"Hopefully with the new program, it really opens it up," says Terry Roycroft, CEO of the Medicinal Cannabis Resource Centre (MCRCI).
Roycroft's business helps people meet the requirements for Health Canada's approval to possess medical marijuana. Clients pay between $3,000 and $4,000 for guidance, along with help filling out Health Canada's forms and connection to a doctor who's willing to consider prescribing marijuana.
Roycroft says more than 2,000 people have come to the clinic since he opened several years ago.
"We do Skype appointments for people in other provinces," he says. "This is a consultation with our doctor in British Columbia, so we're able to help people right across the country."
Medicial marijuana rules change April 1st
It's a business model that's about to get a boost.
On April 1st, Health Canada will no longer be involved in approving medical marijuana use, only licensing the producers.
Doctors will decide who gets medical marijuana and who doesn't, writing a prescription which a patient can take to a federally authorized grower. That grower will in turn deliver the dried marijuana directly to the patient.
The new rules will also do away with the need for a specialist's opinion to treat ailments such as glaucoma, mild arthritis or depression, which could make it easier for more people to access marijuana.
At last count, Health Canada says there were 37,359 people with authorization to possess the drug.
"We're anticipating a much larger demand," Roycroft says. "Health Canada itself predicts 400,000 people by 2024. So there's a pretty rapid increase at this point."
Later this year, Roycroft is planning to open up store-front offices in Ontario and Nova Scotia — provinces with the largest number of medical marijuana users.
Doctors are the new gatekeeper
But what's good for business may be bad for doctors.
"Now that they are the only barrier between a patient and his medicine — it puts them at a little more unease," Roycroft says.
"This is one of the reasons why we're feeling that some of the doctors that were supporting it in the past may not be willing to do that now — because of that additional pressure of them being the line between that."
Dr. Arnold Shoichet agrees.
The B.C. doctor is among the small minority in his profession who have embraced marijuana as efficacious.
"I was pretty skeptical that marijuana had much of a medical value at all," Dr. Shoichet says, describing how he felt just a few years ago when he was set to retire after four decades in family practice.
Now 70 years old, Dr. Shoichet says that, after study and first-hand observation, he's convinced marijuana has brought relief to people whose suffering couldn't be alleviated by conventional treatment.
Dr. Shoichet says the rule changes for accessing medical marijuana are subtle but significant. And he understands why his colleagues are reluctant to become gatekeepers for the drug.
"There are no guidelines for dosage or administration. No clear outlines of side effects and risks. There are no standards for preparation," Shoichet says. "It's a very awkward position for doctors to be in."
It hasn't discouraged Shoichet, who works out of Roycroft's clinic and is helping to line up doctors for the new offices in Ontario and Nova Scotia.
And although Shoichet has formed a group of some 40 like-minded physicians, the demand for medical marijuana means he sees some of his patients remotely, via Skype.
"I think that's a good reason to use telemedicine" he says. "It would also be a good thing for more doctors to be willing to become involved in this area of care."
Many doctors wary about prescribing marijuana
But the new system for prescribing marijuana has most in the medical profession more reluctant than ever.
"They regard it as more of a challenge," says Dr. Galt Wilson, deputy registrar of the B.C. College of Physicians and Surgeons.
The College's position is in line with those of other provincial colleges and the Canadian Medical Association: Marijuana's benefits are unproven, and its effects are risky.
"We have a perspective, and that's one of skepticism," Dr. Galt says. "But we don't punish doctors for having a different opinion."
In any event, the College specifically recommends against prescribing marijuana by telemedicine.
"The challenge of balancing benefit and risk requires a comprehensive assessment," Dr. Galt says. "We're skeptical that most doctors would be able to manage that without a face-to-face relationship with the patient."
Dr. Shoichet says he has no trouble weeding out bogus claims for the drug, and he only sees patients via Skype after reviewing their detailed medical files.
And although the Vancouver clinic is expanding with brick-and-mortar offices in other provinces, CEO Terry Roycroft says the continued shortage of doctors means they'll continue to rely on technology like Skype.
"The problem is that a lot of these people aren't able to travel. We have a number of patients who don't ever leave their homes, and short of sending a doctor out there to see them, they'd have no other real options to do this."