Pubdate: Tue, 02 Jun 2015
Source: Globe and Mail (Canada)
Copyright: 2015 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Mike Hager
Page: A1

CLINICS SEEKING REFERRAL FEES FOR PATIENTS, B.C. GROWER SAYS

One of Canada's largest licensed medical marijuana producers says it
has repeatedly been hit up by specialized clinics asking for money in
exchange for referring patients to them - a practice that underscores
the lack of clear rules governing the relationship between consumers,
their doctors and growers in the nascent industry.

While many of the provincial colleges that regulate doctors forbid
physicians to charge patients or growers directly for marijuana
prescriptions, it is less clear whether those restrictions apply to
clinics that employ doctors. The federal regulatory regime implemented
a year ago has sprouted a cottage industry of cannabis clinics for
patients whose own doctors may be uncomfortable prescribing medical
cannabis. (Pot dispensaries that have exploded in Vancouver and are
popping up around the country operate illegally and are
unregulated.)

Tilray, a U.S.-owned medical marijuana grower in Nanaimo, B.C., has
pulled out of Canada's main industry lobby group over what it says is
a lack of ethical guidelines for producers. Tilray is creating a
competing association and calling for a national code of ethics that
would forbid growers from paying fees for patient referrals, which it
says can be as high as $400. (The Canadian Medical Cannabis Industry
Association said the proposed code could make it harder for its
members to sponsor research and could violate Canada's competition
laws.) Fellow producers Whistler Medical Marijuana Corp. and Canni Med
echoed Tilray's assertions that clinics had asked for referral fees.

A Health Canada spokesman said on Monday the department is "concerned
about reports" of such fees and is "actively looking into the issue"
to determine whether any licensed producers were in a conflict of
interest. He added that Health Canada expects producers to "adhere to
a high standard of ethical conduct."

At the beginning of last month, the British Columbia College of
Physicians and Surgeons revised its professional standards to forbid
doctors to charge patients or producers any fees for a medical
marijuana prescription, as is the case in Ontario, Alberta, Nova
Scotia, Newfoundland and Quebec. Since the change, the B.C. college
has not had any complaints or informal inquiries regarding payments
involving producers, doctors or clinics, senior deputy registrar Galt
Wilson said.

"If you diagnose pneumonia and you prescribe an antibiotic, you don't
get to charge extra for the prescription," Dr. Wilson said. "So,
similarly, if you are prescribing cannabis for a medical condition,
that as far as we're concerned is a prescription: Don't [charge for]
it."

However, Dr. Wilson said the issue gets murkier when clinics
specializing in medical marijuana prescriptions charge growers for
referrals.

"I anticipate some legal questions will have to be addressed," Dr.
Wilson said when asked whether the clinics fall under the college's
jurisdiction.

Greenleaf Medical Clinic in Abbotsford, B.C., charges new patients
$333.50 for consultations with its experts, but president and CEO
Fonda Betts said a visit and a prescription from the clinic's doctor
are free and producers are not charged for referrals.

She alleged many of her competitors in Ontario are asking producers
for a referral fee or a slice of profit, which is often about 15 per
cent of the value of the prescription. She said this can net a clinic
about $650 a year for the average prescription of about a gram and a
half of dried marijuana a day. Ms. Betts said Greenleaf is reviewing
the business case for switching to that model because it would shift
the financial burden from patients to producers while allowing the
clinics to continue dispensing knowledge about the system.

"It's not like the patients can go to a pharmacy and ask questions, so
the clinics exist because we're an educational resource for patients,"
Ms. Betts said.

Toronto doctor Danial Schecter sees an inherent conflict of interest
if a doctor works at a clinic that makes money for each patient it
passes on to a licensed producer. He said his small Eglinton Avenue
medical marijuana clinic does not charge producers for referrals nor
ask patients to pay for their initial consultation or
prescription.

"If a physician starts getting a kickback for how much a patient will
be ordering, there's a natural incentive for a physician to want to
prescribe more and that's very very problematic because, at least in
my clinical experience, patients often get a much better response when
they use less cannabis and they don't use it every day," he said. "If
they're only getting fees through [the provincial medicare plan] and
they're not getting any kind of kickback whatsoever, then, sure, I
don't really see how it matters.

"But you could always make the argument that they're working at the
clinic [and] the management is going to encourage them to write higher
[-dosage] prescriptions so that they can make more money."

Dr. Schecter said his clinic is looking to sign research contracts
with licensed producers to generate research "that will actually be
value-added."

The pressure for clinics and producers to gain any competitive
advantage will likely become more intense as demand for medical
marijuana is expected to increase tenfold and fuel sales of
$1.3-billion in the next decade.

Dr. Wilson said "the only way of accessing it legally is through the
doctor, and imagine if you had to go to the doctor to get a case of
beer: That's where the demand is in my view."
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MAP posted-by: Matt