Pubdate: Tue, 02 Jun 2015
Source: National Post (Canada)
Copyright: 2015 Canwest Publishing Inc.
Contact: http://drugsense.org/url/wEtbT4yU
Website: http://www.nationalpost.com/
Details: http://www.mapinc.org/media/286
Author: Tom Blackwell
Page: A1

DOCTORS PAID FOR MARIJUANA REFERRALS

Ethics Rules Prohibit Rebates

Doctors and clinics are receiving fees of as much as $350 per patient 
from medical-marijuana producers eager to snag customer referrals, 
despite professional rules in some provinces that explicitly outlaw 
such payments, producers say.

Physicians working under federal law do not prescribe a specific 
brand of cannabis, but some try to steer patients toward particular 
cannabis suppliers - and expect reimbursement, industry members report.

Doctors sometimes tell companies the money is to subsidize the cost 
of verifying patient information, or providing marijuana-related 
services to patients not covered by medicare.

But one government-approved pot grower charges the payments are 
essentially "kickbacks." Professional ethics rules in most of Canada 
prohibit physicians' receiving "rebates, fees, gifts or other 
incentives" in return for patient referrals. Nanaimo, B.C.-based 
Tilray showed the National Post copies of unsolicited invoices it has 
received from two individual doctors, three clinics and two "patient 
aggregators" that work with health professionals, requesting payments 
or even a share of cannabis sales.

Most ask for $50 per patient, but others have verbally requested as 
much as $350 - while some aggregators propose deals giving them up to 
20% of a producer's revenue, it says.

The College of Physicians and Surgeons in both Ontario and British 
Columbia have issued statements saying it is unacceptable for doctors 
prescribing marijuana to charge fees to either patients or licensed 
producers. The marijuana approvals they sign for patients are akin to 
writing drug prescriptions, which is a government-insured service, 
stress both regulators.

"The college hasn't heard anything about physicians allegedly 
receiving 'kickbacks' from marijuana producers," said Susan Prins, a 
spokeswoman for the B.C. agency. "[But] this practice would 
absolutely be in contravention of the professional standard on 
conflict of interest. If admitted or proven, a disciplinary 
consequence would be likely."

Health Canada, which accredits cannabis producers, is "actively 
looking into the issue," spokesman Andre Gagnon said in an emailed 
response to questions.

The department "is concerned about reports that some physicians may 
be charging fees," he said. "Health Canada expects that all licensed 
producers will adhere to a high standard of ethical conduct."

One patient advocacy group says it has fielded numerous complaints 
from people who have been directed by a marijuana-prescribing doctor 
to a specific producer. Most users would prefer to shop around for 
the supplier that best meets their needs, said Laurie MacEachern of 
the Medicinal Cannabis Patients' Alliance.

"This is a huge barrier for us," she said. "They [doctors] will hook 
you up with licensed producers that support them in whatever way .... 
Now you're tied to that producer, you can't do anything else, you 
can't go to another one."

None of the clinics, doctors or intermediaries mentioned in invoices 
and correspondence shown to the Post by Tilray responded to requests 
for comment.

Some noted in that correspondence, however, that some of the services 
they provided to patients - such as how to use marijuana vaporizers - 
were not funded by medicare. Others cited the cost of verifying 
patient information for producers.

Under the new federal system that went into effect just over a year 
ago, patients obtain an approval for medicinal marijuana from a 
doctor, then use that approval to order cannabis from one of about 25 
licensed producers.

Added to the mix are groups that Tilroy CEO Greg Engel calls 
aggregators, middlemen who sign up patients and then direct them to 
certain physicians and marijuana producers with whom they have arrangements.

Some companies have no compunction about offering cash incentives to 
clinics, one doctor's office suggests in a letter to Tilray.

"We have been contacted by a number of licensed producers who would 
like to 'purchase' our patients for significantly higher amounts," a 
B.C. clinic wrote to the company, saying it wanted only $50 per 
patient to cover uninsured costs.

Tilray - among the largest players in the fledgling industry - says 
it refuses to pay the fees doctors and intermediaries are requesting.

In response, some clinics and aggregators have directed patients to 
switch to another, more-compliant marijuana supplier, says Engel.

"It's very concerning," he said. "It taints the whole industry. We 
should be holding physicians to a higher standard."

Some marijuana producers, however, defend making payments to clinics 
or aggregators, saying the money is needed to keep the facilities afloat.

OrganiGram of Moncton, N.B., says it and two other three other 
producers have signed agreements to supply marijuana to patients of 
Trauma Healing Centers, which specialize in treating veterans and 
first responders with PTSD. The deal "has definitely brought us a lot 
of business," Brett Allan, OrganiGram's business-development 
director, said in an interview.

"We'd rather have it not be the case, absolutely," he said about 
making payments to clinics, but said for now such specialty offices 
are necessary, given most other doctors refuse to prescribe marijuana.

Meanwhile, Tilray said it planned to announce Tuesday that it is 
setting up a new industry association, after the existing trade group 
would not agree on a new code of ethics that would bar such payments.

Neil Belot, executive director for the Canadian Medical Cannabis 
Industry Association, said the organization is eager to maintain 
ethical standards, but legal advice suggested that imposing Tilray's 
proposed rules across the sector could have contravened competition laws.
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MAP posted-by: Jay Bergstrom