Statements on medical cannabis from the provincial and territorial licensing bodies are listed below. Please see the list of Association Statements here.
The College of Physicians & Surgeons of Alberta recommends caution when making the decision to prescribe marijuana for a patient. This recommendation is based on the lack of scientific evidence regarding medical marijuana’s risks and benefits and the lack of clarity surrounding medical legal issues.
Physicians are advised that they should not prescribe any substance for their patients without knowing the risks, benefits, potential complications and drug interactions associated with the use of that agent. Currently, that caution includes marijuana in its smoked form. Furthermore, physicians may be the subject of accusations or suggestions of negligence, including liability if a prescribed drug (even prescribed marijuana) produces unforeseen or unidentified negative effects.
It is the position of the College of Physicians and Surgeons of Manitoba and of most medical professionals in the country that there is very limited evidence regarding the efficacy of marijuana for medical purposes. In addition, marijuana is not a regulated drug which has been subjected to rigorous scientific testing and therefore cannot be prescribed in the same way as other narcotics are prescribed
Medical marijuana has been advocated for a very wide range of conditions. Nevertheless, physicians should remember that strong medical evidence to support any particular use remains lacking. Anecdotal evidence from both patients and physicians has been available for some time. Some assert that marijuana may reduce a patient’s need for other, potentially more dangerous, drugs. In other words, a physician may conclude that it is in the best interest of the patient to consider prescribing medical marijuana. As always, the patient’s best interest should be the primary consideration in any treatment plan. Hence, physicians may find it necessary to educate themselves on the situations where medical marijuana may be considered a potentially useful alternative.
The College believes that physicians should not be expected to facilitate patient access to a substance, for medical purposes, for which there is no body of evidence of clinical efficacy or safety. As well, medical standards and guidelines for prescribing of marihuana, addressing issues such as standardized dosage or quality control, are lacking. The amount of active ingredients in marihuana varies significantly, depending on the origin and method of production of the substance. Also, many uncertainties remain about the effects, whether considered beneficial or harmful, of marihuana use.
Any physician who wishes to familiarize himself with the new framework for prescribing cannabis must read the document Guidelines concerning the prescription of dried cannabis for medical purposes in full. A summary is provided below.
1.The use of dried cannabis for medical purposes is not a recognized treatment.
2.An unrecognized treatment can only be used within a research framework.
3.As of April 1, 2014 and until further notice, only certain indications will have to be considered.
4.Before considering the use of dried cannabis to treat a medical condition provided for in the previous regulations, other therapeutic options must be considered, in particular other forms of cannabinoids authorized for prescription by Health Canada.
5.A physician who is asked to prescribe dried cannabis must read the medical literature and inform his patient that dried cannabis can only be prescribed within the framework of a research project.
6.Before prescribing dried cannabis, the physician must obtain the written consent of the patient participating in a research project (consent form) and carry out a complete medical assessment (assessment and follow-up form).
7.When a physician prescribes dried cannabis, he must plan the patient’s follow-up in accordance with the assessment and follow-up form and keep a register of all patients for whom he has prescribed dried cannabis.
8.A physician may not supply the patient directly with dried cannabis or deal in cannabis or cannabinoids.
9.A physician may not become or apply to become a cannabis producer.
10.The prescribing physician must collaborate with the Collège and its partners in the collection of scientific data in order to improve knowledge and practices with respect to the use of cannabis for medical purposes and to ensure patient safety.
The bylaw begins with a statement that there has not been sufficient scientific or clinical assessment to provide evidence about the safety and efficacy of marihuana for medical purposes. The bylaw begins with an acknowledgement that federal government regulations have authorized the use of marihuana for medical purposes.
A physician cannot authorize the use of marihuana for a patient unless the physician is also the treating physician for the condition for which the patient is authorized to use marihuana. For example, if a patient is to be authorized to use medical marihuana to deal with symptoms of MS, the physician must also be the treating physician for the patient’s MS.
A physician must review the patient’s medical history, review relevant records pertaining to the condition for which the use of marihuana is authorized and conduct an appropriate physical examination before authorizing the patient’s use of marihuana.
The patient must sign a written treatment agreement which contains the following:
A) A statement from the patient that the patient will not seek a prescription for marihuana from any other physician during the period for which the marihuana is prescribed;
B) A statement by the patient that the patient will utilize the marihuana as prescribed, and will not use the marihuana in larger amounts or more frequently than is prescribed;
C) A statement by the patient that the patient will not give or sell the prescribed marihuana to anyone else, including family members;
D) A statement by the patient that the patient will store the marihuana in a safe place;
The physician’s record for the patient must include the requirements for all medical records and, in addition, contain the following:
A) The treatment agreement signed by the patient;
B) The diagnosis for which the patient was authorized to purchase marihuana;
C) A statement of what other treatments have been attempted for the condition for which the use of marihuana was prescribed and the effect of such treatments;
D) A statement of what, if anything, the patient has been advised about the risks of the use of marihuana;
E) A statement that in the physician’s medical opinion the patient is likely to receive therapeutic or palliative benefit from the use of marihuana to treat the patient’s condition.
The physician must retain a single record, separate from other patient records, which can be inspected by the College, and which contains:
A) The patient’s name, health services number and date of birth;
B) The quantity and duration for which marihuana was prescribed;
C) The medical condition for which marihuana was prescribed;
D) The name of the licensed producer from which the marihuana will be obtained, if known to the physician.
Physicians who prescribe marihuana will be required to provide the College with the information referenced in paragraph 6:
A) Every twelve months if the physician has prescribed marihuana to fewer than 20 patients in the preceding 12 months;
B) Every six months if the physician has prescribed marihuana to 20 or more patients in the preceding 12 months.
The bylaw prohibits physicians from diagnosing or treating patients at the premises of a licensed producer;
The bylaw prohibits physicians who prescribe marihuana from having an economic or management interest in a licensed producer;
The bylaw prohibits physicians from storing or dispensing marihuana from any location where the physician practices medicine.
The bylaw is numbered Bylaw 19.2 of the regulatory bylaws of the College and is available at the College’s website.
I __________________________ understand that I will be receiving a medical document from Dr. _______________________ which will authorize me to purchase marihuana for a medical purpose. I agree to the following:
A) I will not seek to obtain a medical document to authorize me to purchase marihuana from any other physician during the period for which the marihuana is authorized;
B) I will utilize the marihuana as authorized in the medical document and I will not use the marihuana in larger amounts or more frequently than is authorized in the document;
C) I will not give or sell the prescribed marihuana to anyone else, including family members;
D) I will store the marihuana in a safe place;
E) I understand that if I break any of these conditions, Dr. _________________ may refuse to provide any future medical authorization to purchase marihuana.
Patient’s signature, Date
Consult Bylaw 19.2 found in this document
Accessed online: 9-June-2014 at: http://www.cps.sk.ca/CPSS/Programs_and_Services/Prescription_Review_Program.aspx?PrescriptionCCO=4