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Every physician in Canada is guided by the ethical precept: "first, do no harm." Doctors across Canada are concerned that the new federal "Marijuana for Medical Purposes Regulations" released Wednesday not only violate that precept, they compromise Health Canada's role in patient safety and protection of the public.

Marijuana is a complex substance and much remains unknown about its use as a medical treatment. Each strain differs from others in strength and effect. The effects on a patient may differ depending on whether the product is smoked, vaporized, or taken orally with food. This variation makes it difficult to issue standard recommendations regarding the correct dose or possible interactions with other drugs. Serious health risks associated with marijuana use have been identified including the risk of psychotic episodes in younger users. Most importantly, the health benefits claimed for marijuana still need to be proven in rigorous, controlled scientific studies.

Current federal laws require that, before a drug may be prescribed in Canada, extensive research and testing, including clinical trials, must be undertaken to establish its safety and efficacy. This research also provides physicians with critical information for the use of a medication including when to prescribe the drug and in what dosages, and what its benefits, risks and possible side effects are. Let us be clear: this information does not yet exist for marijuana.

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The Federation of Medical Regulatory Authorities of Canada and the Canadian Medical Association strongly believe that physicians should not be asked to prescribe substances whose claims of effectiveness and safety have not been established with clinical research. To ask physicians to prescribe and dispense a substance that has not been clinically tested is akin to asking them to write prescriptions while blindfolded. It is our firm view that medical marijuana should be subject to the same regulatory requirements as prescription pharmaceuticals.

The general public largely shares this view. According to recent polling conducted by Ipsos-Reid for the CMA, an overwhelming majority of Canadians (90 per cent) believe that research on the effectiveness, safety and risks of medical marijuana is needed so that we can more clearly understand its potential role in patient care. This same poll found that the majority of Canadians (79 per cent) agree that Health Canada should maintain its role, while a significant majority (85 per cent) agree that medical marijuana should be subject to the same rigorous testing and approval standards as prescription medication.

Canadians would not want physicians to prescribe drugs for heart disease, cancer or any other illness without the appropriate scientific evidence and guidelines. Why does the federal government want them to do so with marijuana? The federal government's decision to do so undermines quality patient care and potentially jeopardizes the safety of patients.

Physicians are deeply concerned about the difficulty that many patients have in their battles with chronic pain and other serious health problems. Clearly, there is a need for more effective treatment options. We support and encourage further research toward the development of new knowledge to improve patient care and to expand the treatment options available. However, to ensure patient safety and quality treatment, the use of marijuana as a medical treatment must be underpinned by the appropriate research and clinical trials.

As such, Canada's doctors urge the federal government to rescind the new marijuana regulation and replace it with a robust regulatory framework that treats marijuana as other drugs in Canada are treated. The Canadian Medical Association and the Federation of Medical Regulatory Authorities of Canada are ready to work with Health Canada on a regulatory approach that will effectively serve patient safety, best clinical practice, and optimal patient care.

Dr. Anna Reid is President of the Canadian Medical Association, representing Canada's physicians. Dr. Rocco Gerace is President of the Federation of Medical Regulatory Authorities of Canada (FMRAC); FMRAC is the privileged voice of the thirteen provincial and territorial medical regulatory authorities.

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