Pubdate: Wed, 14 Aug 2013
Source: National Post (Canada)
Copyright: 2013 Canwest Publishing Inc.
Contact: http://drugsense.org/url/wEtbT4yU
Website: http://www.nationalpost.com/
Details: http://www.mapinc.org/media/286
Author: Tom Blackwell

DOCTORS PLAN DEDICATED POT CLINIC

Role of Physicians in Marijuana Treatment Unclear

A pair of Ontario doctors is planning a brave foray into the perilous 
field of marijuana medicine: a new clinic dedicated solely to 
assessing people for possible cannabis prescriptions, where patients 
could also pick up their dose of pot.

Dr. Danial Schecter said he has long been convinced of the benefits 
of the drug, and has the expertise most of his colleagues lack in 
assessing patients and prescribing medication.

Yet even as a website promotes the Cannabinoid Medical Clinic and a 
potential location in the Toronto suburbs, he and his partner have 
decided to move slowly on the project. With another, unrelated 
physician facing multiple criminal charges for marijuana-prescribing 
activity, advisors have warned them to tread carefully.

"At the moment, we're reticent to go full steam ahead ... until we 
can get our lawyers to be more confident that we won't be putting our 
licences and careers and livelihoods in jeopardy," said Dr. Schecter, 
based in Midland, Ont. "If physicians are seen making lots of money 
off of cannabis, that's not going to look good."

Their predicament underlines the uncertain environment for doctors 
interested in marijuana therapy, even as evidence suggests it has 
value for some conditions. Under new rules being phased in by Health 
Canada, physicians will arguably have an even bigger role in the 
process than they had under previous regulations, writing 
prescriptions that patients can then take to a licensed marijuana 
producer, with no need for a government permit.

At the same time, though, professional organizations like the 
Canadian Medical Association and regulators like Ontario's College of 
Physicians and Surgeons are alerting doctors to the potential 
pitfalls of prescribing dried pot, as opposed to approved medications 
that contain cannabis.

Without good scientific evidence around the proper dosages, safety 
and efficacy, it is unclear how doctors can fulfill their duty to 
ensure patients get safe and effective treatment, says the college.

"We would advise physicians to exercise caution," Prithi Yelaja, a 
spokeswoman for the regulator, said in an email response to questions.

Since the federal government first allowed medical use of marijuana 
in 2001, a smattering of physicians have been willing to assess 
whether patients suffer from one of the conditions eligible for the 
plant. Those include cancer, severe arthritis, multiple sclerosis and epilepsy.

In Vancouver, the Medicinal Cannabis Resource Centre helps people 
with therapeutic pot applications, its non-physician staff referring 
eligible patients to affiliated doctors, Dr. Arnold Shoichet being 
the most prominent among them.

Dr. Schecter's proposed clinic, which originally was supposed to open 
this summer in north-end Toronto, would appear to go a step further, 
operating as a physician's office staffed by him and a colleague. 
Patients who secured a prescription could seek out an independent 
producer - though none have been licensed by Health Canada yet - or 
pick up their cannabis at the clinic, the website says. The new rules 
allow doctors to "transfer" marijuana to patients, but not actually 
produce and sell it.

The details of exactly what the clinic would do, however, are in 
flux, said Dr. Schecter. Lawyers have suggested they must be careful 
of the "optics" around the practice, he said. But to limit revenue by 
relying solely on medicare billings for consultations with patients 
may not be a sustainable business model, admitted the physician.

Looming over the plan is the case of Dr. Rob Kamermans, the 
rural-Ontario physician who signed 4,000 medical-marijuana approvals 
in little over a year - charging fees on top of medicare billings - 
and now faces fraud, forgery and other charges.

Dr. Schecter said the key is to assess patients with proper 
diligence, noting that he has seen some of Dr. Kamermans' former 
patients and would not have prescribed marijuana to them.

"He went about it in the wrong way," argued the physician. "I respect 
the fact he really put himself out there and tried to help people ... 
[But] it's too bad he didn't take better care of himself."

The CMA states bluntly that there is "no clinical evidence" to back 
up the medical use of marijuana, though that view appears arguable. 
According to the Mayo Clinic, for instance, there is class-A 
scientific evidence - including randomized clinical trials - that 
suggests it is effective against chronic pain and some symptoms of 
multiple sclerosis.

Dr. Schecter said he is working closely with Canadian Consortium for 
the Investigation of Cannabinoids, a network of academic researchers 
and physicians who want to build a base of scientific evidence for 
cannabis as a treatment.
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MAP posted-by: Jay Bergstrom