The provincial bodies that regulate Canada's physicians have no way of tracking how doctors are prescribing medical marijuana, leaving them unable to determine how often the drug is prescribed, to whom and in what quantities.
That leaves them with little way to keep tabs on prescribing practices, say the doctors' colleges in British Columbia and New Brunswick, where regulators are asking for more tools to track medical marijuana.
Earlier this year, a federal auditor-general's report found that just four doctors issued more than half of all marijuana prescriptions for veterans. Ottawa recently announced it will rein in pot coverage for veterans, a small but lucrative patient base for Canada's two dozen licensed producers. Veterans Affairs Canada (VAC) said last week that reimbursements this fiscal year could reach $75-million.
British Columbia's PharmaNet database logs prescriptions for opioids and other psychoactive pharmaceuticals, but not medical marijuana, because Health Canada has neither licensed nor approved it as a therapeutic product.
"If I hear a murmur about a doctor in a community in B.C. and it has to do with anything but cannabis, I can look it up immediately," said Galt Wilson, senior deputy registrar responsible for the complaints and investigation department of the College of Physicians and Surgeons of B.C. "But I can't do that with cannabis."
The college could investigate by interviewing the physician, seizing a copy of the patient's record and reviewing the quality of the physician's assessment – however, that is complicated by the dearth of science on appropriate dosages and daily amounts for specific conditions, and how the drug is consumed.
The college could investigate unusual prescriptions better if Health Canada licensed marijuana and assigned it a drug identification number, Dr. Wilson said.
In 2008-09, five veterans incurred costs of $19,088, according to VAC. From April to September of this year, marijuana for 3,071 veterans cost the federal government $31-million. VAC said last week it will now limit veterans to three grams of medical marijuana per day, down from 10. Exceptions will be considered for those with authorization from a specialist, the department said.
A report by Auditor-General Michael Ferguson released in the spring found that 53 per cent of all pot prescriptions for veterans were authorized by just four doctors. Michel Doiron, an assistant deputy minister with Veterans Affairs, said one physician had written about 800 medical marijuana prescriptions, almost all for the maximum daily limit.
The department reported the physician to a provincial college, Mr. Doiron said. It also reported a licensed producer to Health Canada over unrelated concerns. Neither resulted in disciplinary action.
The change comes amid concerns about veterans groups receiving kickbacks from licensed producers for referrals, and anecdotal reports of medical marijuana being diverted into the black market.
Ed Schollenberg, registrar for the College of Physicians and Surgeons of New Brunswick, said the college has received only one complaint regarding medical marijuana.
"We have investigated a particular physician quite carefully, even using operatives, to the point of having someone go in with, ostensibly, a problem," he said. "As far as we can tell, everything was done quite carefully, in terms of past history and everything else. We had heard all kinds of crazy allegations, but as far as we can tell, they're not true."
New Brunswick, home to Eastern Canada's biggest military base, has a large population of veterans. Only two of about 1,700 physicians in the province regularly prescribe medical marijuana, Dr. Schollenberg said.
Producers have said veterans often require more costly strains, or larger volumes, than the average patient because of the more serious nature of their conditions, such as post-traumatic stress disorder.
Dr. Schollenberg would also like medical marijuana treated as other pharmaceutical drugs so the colleges can keep an eye on it.
"Then we would know who has it, who prescribed it, how much they prescribed," he said. "Right now, there is no way to prove double-doctoring. A patient can go to three doctors in a row and send [the prescriptions] to three different growers and get three times the marijuana they're allowed to have. Without a tight database, there's just no way to control that."
In a statement provided by Health Canada media relations officer Gary Holub, the department said it has not been provided with evidence from VAC, nor has it received a complaint, that would warrant a review.
Veteran Fabian Henry, who co-founded the New Brunswick-based advocacy group Marijuana for Trauma, said the new limit is "not even close to being sufficient" for conditions such as PTSD. Mr. Henry was diagnosed with the condition during his second tour in Afghanistan, and said it typically requires seven to 10 grams a day.
"My life is in danger," Mr. Henry said. "It's hard enough to find a doctor to prescribe cannabis. We were fortunate enough to find doctors compassionate enough, and now they're capping doctors at three grams a day."
Colleges in other provinces have not yet responded to questions on the issue from The Globe and Mail.