Pubdate: Sat, 23 Mar 2013
Source: Regina Leader-Post (CN SN)
Copyright: 2013 The Leader-Post Ltd.
Contact: http://www.leaderpost.com/opinion/letters/letters-to-the-editor.html
Website: http://www.leaderpost.com/
Details: http://www.mapinc.org/media/361
Author: Janet French

Marijuana Medical

DOCTORS CONSIDER NEW RULES

Faced with a future in which doctors have the power to both prescribe 
and sell medicinal marijuana, the College of Physicians and Surgeons 
of Saskatchewan is contemplating what restrictions, if any, it should 
place on the province's physicians.

Bryan Salte, the college's lawyer and associate registrar, told the 
regulatory body's governing council Friday that it needs a plan in 
light of Health Canada's proposal to step away from deciding who has 
access to medicinal marijuana.

The Canadian Medical Association and the Federation of Medical 
Regulatory Authorities of Canada have spoken against the move, saying 
it's unfair to ask doctors to decide who should get a substance 
that's not well-researched or understood.

"My assessment is that it really doesn't make any difference what we 
said, those regulations will come into effect, and we deal with that 
reality," Salte told the council Friday.

"We can cry against the wind all we like, but the impact will be that 
in the not-too-distant future, the matter of prescribing marijuana 
will be solely between a physician and a patient."

One problem with the changes - which were announced by the federal 
health minister in December and could take effect in 2014 - is how 
patients would get the drug, Salte said.

Patients can get it directly from a government-approved supplier, but 
doctors and pharmacists could also sell it to them, which puts 
doctors in a potential conflict of interest by both prescribing and 
selling the product. An unscrupulous physician could find a 
money-making opportunity there, he noted.

The college could ban Saskatchewan doctors from prescribing 
marijuana, but Salte said he doesn't recommend it, because that would 
likely result in a successful charter rights legal challenge.

Salte said the college council must decide if it should create a set 
of expectations for doctors who are willing to prescribe marijuana. 
For instance, the college could require doctors to inform patients 
about the lack of scientific evidence about marijuana's effectiveness 
before they leave with a prescription.

He also questioned whether doctors should have to take a training 
course before the college permits them to prescribe marijuana. The 
guidelines Health Canada has set for prescribing marijuana based on a 
patient's diagnosis would disappear if the recommendations are 
adopted, Salte said.

Tracking marijuana prescriptions is another move the council should 
consider, said Salte. Currently, doctors' prescribing habits for 
medicines like opiates and anti-anxiety drugs are recorded by the 
Prescription Review Program in an effort to prevent abuse and illegal 
trafficking of these addictive substances.

Salte advised the council to make a decision quickly and proactively, 
before the "horses will have left the barn."

Council member and Regina orthopedic surgeon Dr. Alan Beggs said he 
has patients with back pain who both seek and use marijuana to manage 
their pain. Making a prescription onerous to get is "probably the 
best safeguard" against abuse, Beggs said.

Some doctors said they haven't given up lobbying the federal 
government to stop the changes.

"I have a feeling that a lot of physicians are still not very 
comfortable prescribing marijuana, either because they don't have the 
supporting evidence to show (how it helps), or simply because there 
are a lot of indications," said Estevan family doctor Dr. Edward Tsoi.

College council president Dr. Mark Chapelski asked council members to 
discuss the issue with their colleagues. The matter will be back 
before council at its next meeting in June.
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MAP posted-by: Jay Bergstrom