Inside the New Medical Marijuana Regulations
Toronto health lawyer, Lonny Rosen, says there have been some changes with respect to the use of medical marijuana. Patients in Canada have been allowed to use marijuana for a long time, so what has changed?
Since approximately 2002, patients have been permitted to be authorized to possess or grow marijuana, that authorization is issued by Health Canada with a letter from a physician supporting it. Since April 2014, a new regime has been in place. Under this new regime, physicians write prescriptions for marijuana, patients can take those prescriptions and order dried marijuana from a licensed producer. They [authorized patients] no longer obtain marijuana from Health Canada.
Marijuana is not like any other drug, right?
No, it is not any other drug from the physician’s perspective. Physicians were not trained to prescribe marijuana when they were in medical school or during their residency, there are no evidence based studies with respect to the efficacy of marijuana nor are there guidelines for physicians with respect to the quantity of marijuana to prescribe.
What should physicians know if they are asked to prescribe marijuana?
There is in place, right now, a policy with the College of Physicians and Surgeons of Ontario. That policy provides that physicians cannot be required to prescribe marijuana or to write a letter in support of an exemption for marijuana. That will continue under a new policy which is up for consultation right now. Physicians should proceed cautiously and should only prescribe marijuana where they are comfortable that the prescription is appropriate for the condition that they are treating.
Is the new policy in effect?
The new policy is not yet in effect, but it is up for consultation. Unless the College receives significant feedback that results in a major change to the policy, it is likely that a policy or something very close to it will go into effect. Physicians should really adapt their practice to comply with that policy now.
What has changed from the old policy?
The new policy sets out specific obligation for physicians before, during and following the prescription for marijuana. Under both the old and the new policy physicians should proceed with caution and should only provide marijuana prescriptions where they are comfortable. Under the new policy physicians have certain obligations with respect to the prescription of marijuana.
What are the obligations?
These include undertaking a comprehensive assessment of the patient before prescribing marijuana in order to ensure that the marijuana prescription is appropriate, also in that assessment, to assess patients with respect to their risk of diversion or addiction. Physicians should also take a comprehensive examination. Physicians have an obligation to obtain informed consent. Part of that has to include a discussion with patients of the risks of marijuana including the fact that there are no evidence based studies confirming its advocacy. Physicians should also require patients to enter into t treatment agreement dealing with a number of issues with respect to safety of marijuana.
That’s a written agreement?
That is a written agreement, yes.
Is there anything else to know?
Finally, physicians have a lot of questions with regards to charging fees associated with marijuana. Physicians have to be very careful, because if they are prescribing marijuana as part of an insured service, then that is a service that is billed to OHIP. It is not appropriate to charge patients separately for aspects of that service, however, physicians can charge patients for uninsured services. That is services that are not covered by the Ontario Health Insurance Plan, for they must be very careful not to accidently or not to be seen charging patients for aspects of what is already an insured service.
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