I Get High With a Little Help From My…Doctor?

In August of this year, one of the hot topics for discussion at the Canadian Medical Association’s (CMA’s) Annual Meeting in Ottawa was the prescribing of medical marijuana by Canadian doctors. This, in part, was a response to the federal government’s restructuring of Canada’s medical marijuana system in the early part of 2014.

Prior to the restructuring, patients would seek authorization directly from Health Canada to either produce their own marijuana or obtain it directly from suppliers. The changes now essentially make the physician the gatekeeper ¬ patients need to obtain a prescription from their physician which, in turn is then submitted to one of an increasing number of federally licensed growers. This has caused significant discomfort for many physicians who simply are not satisfied that the science supports the use of this drug. Even if it did, do the supposed benefits of marijuana use outweigh the known risks?

Dr. Louis Hugo Francescutti, then the outgoing president of the CMA, stated it this way: “It’s just bad medicine to be asked to authorize a product when we don’t know how it works, we don’t know when it works, for whom it works. Where are the studies? We try to base what we do on evidence.”

Another concern expressed by Dr. Francescutti is that doctors will face enormous pressure from patients who insist that marijuana helps them, and a regime that he says “calls on doctors to ‘blindfoldedly’ prescribe a medication.” He fears that patients frustrated by physicians’ refusal to prescribe will turn to emergency departments.

Finally, Dr. Francescutti raised an interesting collateral issue ¬ that of the safety of smoking itself. Even assuming the use of marijuana was clinically proven to be beneficial, he wishes there were ways to administer it other than as a drug to smoke. “If we could deliver it through a cookie or a milkshake or a pill or a liquid, and we know that it works, well we would welcome it with open arms because it’s another tool we can use.

At the same conference, Health Minister Rona Ambrose refuted Dr. Francescutti’s concerns, saying, “Health Canada does not endorse the use of marijuana, nor is it an approved drug in this country, nor has it gone through any of the clinical trials that other pharmaceutical products that are approved in this country have gone through.”

In the meantime, medical marijuana suppliers are becoming increasingly aggressive. A simple Google search of “medical marijuana” reveals numerous websites dedicated to advocating the use of this drug. Much of this advocacy is focused directly on physicians.

One example: “For the sake of our patients we strongly encourage you to be open to learning first-hand the medical benefits of marijuana. If you sign the Marijuana Medical Access Regulations forms, thus allowing your patients to try medical marijuana as an alternative, you are helping them into the only legal program that allows them to be exempt from the criminal code of Canada for their prescribed amount. This exemption is valid for one year. Many doctors fear Health Canada and opt to only sign forms for compassion clubs, however this does not exempt your patient from possession charges and they may be harassed or arrested.”

This is not the first time that a pharmaceutical manufacturer has put pressure on physicians to utilize its product. However, it is arguably the first time that the manufacturer of an otherwise illegal and largely untested product has done so. Adding to the theatre of the absurd, Ross Rebagliati is the founder of Ross’ Gold, a “budding” BC company seeking to license a brand system distribution process for medical marijuana in Ontario. Readers may remember Mr. Rebagliati as the Canadian Olympic champion snowboarder who was notoriously stripped of his gold medal in Nagano, Japan in 1998 (only to have it returned when it came out that tetrahydrocannabinol [THC], the active ingredient in marijuana, was not a banned substance).

And, just when you thought that all the interest groups were accounted for, in steps organized crime who sees the growing and sale of medical marijuana as a “growth” industry. According to RCMP, many criminal organizations are using licensed medical marijuana grow operations as a front for the more lucrative growth and sale for non-medical purposes.

All of this raises very interesting and complex legal and ethical issues, all against a political backdrop where the leader of the federal Liberal party is advocating the de-criminalization of marijuana. This should remind us to pause and reflect on the fact that, like it or not, possession and trafficking in marijuana is still a criminal offence in Canada. As Dr. Francescutti points out, doctors are being put in the very uncomfortable position of being asked to prescribe an otherwise illegal drug, largely untested, for a variety of ailments with only the benefit of anecdotal evidence to support the use.

This article was originially published in the Alberta Doctor's Digest.