Pubdate: Mon, 31 Mar 2014
Source: Globe and Mail (Canada)
Copyright: 2014 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Sheryl Ubelacker

NEW MEDICINAL POT LAWS DIVIDE DOCTORS

Flood of prescription requests expected as physicians' groups caution
members over uncertainties about the effects of cannabis

"What about marijuana?"

It's a question that likely will soon be posed by a growing number of
patients in more and more doctors' offices across the country.

Revamped federal regulations governing access to medical marijuana
officially take effect this week, and Health Canada projects the
number of users will balloon from the current 38,000 to 450,000 within
a decade, based on recent growth rates.

As of Tuesday, federal authorization to possess medicinal pot for
patients with chronic pain, multiple sclerosis and a variety of other
ailments will shift from Health Canada to physicians, who will be
responsible for writing prescriptions for the drug if they so choose.

Under the new program, those prescriptions will allow patients to
purchase up to 150 grams of dried weed each month - ideally, in the
government's view - from licensed commercial growers that are setting
up shop across the country.

Indeed, that was a key intention of the amended Marihuana for Medical
Purposes Regulations (Health Canada spells marijuana with an "h").
Only regulated and inspected producers would be allowed to sell
quality-controlled weed for medicinal purposes, making it illegal for
patients or their current suppliers to operate even small, home-based
grow ops.

But the plan went up in smoke March 21, at least temporarily, when a
B.C. federal court judge granted an injunction allowing anyone
currently licensed under the sun-setting rules to continue growing
plants until a constitutional challenge mounted by a group of patients
is heard.

Even without that legal wrinkle, the seismic shift in how Canadians
can obtain cannabis has polarized the medical community and left many
questioning how easy it might be for recreational users to abuse the
system - and the trust of doctors who are its gatekeepers.

John Goodhew, who has been helping patients access medical marijuana
since the mid-1990s, says the new setup and attendant media attention
will likely mean a flood of requests for the drug.

"This is patient-driven, not doctor-driven," Dr. Goodhew said. "So
it's seldom that I'm going to have a patient in my office who has
something and I'm going to say: 'Hey, why don't you try marijuana?'
That's really not the way it happens," explains the primary-care
doctor, whose downtown Toronto practice includes about 300 patients
with HIV.

"It comes down to the reason somebody wants to use
it."

While weed contains the psychoactive ingredient THC
(tetrahydrocannabinol), there are hundreds of other compounds in the
plant that may have remedial effects: Many people with HIV or cancer
use pot to stimulate their appetite to prevent wasting and to combat
nausea caused by the drugs fighting their disease.

People with MS who use pot say it helps relieve muscle spasticity;
some people with epilepsy attest that marijuana reduces their
seizures; while others with chronic pain report the drug eases their
suffering.

One positive aspect of the new rules, Dr. Goodhew offers, is that they
do away with administrative red tape, allowing the doctor to judge
whether a patient might benefit from cannabis when conventional
pharmaceuticals have failed to provide relief.

"I have many patients in my practice who use medical marijuana, but
it's in the context of comprehensive, ongoing care I provide my
clients," said Dr. Goodhew, contradicting any notion he is a Dr. Dope.

"So people can come in with any condition and say: 'Sign me up for
marijuana.' But likewise they can come in for many conditions to have
OxyContin prescribed - I'm not going to prescribe it," he says of the
highly addictive painkiller, recently replaced by a more tamper-proof
pill called OxyNeo.

"It's going to have to be appropriate. I'm still going to be looking
for some of the key symptoms that we know marijuana helps with, things
like nausea, weight loss, muscle spasticity, epilepsy and chronic
pain, of course."

Yet doctors' groups, including provincial Colleges of Physicians and
Surgeons, are cautioning members against prescribing the drug,
primarily because of uncertainties about its effects. Doctors, they
stress, are under no obligation to authorize any patient to use marijuana.  
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