicians’ concerns with the federal government since before the first regulations concerning medical marijuana were developed in 2001. Since then it has issued 11 additional briefs, resolutions and policy documents, and met with Health Canada officials numerous times.

“We were saying the same things about marijuana in 2001 that we are saying today — that we do not have the information we need concerning proper dosage for medical purposes, for instance , or on how it interacts with different medications,” said Francescutti. “Our message has always been the same: physicians should exercise significant caution when it comes to medical marijuana.”

The Canadian Medical Protective Association (CMPA) agrees. Advice it released last October states that physicians “are not obliged to complete a medical document for medical marijuana if they are unfamiliar with its treatment use or feel it is medically inappropriate.”

The CMPA does say that physicians should be aware of their regulations and policies released by their respective regulatory colleges. However, most colleges — those in Alberta and Saskatchewan are recent exceptions — do not have policies on marijuana used for medical purposes.

Although the number of authorizations for using marijuana for medical purposes has been increasing — it stood at 38,507 in November 2013 — two jurisdictions account for 78% of the users (19,265 in British Columbia and 10,876 in Ontario).

The CMA has surveyed its members and the public about the issue. A 2013 poll of Canadians found that 85% think marijuana should undergo the same testing and approval processes required for other prescription medication.

As well, a June 2012 survey of CMA members found that 70% of respondents had seldom (42%) or never (28%) been asked about marijuana by patients. The vast majority of respondents (85%) said information on potential risks and benefits of the drug would be useful or very useful.

Francescutti said the CMA will continue to follow the issue closely. It is waiting for Health Canada to release a consensus statement on marijuana later this year, but he cautions that this will be based on the limited evidence currently available.

“We’re also going back to members to ensure we have their input,” he said. “An information session has already been scheduled for the CMA’s annual meeting this August.

“As for the present, our existing policy stands. Until we have seen scientifically valid evidence, we will not support its use. I think my predecessor, Dr. Anna Reid, put it well — asking doctors to write prescriptions for marijuana without having valid evidence supporting its use is akin to asking them to work blindfolded.”

To help physicians understand the marijuana issue, the CMA will on March 19 begin providing up-to-date information and resources about medical use of the drug on

Queries from patients: If patients ask about the new regulations regarding marijuana use, physicians can refer them to Health Canada’s website. The CMA’s policy is also online.

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