by James Mendel, OMA Health Policy Department
The Ontario Medical Association has joined the Canadian Medical Protective Association
(CMPA) and the Canadian Medical Association (CMA) in voicing the significant
concerns of Ontario physicians regarding Health Canada's controversial medical
marijuana access regulations.
In a recent letter to Federal Health Minister Allan Rock (opposite), OMA President
Dr. Kenneth Sky outlined the serious problems inherent in the regulations and
their potential negative impact on both physicians and patients. Dr. Sky urged
the federal minister to pursue an immediate review of the regulation to address
members' concerns.
In October 2001, the Canadian Medical Protective Association issued a comprehensive
information sheet, advising its members on the proper approach in the event
that a patient requests medical marijuana.
The CMPA advises physicians wishing to authorize medical marijuana for their
patients not to complete Parts 3, 4 or 5 of the Physician Authorization Form,
unless the physician has detailed knowledge that would enable him or her to
make such declarations.
The information sheet is posted for reference on the CMPA Web site under the
"News and Notices" section (http://www.cmpa.org/cmpaweb/public/english/pdf/web_marij-e.pdf).
The OMA supports the view that adequate information is not presently available
to enable physicians to make a declaration of risks and benefits in Part 3,
and that physicians should not be asked to recommend dosage in Part 4.
The OMA has recommended to the federal health minister that the Physician Authorization
Form be revised to remove the requirement for a declaration on risk and benefits,
and that which pertains to dosage.
The OMA also recommends that one general or family practitioner is sufficient
to complete the authorization form. Currently, the regulation may require one
or two specialists to authorize an application, depending on a patient's condition.
The OMA Drugs and Pharmacotherapy Committee, in conjunction with the OMA Health Policy Department, is carefully monitoring this issue, and relevant updates will be provided to members via the OMA Fax and E-mail Network, WebLink, and the Ontario Medical Review.
Dear Minister Rock:
The federal regulation on medical marijuana presents numerous different challenges
for physicians that may wish to authorize the drug for their patients. The OMA
acknowledges the time constraints under which the regulation was introduced.
We approve the decision to make the patient the applicant in the process. It
is clear, however, that the regulation satisfies neither physician concerns
about process nor patient concerns about timely access to treatment.
The OMA supports the recommendations set out in an October 2001 information
sheet by the Canadian Medical Protective Association. We agree that physicians
do not have sufficient information to make a declaration of risks and benefits,
or to accurately estimate dosage requirements. We support the CMPA advice to
physicians that they do not complete Sections 3, 4 or 5 of the physician's authorization
form. This removes the requirement that a physician make an untrue statement,
and attempts to facilitate patient access where the physician thinks the patient's
condition would benefit from medical marijuana.
Further to improving access to medical marijuana, the OMA believes that one
family physician should be sufficient to authorize a patient's application in
categories 1, 2 and 3. The regulation requires one or two certified physician
specialists to approve an application for medical marijuana in categories 2
and 3 respectively. Because of the already lengthy waiting lists for specialist
referrals, this requirement makes timely access to medical marijuana very difficult
to achieve. For some, geography hinders access to one, let alone two specialists,
so that access to medical marijuana will be virtually impossible.
Physicians who specialize in the treatment of chronic non-malignant pain would
welcome the ability to improve timely access to medical marijuana for their
patients. Some of these physicians are not certified as specialists, yet they
have built their careers on specialized practice and are widely considered to
be experts in the field of pain management, and are relied upon by their colleagues,
specialists and non-specialists alike. Unfortunately, the regulation denies
their expertise, and requires them to seek out specialists to facilitate treatment.
Because patients with chronic pain require intensive management and knowledge
of pharmacotherapy, many general practitioners require expert or specialized
help to manage these patients. Physicians who specialize in treating chronic
pain are well known among their peers, accepting referrals for patients who
do not respond to conventional therapies.
We also point out that physicians should not be required to declare an understanding
of a Notice of Compliance. In Section 4 of the patient's application, the patient
is directed to contact a physician if he/she does not understand the significance
of the absence of a Notice of Compliance for medical marijuana. Knowledge of
a Notice of Compliance is not relevant to physicians' practice.
The OMA supports an immediate review of the medical marijuana regulation, guided by the following principles:
The issues raised in this letter require an urgent solution. We look forward
to immediate progress in resolving these issues.
Yours truly,
Kenneth Sky, M.D., FRCS(C)
President
Letter to physicians from OMA (HTML)
Letter to be attached to the Medical Practitioner Form and Medical Specialist Form (HTML)