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High Times Ahead: How is the Impending Legalization of Cannabis Impacting Physicians?

26-Oct-17

By: Nathaniel Brenneis

On April 13, 2017, the Federal Government finally released Bill C-45, or the “Cannabis Act,” to considerable fanfare and buzz.  What Bill C-45 proposes is a regulatory framework legalizing cannabis for recreational purposes in Canada.  The Federal Government has indicated that it expects Bill C-45 to receive Royal Assent no later than July 2018 Researchers, entrepreneurs, and policy-makers across Canada are scrambling to prepare for how this new law will impact the country.

What’s in the Bill?

Bill C-45 generally adheres to the recommendations the Task Force on Cannabis Legalization and Regulation (the “Task Force”) published in its final report in December 2016.  The predominant theme of Bill C-45 is to promote and protect public health and safety, prevent youth from accessing cannabis, and deter cannabis-related criminal activity.

Some highlights of the legislation include:

  • A prohibition on selling cannabis to any person under the age of 18;
  • Adults will be permitted to possess up to 30 grams of dried cannabis in a public place;
  • Adults will also be permitted to cultivate up to four of their own cannabis plants per residence;
  • The sale of cannabis in a variety of different forms including dried cannabis, cannabis oils, fresh cannabis, cannabis plants and cannabis plant seeds.  Cannabis edibles are currently prohibited, but have been flagged for regulation; and
  • Licenced cannabis producers under the current medical marijuana regime will be automatically grandfathered in as licensees under Bill C-45.

Bill C-45 will not be the final word on cannabis regulation, however.  The statute requires individual provinces and territories to enact legislation to fill in the gaps and address the country’s public health and safety objectives. 

Provincial and territorial governments will also be responsible for licensing and overseeing the distribution and sale process.  This includes the ability to increase the minimum age requirement, to lower the amount of cannabis permitted for personal possession within their jurisdiction, to create additional rules and requirements for the growth of cannabis plants at home, and to restrict locations where cannabis may be consumed.

How Will the Bill Affect Doctors?

But what does Bill C-45 mean for physicians?  At first glance, not a whole lot.  As recommended by the Task Force, the current regulatory regime will remain in place. This means that the Access to Cannabis for Medical Purposes Regulations (ACMPR) will continue to govern the production, distribution, and sale of cannabis for medical purposes.  The role of health care practitioners is unchanged by the introduction of Bill C-45, and physicians will essentially continue to serve as the sole gatekeepers for patients who want to use cannabis to treat their ailments. With access to recreational cannabis, legalization may cause a decline in the number of patients who access cannabis through physicians.

As with the previous regulations, an individual who requires cannabis for medical purposes must first get a medical document from an authorized health care practitioner.  Specifically, under the ACMPR, the medical document must contain similar information to a prescription, including:

  • The patient's name and date of birth;
  • A period of use of up to one (1) year;
  • A daily quantity of dried marijuana expressed in grams; and
  • The authorized health care practitioner's licence information.

While the pending legalization has not brought any new policy developments, it may signal a cultural shift amongst physicians.

There are still many uncertainties and potential dangers surrounding the use of cannabis.  As a whole, the medical community remains divided over, and non-committal towards, using cannabis as a form of treatment.  Nevertheless, recent reports suggest that Alberta doctors are becoming increasingly open to the idea of prescribing cannabis to their patients.

According to the latest stats published by the Alberta College of Physicians and Surgeons (“College”), there was a 50% increase in the number of doctors prescribing cannabis in just the first four months of 2017.  At the end of 2016 there were just 329 doctors in Alberta who were registered to authorize cannabis use as a treatment for 5,254 patients. By April of this year, 495 doctors were filling prescriptions for close to 10,000 Albertans.

Regardless of what motivated these newly-registered physicians to start prescribing cannabis, this trend is likely to continue as legalization nears and cannabis becomes a larger part of everyday Canadian life.  Nonetheless, the Canadian Medical Association, the Alberta Medical Association, and the College all encourage physicians to maintain a cautious approach while policy-makers come to grips with how the new regime will impact the old regime.

After all, there are still many unanswered questions.  For example, how will the relative percentages of CBD and THC be regulated?  Will cannabis be covered under patients’ health insurance?  Will it be included on Alberta’s hospital formulary systems?  Will it be monitored by the Triplicate Prescription Program?

We will be closely tracking these issues as the July 2018 deadline approaches.

Definitions:

THC – The chemical compound in cannabis responsible for a euphoric high.
CBD – Short for cannabidoil, CBD is the cannabis compound that provides the significant medical benefits but does not provide the euphoric high.
 

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