Pubdate: Wed, 05 Dec 2012 Source: Montreal Gazette (CN QU) Copyright: 2012 Canwest Publishing Inc. Contact: http://www.canada.com/montrealgazette/letters.html Website: http://www.montrealgazette.com/ Details: http://www.mapinc.org/media/274 Author: Sharon Kirkey Page: A3 DOCTORS CONFLICTED OVER MEDICINAL POT, STUDY FINDS MDs Reluctant to Have Role As 'Gatekeepers' Doctors in Canada are so skittish about the medical use of marijuana that a third of MDs who have been asked to endorse a patient's access to the drug never agree to it, a Canadian Medical Association survey suggests. A further 25 per cent of doctors who responded to the survey said they would "seldom" be willing to support a patient's access to medicinal pot; 64 per cent are worried that patients who request medical marijuana might only want it to get high. The results come as Health Canada prepares to publish proposed new regulations to its medical marijuana access program that could make doctors the sole "gatekeepers" to the drug. The federal agency has proposed removing itself as the ultimate arbiter in approving or rejecting applications to possess pot for medical purposes. Instead, doctors alone would approve such requests. CMA president Dr. Anna Reid says physicians are unfairly being asked to prescribe a drug without the information they need to use it safely and appropriately, "and that's just not acceptable for us." Emergency rooms and psychiatric wards across the country are seeing large numbers of young people with recurring psychosis - people who are actively hallucinating and losing touch with reality - "that is felt by researchers to be actually triggered by marijuana," said Reid, an emergency physician from Yellowknife. She said marijuana is no a longer the same drug it was when she started practising medicine 25 years ago. "We know for a fact that marijuana is much stronger now. "These are the kinds of concerns that have physicians very worried about prescribing it, when we don't know what a safe dose is (and) we don't know how to use it," Reid said. While many patients use marijuana safely, "there's a potential huge harm to this drug." Doctors are worried about "getting caught in the crossfire," she said. The proposed changes to the government's medical marijuana access program could see fewer doctors willing to prescribe it, she said. The CMA survey was sent to more than 2,200 physicians who have agreed to be surveyed online several times a year on various issues. In all, 607 responses were received, with a response rate of 27 per cent. It's not a random sample, meaning, "it's not necessarily representative of the entire physician population," Reid said. "But it's a good snapshot of what physicians are thinking in general." Among the findings: - - More than half (57 per cent) said they had insufficient information on the risks and benefits of marijuana for medical purposes; - - 42 per cent of those surveyed said that patients "seldom" ask about using medical marijuana; 28 per cent said they have never been asked while 27 per cent said they are "sometimes" asked. Only four per cent reported being asked "often;" - - 35 per cent of doctors who had been asked about access said they never support such requests, "while 40 per cent would do so at least some of the time," according to a summary posted on the CMA's website; - - Most (66 per cent) respondents greed that Health Canada should offer liability protection to doctors who support a patient's request for marijuana. (The Canadian Medical Protective Association - the group that provides liability insurance to the nation's doctors - recommends that doctors who complete the "medical declaration" also request that patients sign a liability form agreeing not to make "any claim or complaint or commence any proceedings" against the doctor in relation to their use of marijuana.) Some of the comments illustrate just how conflicted physicians are. "I have been in practice long enough to know that there are a lot of 'scammers' out there who would like to be allowed to use marijuana with no personal accountability," one doctor wrote, while another called cannabis an "excellent medication with an undeservedly bad reputation." The survey results "confirm what I see around me," said Dr. Pam Squire, a family physician and pain expert in Vancouver. "I have had physicians refer patients to me and say to me, 'I'm not really comfortable; I would prefer if you would assess them.' "I think it's another difficult thing (for doctors) to assess because of the risk of abuse, misuse and diversion, and it comes on the heels with the problems that we've had with the opioids," Squire said. Squire signs one or two declarations a month for access to medical marijuana, mostly for patients with fibromyalgia and neuropathic pain. But she said doctors are understandably wary. "I had one patient who claimed he needed 22 grams a day because he was going to bathe in it. I just said, 'I'm sorry.'" When Squire asked another elderly patient how much marijuana she needed for her pain, "she said, 'I only need two grams a day, but my dealer said to ask for 10. "What's happening is that big business has moved in and they are growing it for profit under the guise of licences for (medical marijuana) users." A world leader in cannabis research says small studies are showing that cannabis can provide some relief of neuropathic pain, spasticity and hard-to-treat pain conditions. What's missing is hard data from large clinical trials on the scale that pharmaceutical companies do for a new drug, said Dr. Mark Ware, an associate professor in family medicine and anesthesia at McGill University in Montreal and executive director of the Canadian Consortium for the Investigation of Cannabinoids. But, "I just don't see that kind of research being taken on by commercial producers or medical cannabis growers," Ware said. "The problem is, if (doctors) won't engage in this process until you see those trials, that time may never come," he said. "The reality is today we have to deal with this issue even in the case of some uncertainty." - --- MAP posted-by: Jay Bergstrom