Pubdate: Tue, 30 Sep 2014
Source: Victoria Times-Colonist (CN BC)
Copyright: 2014 Times Colonist
Contact: http://www2.canada.com/victoriatimescolonist/letters.html
Website: http://www.timescolonist.com/
Details: http://www.mapinc.org/media/481
Author: Sheryl Ubelacker
Page: D7
Cited: http://mapinc.org/url/OybDZOB6

CFP GUIDES DOCTORS ON PRESCRIBING POT

TORONTO - The College of Family Physicians has put out guidelines to
Canada's more than 30,000 primarycare doctors about which patients
should or should not be given prescriptions for medical marijuana.

College CEO Dr. Francine Lemire said the lack of research into
cannabis has left many family doctors unsure about which patients
could benefit from medical-grade weed and what dose should be prescribed.

"We're aware that there is demand out there by patients for dried
cannabis for medical purposes," Lemire said Monday from Ottawa. "We're
aware of the relative lack of evidence =C2=85 for when to authorize or no
t
to authorize [its use].

"And we felt that it was important for us to share what evidence there
is with physicians and to support them in how to prescribe."

The college's recommendations, which are spelled out on the
organization's website, say there is no research evidence supporting
the use of cannabis for low back pain or fibromyalgia, but it could be
considered for nerve-damage pain caused by such conditions as multiple
sclerosis, metastatic cancer, shingles, diabetic neuropathy and severe
injury.

Even in the case of such pain-causing conditions, doctors should
consider using medical pot only after trying standard medications and
therapies, including pharmaceutical cannabinoids, the document says.

"Authorizations for dried cannabis should only be considered for
patients with neuropathic pain that has failed to respond to standard
treatments."

Before prescribing, the college advises doctors to conduct a pain
assessment, assess patients for anxiety and mood disorders, and screen
them for existing substance use disorders.

The guidelines say patients under 25, those with substance abuse,
cardiovascular or respiratory disease, and women who are pregnant,
planning to become pregnant or breastfeeding should not be prescribed
medical marijuana.

When its use is considered appropriate, the family doctor should
regularly monitor the patient's response to treatment and discontinue
authorization for its use if the smokable herb is clearly ineffective
or causing harm, the college said.

In April, Health Canada changed its regulations to put prescribing of
therapeutic marijuana in the hands of doctors, while supply of the
dried herb was handed over solely to licensed growers for distribution
to patients. Previously, patients with proven medical need had been
allowed to grow or buy cannabis for personal use.

The shift in regulations put doctors across the country in an
unenviable position: the onus for authorizing the use of medical pot
was now their responsibility, yet many knew little about which
conditions might be helped by the herb, what dose was appropriate and
when it shouldn't be given to a patient, Lemire said.

"We realize they have been placed in a difficult situation, that the
conditions that many patients present with when they're requesting
marijuana are often complex, that the evidence to prescribe medical
marijuana is often lacking," said Lemire, stressing that it's critical
that more research into pot's safety and effectiveness for various
diseases be conducted.
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