MEDICAL MARIJUANA

It is often problematic when patients request a particular
medication, particularly when the clinician has reservations about the
request. Examples in everyday practice include requests for sleeping
pills and analgesics, or antibiotics for nonbacterial illness.

However, for most of us, few requests generate more apprehension than
a request for so-called medical marijuana. Despite this, BC still has
the highest per capita use of medical marijuana in Canada.

In my opinion, medical marijuana is no more medical than so-called
medicinal alcohol. In 2001, Health Canada delegated the responsibility
for prescribing medical marijuana to physicians to treat serious
illnesses unresponsive to conventional treatment.

The criteria for accessing medical marijuana are relatively stringent.
Access to medical marijuana can be obtained by completing Health
Canada's Medical Practitioner's Form B1 or Form B2. Form B1 asks you
to confirm that your patient has a malignancy or degenerative
neuromuscular condition, on the premise that most physicians would
consider this use of medical marijuana a type of palliative therapy.
This form takes 5 minutes to complete.

Form B2 is for those very unusual situations that do not fit the
criteria for Form B1 and requires endorsement or completion of the
form by a specialist. This form takes 10 to 15 minutes to complete.
Far easier, however, is a form supplied by the BC Compassion Club
Society (BCCCS), which is a series of check boxes and takes only a
minute to complete.

However, unless you are a pharmacologist specializing in cannabinoids,
about the only statement that you can reasonably agree with (in
accordance with the recommendations of the College of Physicians and
Surgeons of British Columbia) is that "this patient has reported that
his/her symptoms are helped by cannabis."

Most physicians are unaware that the BCCCS Practitioner's Statement
does not grant patients a federal authorization to possess marijuana
and does not protect your patient from prosecution. Practically,
however, police are usually reluctant to prosecute a patient who has a
physician endorsement for possession of marijuana.

The BCCCS medical access forms are far less prescriptive than the
federal access forms, hence their use by patients with conditions that
are far from palliative and which include chronic headaches, anxiety,
and even Axis I disorders. Requests from these patients can leave me
truly baffled.

. Why would I recommend a substance that has over 60 different
cannabinoids whose actions and effects I know nothing about?

. How can I recommend a substance that has no quantifiable
strength?

. At what point does the function of a substance that is almost always
used recreationally become medical?

. Why would the CMPA recommend that I have patients complete the
release form for medical practitioners when endorsing marijuana? Will
this really protect me against any claims?

In short, I, like most of you, will move heaven and earth to ensure
the comfort of my patients in need of palliative care, even to the
point of prescribing THC and, on occasion, completing the federal
access form for medical marijuana. But to all the other patients
wishing my endorsement to sail the misty, uncharted waters where I
don't belong and don't want to be-don't ask me.