Pubdate: Tue, 30 Sep 2014
Source: Globe and Mail (Canada)
Copyright: 2014 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Carly Weeks
Page: A4
Referenced: New CFPC Release: Dried Cannabis Preliminary Guidance 
(September 2014): http://mapinc.org/url/OybDZOB6

DOCTOR'S GROUP OFFERS GUIDE ON POT ACCESS

Physicians Must Authorize Use of Marijuana, but a Lack of Research 
into Drug's Benefits Makes It Difficult to Know When to Prescribe

The College of Family Physicians of Canada has created new guidelines 
to help doctors determine if and when a patient should have access to 
marijuana to treat chronic pain or anxiety.

The college's recommendations advise doctors to only approve access 
to medical marijuana for treatment of pain in patients who haven't 
responded to other treatments, and say it is not appropriate for 
people under 25, those with a personal or family history of psychosis 
and those with a substance abuse disorder. The recommendations - 
which are not binding - also say medical marijuana is not appropriate 
therapy for insomnia or anxiety.

The document was created to address the predicament doctors face 
because of new rules that make them responsible for approving access 
to medical marijuana despite the fact it has not been studied 
in-depth by Health Canada or approved for therapeutic purposes.

A court ruling requires the department to provide access to medical 
marijuana when authorized by a physician. The challenge for doctors 
is that no comprehensive, systematic scientific evidence has been 
conducted to determine how effective medical marijuana is, what 
conditions it helps with, and who can best benefit from it.

"Physicians are in a difficult situation with a product that remains 
illegal in Canada and yet for which they are now asked to actually be 
the prescriber of this substance," said Francine Lemire, CEO of the college.

Or, as the document puts it: "We are asked to authorize our patients' 
access to a product with little evidence to support its use, and in 
the absence of regulatory oversight and approval."

The gaping evidence gap prompted the Arthritis Society to also 
announce Monday it wants more research to study the impact of medical 
marijuana on pain. The organization is preparing to fund clinical studies.

"I think it's high time that we found something to help the 
4.6million Canadians living with arthritis and trying to do something 
to help," said Jason McDougall, chair of the Arthritis Society's 
scientific advisory committee and a pain researcher at Dalhousie University.

The Arthritis Society is planning to earmark some of its funds to an 
open competition where researchers can apply to study medical 
marijuana. Dr. McDougall says research will allow the medical 
community to have a clear idea of how marijuana works and what role 
it should play in pain management and other conditions.

"I think physicians are hesitant about it because they don't fully 
understand," Dr. McDougall said. "That's why we require this ... research."

Chris Simpson, president of the Canadian Medical Association, said 
the new college guidelines will be a critical tool for doctors and 
can help prevent the emergence of a "Wild West" when it comes to 
prescribing medical marijuana. "I think it's appropriately cautious," he said.

Dr. Simpson added the country's doctors have never faced a situation 
like this before.

It's estimated that about 40,000 Canadians use marijuana for 
medicinal purposes, and many say it helps them control pain, 
seizures, dementia, glaucoma and a host of other conditions.

The latest developments come just weeks after the Canadian Medical 
Association adopted a motion that officially opposes smoking 
marijuana or any other plant. The CMA argues that smoking carries 
clear health risks and that there is no good research backing the use 
of medical marijuana.

But Dr. Simpson said the position is based on the current lack of 
evidence and that news of the Arthritis Society's commitment is a 
"positive development."

"We're operating or being asked to operate in an information or an 
evidence vacuum," he said.

Dr. Lemire said the college will continue to meet with Health Canada 
and will press the need for more research. "We have to accept what is 
currently in place," she said.
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MAP posted-by: Jay Bergstrom