The professional organization that regulates the conduct of B.C. doctors is cracking down on how patients access medicinal marijuana, and some MDs in the province are not happy about it.
In a telephone interview, Dr. Ian Mitchell, a Kamloops-based physician and clinical associate professor at UBC, described the new rules as “excessive” and “beyond Health Canada requirements”.
“This is very restrictive and a big change from the past,” he told the Georgia Straight. “These new regulations make it almost impossible for anybody to comply with them.”
The revised policies come in the form of a recent College of Physicians and Surgeons of B.C. “professional standards and guidelines” memo. The March 2015 document concerns how doctors should issue what Health Canada calls a “medical document” (as opposed to a prescription) that patients require to order marijuana from federally authorized suppliers.
It states that cannabis is “not appropriate” for patients under the age of 25; for those who have a history of psychosis, a cannabis disorder, or a substance-use disorder; or for anybody with a cardiovascular or respiratory disease.
The document is an official college “standard”, according to the regulator’s website, which means it reflects “relevant legal requirements” that are enforced under the province’s Health Professions Act.
It goes on to state that a physician should not complete a patient’s medical document for marijuana unless they have a “longitudinal relationship” with that individual or are in contact with a physician who has such a relationship. Finally, it forbids doctors from charging patients for the completion of the medical document.
In a telephone interview, Dr. Galt Wilson, senior deputy registrar for the college, said the memo obtained by the Straight has since been recalled and is being revised to incorporate members’ input. But Wilson stressed that the college is dissatisfied with the status quo, and he defended several of the memo’s specific provisions.
“We’ve turned up examples of what we consider substandard medical care associated with marijuana authorization,” he told the Straight. “So we wanted to put the word out that we expect the same high standard of care for this situation as we do for every other medical service.”
According to Wilson, a set of more specific guidelines was required because the potential health benefits of marijuana have yet to be sufficiently researched.
He said that chief among the college’s concerns is the increasing number of physicians who are charging patients for the completion of Health Canada’s required medical document. Wilson argued that this has created a potential conflict of interest, where doctors have a cash incentive to find a reason to recommend marijuana. Wilson explained that the college has therefore ordered doctors to treat the medical document as a prescription, for which they are not permitted to charge a separate fee.
“What we’ve seen is some pretty superficial assessments,” he said. “And we’ve seen really concerning examples of what we regard as a conflict of interest.”
Wilson stressed that in revising standards around marijuana, the College of Physicians and Surgeons of B.C. is taking cues from the College of Family Physicians of Canada, which issued a 28-page report on the matter in September 2014.
The new rules will apply to more than 25,000 British Columbians who are authorized to purchase medicinal marijuana from Ottawa-approved suppliers. They could also impact Vancouver residents who purchase cannabis products from the city’s estimated 65 storefront dispensaries. Although those businesses operate illegally, some require clients to hold proper Health Canada authorization to possess marijuana.
Doctors across the country are debating the B.C. college’s new rules. That’s evident in a package of emails obtained by the Straight that were sent between some 70 Canadian physicians who have formed a group called Practitioners for Medicinal Cannabis (PMC). Many messages argue that the new standards are overly stringent. One email, for example, suggests that the college is “endangering the public by indirectly obstructing access”. Others express similar sentiments.
Dr. Arnold Shoichet is a board member for the Vancouver-based Medicinal Cannabis Resource Centre and a founding PMC member. In a telephone interview, he described the dominant reaction to the college’s move on marijuana as “distress”.
“Many of the participants within the PMC have verbalized their concerns about the way the college is choosing to address its responsibilities,” Shoichet said. “Their restrictions are, in a sense, tying the hands of the medical practitioners who are supportive and willing to get involved.”
In separate interviews, Shoichet and Mitchell took issue with the college’s order that physicians treat Health Canada’s medical document as a prescription. They argued the form is significantly more complicated and time-consuming than any prescription and should, therefore, be subject to a fee at the discretion of physicians.
Shoichet added that B.C. isn’t the only province whose medical regulatory agency has moved against marijuana. The Ontario College’s policy on cannabis includes similar provisions, he noted.
“Regulatory authorities across the country seem to be doing the same thing,” Shoichet observed. “Why are they doing that?”