NEW MEDICINAL MARIJUANA RULES EASE ONUS ON PHYSICIANS

Revised regulations governing Health Canada's medicinal marijuana program
reduce the onus on physicians as gatekeepers, but the 4-year-old program is
still cause for concern, says the CMA.

Under the revised Marihuana Medical Access Regulations, which came into
effect June 29, physicians no longer have to make a risk=ADbenefit
declaration or recommend daily dosages.

Instead, applicants must acknowledge that the benefits and risks are not
"fully understood" and that they accept those risks. Applicants also
recommend their own dosage and route of administration, which the physician
notes in his or her declaration.

Physicians must also state which of 2 categories (down from 3) the patient
falls under (end-of-life or debilitating symptom) and that conventional
treatments are inappropriate or ineffective.

CMA's Chief Medical Officer says that while this is a "more acceptable"
approach, the CMA is still "fundamentally opposed because of the lack of
[scientific] evidence. Physicians should not be gatekeepers to an unproven
product," says Dr. Isra Levy.

"It's challenging," says Valerie Lasher, manager of Health Canada's
Marihuana Access Division. "We don't have the research we need to make this
an approved drug." The program is "evolving," she says.

The revised regulations also allow for a pilot project involving pharmacists
who will distribute government-grown marijuana. Currently, the legal means
of obtaining marijuana: are to get a government permit to grow it yourself
or assign a grower, or to access the government supply via home delivery or
a physician's office. Lasher says only 1 or 2 Canadian physicians now
distribute marijuana.

"We want to move the program to a primary care model which includes
distribution through pharmacies," says Lasher. The pilot is expected to be
complete by 2007.

The regulations also make it "reasonably clear that it's okay for doctors to
refuse to participate," says Levy.

Such clarity is desirable given that at least 1 college has brokered a
complaint. In 2002, a patient complained to the Ontario college when his
physician refused to prescribe marijuana (Members' Dialogue, March/April
2002:19-20). The college decided the physician was justified. "The issue of
what constitutes the appropriate use of marijuana for medical purposes is
still somewhat unsettled," wrote the committee, which advised physicians to
"tread carefully."