PHARMACIES, NOT MDS, SHOULD DISTRIBUTE MEDICINAL MARIJUANA

Physicians will no longer be expected to distribute medicinal
marijuana if Health Canada accepts the advice of an advisory
committee. "There are many problems with the system now in place,"
says Dr. Robert Goyer, chair of the stakeholders committee that
advises the federal Office of Cannabis Medical Access (OCMA).

Goyer says the rush to establish a distribution system for the drug
forced some quick decisions. "We had to come up with a plan," he says.
Ottawa was forced to introduce rules for making the drug available for
medical purposes to comply with an Ontario court decision (CMAJ
2003;169[3]:222).

The committee thought it had time to develop solutions and was
considering distribution through hospital pharmacies -- the system
used in Holland. Instead, the OCMA made a last-minute decision that
the government supply medicinal cannabis via the physicians who sign
their assessment forms. "I regret that decision was made," says Goyer.

Dr. Gregory Robinson, a former public health specialist who uses
cannabis to relieve his AIDS symptoms, quit the advisory committee
over that decision, saying it drove a wedge between doctors and
patients. "It's ludicrous that doctors should be distributing when we
have a system for that: pharmacies."

Medicinal marijuana went on sale in Dutch pharmacies Sept. 1. About
7000 patients are eligible for prescription marijuana, which is sold
in 4.5-g containers for $48 to $60, depending on potency. Dutch
patients are advised not to smoke the plant, but to use vaporizers or
make marijuana tea. The drug's cost is covered by government health
insurance.

The Canadian advisory committee, which met this month, will also look
at changing the patient assessment form, which now asks physicians to
determine that the benefits of taking cannabis outweigh the risks.
"But how can they make that decision when it's based mainly on
anecdotal information?" Goyer asks. "Maybe we don't have enough data
to support a clear-cut case of benefit outweighing the risk."

In the "near future," he says, physicians may be asked to state
instead that "conventional therapies have failed."

Meanwhile, information for health professions, recently released on
the OCMA Web site (www.hc-sc.gc.ca/hecs-sesc/ocma/), will serve as the
"equivalent of a product monograph." Previously, "physicians had
nothing even if they wanted to discuss [the issue] with patients,"
says Goyer. "At least they now have some peer-reviewed documents
regarding the medical status of cannabis."

The committee is also reviewing the need for some patients to have a
physician and 2 specialists sign their access form -- Goyer says 1
specialist should be enough. -- Barbara Sibbald, CMAJ