Doctors across the country will be pushed next week into the role of medical-marijuana gatekeepers, becoming the final decision makers on who gets legal pot.
It's a role that most physicians do not want to play, and a change that could make it potentially more difficult for patients already struggling to find doctors willing to endorse their use of marijuana.
Physicians say their chief concern is the lack of clinical trials demonstrating the need for and safety of medical marijuana; in addition, there is the lesser worry of providing pot to recreational users masquerading as patients. Canadian doctors were already wary of supporting applications for medical marijuana. Only 7 per cent of all physicians and 14 per cent of family doctors support active authorizations to possess medicinal cannabis, according to Health Canada figures crunched for The Globe and Mail.
Under the new system, the buck stops with doctors. Health Canada currently issues "authorizations" for people to possess medical marijuana after receiving a form signed by a doctor that confirms the patient has one of a list of symptoms or conditions that might be helped by smoking pot.
Now, doctors will be asked to fill out a form no more formal than a school permission slip, which patients send directly to a licensed private pot grow-op.
"I recognize that it seems subtle, but it's actually quite a profound change because it's essentially asking us to write a prescription," said Chris Simpson, the president-elect of the Canadian Medical Association, which represents the country's nearly 75,000 doctors.
The enhanced responsibilities assigned to physicians in the new system have largely been overshadowed by Ottawa's decision to limit legal marijuana sales to large, licensed grow-ops, a plan that was dealt a blow Friday by a Federal Court ruling that will allow approved medical marijuana growers to continue cultivating their own plants until a constitutional challenge is heard.
But that injunction has no bearing on Health Canada's intention to stop handing out the so-called authorizations.
The CMA, along with the umbrella organization that speaks for physicians' self-regulating colleges in the provinces and territories, fought the changes, arguing doctors should not be asked to prescribe a substance that has not been subjected to the same rigorous clinical trials and approvals as pharmaceuticals.
Having lost that battle, the colleges have been busy passing new standards and guidelines to help their members navigate the new marijuana landscape.
"[Health Canada] is washing their hands of it. Now, the only oversight of the prescriptions are the colleges," said Heidi Oetter, registrar of the College of Physicians and Surgeons of British Columbia. "We're not happy."
The medical profession's reluctance to prescribe pot has opened the way for the expansion of a Vancouver company that connects patients seeking medical marijuana with doctors willing to support them.
The Medicinal Cannabis Resource Centre, Inc., which already sees out-of-town patients via Skype for a $400 fee, is planning to open offices in Toronto, Halifax and Edmonton this spring.
It is also in the midst of setting up a slate of affiliate doctors willing to occasionally prescribe pot from their own offices.
"I think the new regulations are making it more difficult for physicians because they give them no guidelines, which the old ones did," Arnold Shoichet, the company's medical director, said. "I see people referred to me because [their] doctor says, 'I don't know where to start. Go find somebody who does.'"
Most of the provincial and territorial colleges of physicians and surgeons warn of the potential hazards of prescribing marijuana, including the paucity of guidance on dosing, lack of quality standards on strains that can differ dramatically depending on the grower and concerns about how pot might interact with other medications. But they leave it to individual doctors to decide whether to prescribe pot.
One quirk of the new rules erases the requirement for a specialist physician to sign off in some instances, meaning some patients will have one fewer hoop to jump through if they can find a willing doctor. That change could make medicinal marijuana easier to get.
A total of 5,363 physicians across the country were supporting active authorizations under the old system as of March 17, according to Health Canada. Of those, 2,228 practice in Ontario, 1,453 in B.C., 407 in Alberta, 347 in Nova Scotia, 330 in Quebec and the rest scattered across the remaining provinces and territories.
However, the number of doctors could be higher because, as of last fall, doctors could chose to use either the new or old approach as the program was phased in.
Terry Roycroft, chief executive officer of MCRCI, said he founded his company to fill the void left by a medical profession that largely refused to help sick people get the cannabis they need.
"Our clinic … was developed out of necessity," Mr. Roycroft said. "If the college [of physicians and surgeons] was more supportive and they were willing to work on an educational program with those doctors [who won't prescribe pot] that would be great."
Mr. Roycroft said the company has helped about 2,500 patients secure permits to possess marijuana since 2011.
About 60 per cent of those patients come in-person to the Vancouver clinic, which costs $300. The rest see a doctor via Skype for $400, a price Mr. Roycroft is aiming to lower. Potential patients have to provide medical records from their primary care doctors before a long appointment with Dr. Shoichet or another doctor, he said.
"It's not the majority of people who use cannabis for medical purposes," Dr. Shoichet said. "But the ones that do gain so significantly that their care should be a priority."