There has been a great deal of attention recently given to the new Marijuana for Medical Purposes standard introduced by the College of Physicians and Surgeons of British Columbia. The new British Columbia standard is more restrictive than the guideline it replaced (in fact it has taken British Columbia from being one of the most liberal provinces in this regard to one of the more restrictive). For example:
1. The standard prohibits physicians from charging patients or licensed producers for the completion of medical documents (or anything related thereto). The guideline was silent on this issue.
2. Whereas the guideline permitted physicians to dispense cannabis to their patients (albeit without a dispensing fee being charged), the standard now prohibits dispensing.
3. Under the guideline, the only prerequisite for providing a medical document was confirmation that conventional therapies had been tried and failed. This remains in the new standard, but is accompanied by much stronger language that cannabis is “generally not appropriate” for a number of categories of patients, including those under the age of 25. So while not an absolute prohibition, physicians who choose to provide a medical document to a patient in one of these categories (despite the “strong relative contraindications”) will have to provide “detailed documentation of their rationale”. Ontario is the only other province to include similar language regarding patients under the age of 25. This is understandably concerning to parents in these provinces with children facing serious health challenges such as intractable epilepsy who have found that cannabis provides tangible benefits for their children.
4. While a proper assessment of the patient was required under the guideline, the new standard also requires that the physician have a “longitudinal treating relationship” with the patient, or be in direct communication with the physician who does (and have that physician’s “well-documented agreement” to the use of cannabis).
But cannabis prescribing restrictions are not unique to physicians in British Columbia. In fact, whether by way of “guideline”, “standard”, “policy” or “by-law”, each provincial college of physicians and surgeons has imposed its own set of restrictions. While there are some common themes throughout, no two are the same.
In Alberta, physicians must register with their college to be an “authorizer of marihuana for medical purposes”. In Saskatchewan, before providing a medical document, physicians must have their patient sign a treatment agreement containing prescribed statements. Ontario physicians are required to follow the ‘low and slow’ approach, initially prescribing only low-THC strains. In Quebec, physicians may only prescribe cannabis to patients who have agreed to participate in a research study. And while there is nothing in the MMPRs prohibiting a patient from obtaining multiple medical documents (in order to permit them to purchase cannabis from two or more licensed producers simultaneously), the New Brunswick college advises physicians to limit patients to a single licensed producer “for the sake of consistency”. Some provinces prohibit the provision of medical documents via telemedicine. Some require the physician to provide the provincial college with information concerning the medical documents they have written.
In addition to the myriad of provincial college restrictions, various physician associations (including the Canadian Medical Association and the College of Family Physicians of Canada) have also published recommendations, position statements and guidance documents on prescribing cannabis. The Canadian Medical Protective Association reminds physicians that they should “know and abide by” all applicable guidelines and policies. Yikes! What a minefield!
The message being delivered to physicians by regulatory bodies and professional associations is clear…if you are going to prescribe cannabis, do so with extreme caution (oh, and you may be putting your medical licence in jeopardy and exposing yourself to legal action). It’s no wonder that many physicians are refusing to even consider cannabis as part of a treatment plan for their patients.
This obviously poses yet another challenge for MMPR licensed producers. The key will be for licensed producers to: (1) continue with efforts to educate physicians on the medicinal benefits of cannabis (while not falling afoul of advertising restrictions); (2) provide financial and other support to promote research; and (3) assist physicians with the creation of protocols for prescribing cannabis which will help them mitigate the associated risk. Who’s up for the challenge?!
This blog post is for informational purposes only and does not constitute legal advice.