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Medical cannabis: should Canadian doctors prescribe on demand?
While many Canadian doctors are reluctant to prescribe medical cannabis to patients due to lack of scientific study and regulatory authority rules, The Globe and Mail explains that it’s safer than opioids and does alleviate pain.
What happens when conventional pain medication doesn’t work?
A Globe reader asked for advice about his father, terminally ill from cancer. The patient’s pain medication was ineffective, yet his doctor wouldn’t give him a cannabis prescription because he didn’t see adequate evidence of its efficacy in the medical literature. According to the Globe, the doctor might have an ethical obligation to refer the patient to a practitioner who was willing to give cannabis. However, the regulatory situation is complex.
Canadian regulatory bodies often block the usage of cannabis
As the not-for-profit CMPA states, many regulatory authorities in most provinces and territories forbid patient usage of cannabis or advise against it. A physician should consult with the appropriate authority if he or she wishes to prescribe cannabis. Lack of scientific evidence is a primary stumbling block, both for regulators and doctors., and this places doctors in a difficult position – should they prescribe an unproven remedy, and if it should fail to be effective, will they be held liable?
The changing legal status of cannabis
The CMPA notes that under a law introduced in 2013 and 2014, patients who receive signed approval from doctors can have marijuana from licensed commercial producers. The producers can also supply it directly to the physicians. Cannabis oil and the fresh and dried varieties of marijuana are permitted. This law has been invalidated due to a challenge from certain producers who felt it was unfairly restrictive. Still, it is in place until August 2016, and the new law should not significantly alter patients’ rights.
Benefits and advantages of a prescription
Toronto physician Dr. Vincent Maida has done research on medical cannabis and used it with dying patients. While he notes the strong differences in response to the drug among patients, he supports a trial-and-error approach with cannabis. Patients can try different ratios of two medically active compounds, CBD which is not psychoactive, and psychoactive THC in commercially grown and licensed cannabis to see what works best. He also points out that many people die each year from opioids, but not one has ever died from a marijuana overdose.
Dr. David Juurlink adds that cannabis is far ahead of many other drugs in terms of safety. Further, he explains that opioids have negative side effects, can cause patients to become dependent on them, and can actually increase pain if used in the long term. The Globe also says that cannabis research shows the drug may have a positive effect on cancer symptoms, alleviate pain, and reduce nausea and restore appetite in those who have chemotherapy. A small risk of psychosis is one possible drawback to cannabis use when high THC products are used.
What should a doctor do with a patient who wants cannabis?
Dr. Juurlink advises that in the case outlined by the Globe reader, the doctor should consider the usage of medical cannabis. Dr. Maida thinks that the patient can be referred to a physician who understands the benefits of this drug – as in other cases where doctors have personal objections to certain types of treatment.