Pubdate: Tue, 30 Sep 2014
Source: Toronto Star (CN ON)
Copyright: 2014 The Toronto Star
Contact:  http://www.thestar.com/
Details: http://www.mapinc.org/media/456
Author: Sheryl Ubelacker
Page: A6
Referenced: New CFPC Release: Dried Cannabis Preliminary Guidance 
(September 2014): http://mapinc.org/url/OybDZOB6

DOCTORS GET ADVICE ON MEDICAL POT

Marijuana Should Only Be Prescribed After Trying Regular Medicine, College Says

The College of Family Physicians has issued guidelines to Canada's 
more than 30,000 primary-care doctors about which patients should and 
should not get prescriptions for medical marijuana.

College CEO Dr. Francine Lemire said the lack of research into 
cannabis has left many family doctors unsure about which patients 
could benefit from medical-grade weed and what dose should be prescribed.

"We're aware that there is demand out there by patients for dried 
cannabis for medical purposes," Lemire said Monday from Ottawa. 
"We're aware of the relative lack of evidence, good solid evidence, 
for when to authorize or not to authorize (its use).

"And we felt that it was important for us to share what evidence 
there is with physicians and to support them in how to prescribe."

The college's recommendations, which are spelled out on the 
organization's website, say there is no research evidence supporting 
the use of cannabis for low back pain or fibromyalgia, but it could 
be considered for nerve-damage pain caused by such conditions as 
multiple sclerosis, metastatic cancer, shingles, diabetic neuropathy 
and severe injury.

But even in the case of such pain-causing conditions, doctors should 
consider using medical pot only after trying standard medications and 
therapies, including pharmaceutical cannabinoids, the document says. "

Authorizations for dried cannabis should only be considered for 
patients with neuropathic pain that has failed to respond to standard 
treatments."

Before prescribing, the college advises doctors to conduct a pain 
assessment, assess patients for anxiety and mood disorders, and 
screen them for existing substance use disorders. The guidelines say 
patients under 25, those with substance abuse, cardiovascular or 
respiratory disease, and women who are pregnant, planning to become 
pregnant or breastfeeding should not be prescribed medical marijuana.

When its use is considered appropriate, the family doctor should 
regularly monitor the patient's response to treatment and discontinue 
authorization for its use if the smokable herb is clearly ineffective 
or causing harm, the college said.

In April, Health Canada changed its regulations to put prescribing of 
therapeutic marijuana in the hands of physicians, while supply of the 
dried herb was handed over solely to licensed growers for 
distribution to patients.

Previously, patients with proven medical need had been allowed to 
grow or buy cannabis for personal use.

The shift in regulations put doctors across the country in an 
unenviable position: the onus for authorizing the use of medical pot 
was now their responsibility, yet many knew little about which 
conditions might be helped by the herb, what dose was appropriate and 
when it shouldn't be given to a particular patient, Lemire conceded.

"We realize they have been placed in a difficult situation," said Lemire.
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MAP posted-by: Jay Bergstrom