Now that recreational cannabis is legal in Canada, Ontario physicians can expect to receive more questions from patients about both recreational and medical cannabis. The OMA has consulted with the CPSO and CMPA to summarize physician responsibilities regarding this emerging practice issue.
The CPSO has not released any new or updated physician guidance specifically addressing recreational cannabis but has released a brief article on the subject. 3 The CMPA issued an eBulletin to its members in October. Both the CPSO and CMPA indicate that physicians should continue to ask patients about tobacco, recreational drug, and alcohol use as they would have prior to cannabis legislation.
The expectation on the part of the physician providing care does not change in any significant way now that recreational cannabis is legal. It is expected that physicians will remain up to date on emerging issues and maintain a level of knowledge required to have meaningful discussions with their patients.
The legal framework for access to medical cannabis, under which physicians can sign medical documents authorizing access (i.e. prescribe) for patients, was previously outlined in the Access to Cannabis for Medical Purposes Regulations (ACMPR), under the Controlled Substances Act. 2,3 This legal framework remains the same after the legalization of recreational cannabis use, however it is now outlined in the new Cannabis Regulations under the Cannabis Act. 4,5
It continues to be up to each individual physician to decide whether or not to provide a medical document to a patient for medical cannabis. Cannabis is not a Health Canada approved therapeutic product and has not been issued a Notice of Compliance or Drug Identification Number.6
Those physicians who authorize cannabis as a treatment option are expected to have the necessary knowledge to do so. The CPSO has provided an outline of expectations for Ontario physicians who are considering completing medical documents for medical cannabis (see Cannabis-Related Guidance From the CPSO section).
The CMPA outlines its advice on cannabis for medical purposes in its Medical Marijuana: Considerations for Canadian Doctors article. These considerations remain relevant regardless of the legal status of recreational cannabis.7
Key Points from the CMPA:
For questions or guidance on the topic of cannabis, the CMPA encourages physicians to contact its support line.
Toll Free: 1-800-267-6522In Ottawa area: 613-725-2000Telephone service hours: Monday-Friday, 8:30am-4:30pm ET
Physicians should be committed to lifelong learning and are responsible for maintaining the medical knowledge and clinical skills necessary to provide the highest possible quality care to patients. This includes responding to emerging practice issues, such as cannabis.
As noted above, there is no obligation to refer when you:
If you are unfamiliar with the use or management of medical cannabis, or are opposed to considering cannabis as a medical treatment, consider referring your patient to a physician knowledgeable in the area for assessment. Documentation of all decisions and rationale is recommended.
As described in the CPSO policy on Marijuana for Medical Purposes, patients and licensed producers must not be charged for completion of forms or documents related to patient access/prescription of cannabis. These services are considered a constituent element of the associated insured service rendered to the patient.
The OHIP Schedule of Benefits for Physicians (“Schedule”) does not list specific fee codes for physician services resulting in the prescription of cannabis for medical purposes. Physicians should bill OHIP the fee code that best represents the service rendered (e.g., assessment, counselling, etc.)
1 College of Physicians and Surgeons of Ontario. Legalization may see more patients discuss marijuana use. Dialogue. 2018;2 cited 20 Sep 2018.
2 Access to Cannabis for Medical Purposes Regulations, SOR/2016-230.
3 Controlled Substances Act, 1996, S.C.1996, c. 19.
4 Cannabis Regulations, SOR/2018-144.
5 Cannabis Act, 2018, SC. 2018, c 16.
6 Health Canada. Consumer Information – Cannabis (Marihuana, marijuana). Ottawa, ON: Health Canada; 2016 cited 2018 Sep 17.
7 Canadian Medical Protective Association. Medical Marijuana: Considerations for Canadian doctors. Duties and Responsibilities . Ottawa, ON: Canadian Medical Protective Association; 2016 cited 2018 Sep 9.
8 US Customs and Border Protection. CBP Statement on Canada’s Legalization of Marijuana and Crossing the Border. Washington, DC: Department of Homeland Security; 2018 [cited Oct 12, 2018].
9 College of Physicians and Surgeons of Ontario. Policy Statement #8-16: Marijuana for Medical Purposes. Toronto, ON: College of Physicians and Surgeons of Ontario; 2016 [cited Sep 17 2018].
Updated: October 17, 2018