Marihuana Medical Access Regulations (MMAR)
In 2001, The Marijuana Medical Access Regulations (MMAR) enabled Canadians with serious diseases access to medicinal marijuana. Information on Health Canada's MMAR program including up-to-date statistics on the program, a guide on the physicians' role in the process, the position of the CMA, CMPA recommendations, court decisions that have shaped the MMAR Program and more.
December 2012, Health Canada announced revisions to the Marihuana Medical Access Program.
- Marihuana for Medical Purposes Regulations
- Health Canada's Announcement
We would like to thank CCIC members who contributed to these comments.
Learn More
- Medical Cannabis - Access & Authorization (Online CME activity)
- Medical marijuana: an evidence-based guide for medical practitioners (Online CME activity)
Statistics
NOTICE: THIS SECTION IS UNDER REVIEW FOLLOWING THE DEC 2012 PROPOSED AMMENDMENTS TO THE MMAR PROGRAM
We aim to have updated information on the new Marihuana for Medical Purposes Regulations (MMPR) in January 2013. If you would like to contribute to this section of the website please send any suggested content by email to info@ccic.net .
Physicians' role in the MMAR process
There only forms you are required to complete; the B1 (for Category 1 patients) and the B2 (for Category 2 patients). The other forms are for the patient to fill out and you don’t even need to know about them (unless you’re interested, of course). Filling out the forms is not an insured service, and as always the decision to charge for them is at the discretion of the individual doctor.
B1 FORMS
This form may be filled out by a GP or a specialist. They are for patients with the following diagnoses: Multiple Sclerosis, Epilepsy, Spinal Cord injury or Spinal Cord disease, cancer, HIV/AIDS or severe arthritis. B1 forms may also be used for patients who are terminally ill, for compassionate end-of-life care, no matter what the diagnosis.
- Simplest just to use your office stamp with your name, licence number, address etc.
- Fill in the patient’s name, birthdate and phone number, and check the appropriate box for diagnosis
-write in the diagnosis if the patient is terminally ill. - Proposed Daily Amount
Calculating the dose can be done by determining how much the patient currently smokes. One could ask the patient how much they bought last time and how long that amount lasted; for example if they bought an ounce (approx. 30 grams) and it lasted a month that is one gram a day. An average cannabis cigarette ranges from 0.5 g to 1.0 g, so 3 cigarettes a day would weigh a maximum of 3 grams. Health Canada does allow up to 5 grams a day under most circumstances. HIV patients tend to smoke more than that, and Health Canada may allow up to 10 grams a day for these patients.
Calculating the dose for oral ingestion is a little trickier. If the patient is using a standardized product, for example baked goods or encapsulated herb from a Compassion Club, try to find out what the standard dose is. For example, they may ingest a brownie containing 100 mg of THC 3 times a day for a total of 300 mg. Assuming the plant contains 12.5% THC (the Health Canada standard), that would be 125 mg/gram, so 300 mg would be derived from 2.4 grams.
Of note, most “street” marijuana including that from compassion clubs is in the 15-20% THC range so this should be considered when calculating dose. In addition, patients do develop a tolerance to THC, so a long-time user may well need the higher end of the dosing range. By the same token, a cannabis-naive user may only need a couple of puffs to get good analgesic effect, and could make themselves quite sick on baked goods if they are not careful. A good suggestion in this case is to start low and go slow, for example to try 1/4 of a cookie or brownie to start, or 20 mg of standardized oral cannabis.
An additional note: the safety profile of marijuana is actually quite good; overdose may be unpleasant but never fatal and is virtually always via the oral route of ingestion. - is usually not filled out unless the patient’s life expectancy is less than a year.
- sign and date the form
B2 FORMS
The B2 form can be filled out by a specialist in a field appropriate to the patient’s medical condition, or by a general practitioner if the GP has consulted an appropriate specialist who is aware that marijuana is being considered as an alternative treatment.
Examples would include a gastroenterologist or ID specialist for HCV-related anorexia and cachexia; a neurologist or physiatrist for dystonic syndromes or for neurogenic pain not related to spinal cord injury, or a psychiatrist for anxiety disorder or insomnia.
It is important to note that the practitioner does not need to condone or agree with the patient’s use of marijuana for a given diagnosis. One simply has to state that they are aware that conventional treatments have not worked, and the patient is using or wishes to consider using marijuana as an alternative therapy.
- Office stamp
- Write the name of the medical condition and the symptoms (no ticky boxes here)
- Same as for the B1 form
- Part 5: sign and date
| Form | What it is | Who completes this form |
|---|---|---|
| Form A | The statement identifying the applicant. | To be completed by the patient. |
| Form B 1 | Medical practitioners form for category 1 applicants. | To be completed by the applicants practitioner. |
| Form B 2 | Medical practitioners form for category 2 applicants. | To be completed by the applicants practitioner. |
The Health Canada website on the Marijuana Medical Access Regulations contains other information and should also be explored. Click here to access the Health Canada MMAR site.
Canadian Medical Association's Position on Medical Marijuana
CMA Position: 4-Dec-2010
The CMA has always recognized and acknowledged the unique requirements of those individuals suffering from a terminal illness or chronic disease for which conventional therapies have not been effective and for whom marijuana for medicinal purposes may provide relief. However, there are a number of problems with the current Medical Marijuana access program. In order to find a solution to these outstanding problems, CMA makes the following recommendations.
1. The advancement of scientific knowledge about medical marijuana must be encouraged. Given that there are currently over 4,000 patients receiving medical marijuana from Health Canada, CMA encourages the Government to properly study the safety, efficacy, most appropriate amount to be used, and the most effective delivery mechanism for treatment of specific conditions. The same safety and evidence standards should apply to medical marijuana as to pharmaceutical products under the FDA.
2. With the increasing number of patients being prescribed medical marijuana, it is imperative that physicians know and understand the regulations and the use of medical marijuana in their practice settings. As such, CMA calls on the Government to work with the CMA, the Royal College of Physicians and Surgeons, and other relevant stakeholders, to develop compulsory education and licensing programs for physicians who prescribe marijuana.
3. Finally, until the problems with the MMARs are rectified, CMA lacks the basis upon which to revise its current policy. Physicians who wish to prescribe marijuana in their practices should consult relevant CMPA policy and guidelines in order to ensure appropriate medico-legal protection.
To access the full policy on CMA PolicyBase click HERE
CMA General Council 2009 Resolutions Adopted (Unconfirmed)
The Canadian Medical Association will:
- update its policy on medical marijuana; and
- ask the federal government to update the medical marijuana access program and regulations following appropriate consultations with stakeholders and scientific advisory committees, and reinstate support for research into the safety and efficacy of medical marijuana and cannabinoids. (DM 5-2)
CMA Office for Public Health, January 19, 2006.
The CMA has always recognized and acknowledged the unique requirements of those individuals suffering from a terminal illness or chronic disease for which conventional therapies have not been effective and for whom marijuana for medicinal purposes may provide relief.
The new regulations (introduced in June 2005) reduced the onus on physicians to declare the need for, and dose of, marijuana, focusing instead on an attestation of diagnosis and failure of conventional therapies.
The government has now passed regulations which are an improvement to previous regulations. These regulations reduce the potential impact on the patient-physician relationship.
The CMA provided input to the revised medical marijuana regulations and accepts that physicians who feel qualified to recommend this product to patients do so in accordance with the regulations.
The advancement of scientific knowledge about medical marijuana must be encouraged. In order to encourage the research that is necessary to advance such knowledge, government should develop innovative methods to establish the safety, efficacy, most appropriate amount to be used, and the most effective delivery mechanism for treatment of specific conditions. The same safety standards should apply to medical marijuana as to pharmaceutical health products.
Accessed at CMA.ca. For the background and full article please visit the CMA website.
CMA Policy
- Policy resolution GC03-42 - Medical use of marijuana. Approved, 2003-Aug-20.
- Policy resolution GC03-30 - Dispensing medical marijuana. Approved, 2003-Aug-20.
Found in the CMA Policy Base, 11 July, 2009.
Canadian Medical Protective Association recommendations
The Canadian Medical Protective Association recommends “that physicians who complete the medical declaration ask the applicant to sign a release from liability” and keep a copy for future use. For more information please visit the CMPA website.
Release form for medical practitioners (MMAR) - pdf