Medical marijuana

Issue: BCMJ, Vol. 52, No. 7, September 2010, page(s) 329 Editorials
Willem R. Vroom, MD

It is often problematic when pa­tients request a particular medication, particularly when the clinician has reservations about the request. Examples in everyday practice include requests for sleeping pills and analgesics, or antibiotics for nonbacterial illness. However, for most of us, few requests generate more apprehension than a request for so-called medical marijuana. Despite this, BC still has the highest per capita use of medical marijuana in Canada.In my opinion, medical marijuana is no more medical than so-called medicinal alcohol. In 2001, Health Canada delegated the responsibility for prescribing medical marijuana to physicians to treat serious illnesses unresponsive to conventional treatment. The criteria for accessing medical marijuana are relatively stringent. Access to medical marijuana can be obtained by completing Health Canada’s Medical Practitioner’s Form B1 or Form B2. Form B1 asks you to confirm that your patient has a malig­nancy or degenerative neuromuscular condition, on the premise that most physicians would consider this use of medical marijuana a type of palliative therapy. This form takes 5 minutes to complete. Form B2 is for those very unusual situations that do not fit the criteria for Form B1 and requires en­dorsement or completion of the form by a specialist. This form takes 10 to 15 minutes to complete. Far easier, however, is a form supplied by the BC Compassion Club Society (BCCCS), which is a series of check boxes and takes only a minute to complete. However, unless you are a pharmacologist specializing in cannabinoids, about the only statement that you can reasonably agree with (in accordance with the recommendations of the College of Physicians and Surgeons of British Columbia) is that “this patient has reported that his/her symptoms are helped by cannabis.” Most physicians are unaware that the BCCCS Practitioner’s Statement does not grant patients a federal authorization to possess marijuana and does not protect your patient from prosecution. Practically, however, police are usually reluctant to prosecute a patient who has a physician endorsement for possession of marijuana. The BCCCS medical access forms are far less prescriptive than the federal access forms, hence their use by patients with conditions that are far from palliative and which include chronic headaches, anxiety, and even Axis I disorders. Requests from these patients can leave me truly baffled.• Why would I recommend a substance that has over 60 different cannabinoids whose actions and effects I know nothing about?• How can I recommend a substance that has no quantifiable strength?• At what point does the function of a substance that is almost always used recreationally become medical?• Why would the CMPA recommend that I have patients complete the release form for medical practitioners when endorsing marijuana? Will this really protect me against any claims?In short, I, like most of you, will move heaven and earth to ensure the comfort of my patients in need of pal­liative care, even to the point of prescribing THC and, on occasion, completing the federal access form for medical marijuana. But to all the other patients wishing my endorsement to sail the misty, uncharted waters where I don’t belong and don’t want to be—don’t ask me.—WRV

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