Pubdate: Fri, 02 Dec 2016
Source: Globe and Mail (Canada)
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Andrea Woo

TRACK POT PRESCRIPTIONS, DOCTORS ADVISE

Physicians groups say oversight is operating in a vacuum; Health
Canada urged to license marijuana, assign it a drug ID number

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 a 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.
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MAP posted-by: Matt