The federal government has recently changed the rules for medical marijuana. The new rules were developed, we are told, as the result of legal challenges that determined that the old ones were defective and made it unreasonably difficult for patients to access marijuana for medical purposes. While the federal government is trying to make things easier, the College of Physicians and Surgeons of Alberta is working hard to accomplish the opposite. New College regulations will make medical marijuana - in Alberta - inaccessible, and make the College itself vulnerable to legal challenge.
On April Fools' Day 2014 - 1 April - medical marijuana users will wake up to an Alberta in which not a single doctor will be able to authorize marijuana for medical purposes. The default setting adopted in new rules that the Alberta College has recently proposed (but not yet enacted) will be that Alberta doctors will have to register with the College before being allowed to authorize medical marijuana. Currently, the default setting for the prescribing of powerful narcotics like morphine is that all Alberta doctors can do so without question (unless their privileges have been restricted). Furthermore the College has stated that it will not require doctors to apply for such authorization - in other words, if you, dear doctor, don't want to bother adding marijuana to your tool kit you don't have to and we (at the College) won't bug you. The question then becomes how many Alberta doctors will go to the trouble of becoming authorizers of medical weed. This question can likely best be answered by asking what the College will require of doctors who agree to authorize marijuana for patients. The time and cost of these requirements must be weighed against the benefit to the doctor who may have very few requests.
There are many requirements for doctors who would authorize marijuana as a treatment. Here is the College list:
1. The doctor will register with the College as an authorizer of medical marijuana.
2. Will know and comply with all provincial and federal legislation, including the Health Canada document "Information for Health Care Professionals" [94 pages of text; 58 pages of references].
3. Engage in professional education regarding the use of marijuana for medical problems and provide evidence of that training to the College.
4. Document all previous orthodox treatments that have failed to help the patient.
5. Assess the patient's risk of becoming addicted to marijuana by having the patient complete a questionnaire.
6. Complete, with the patient, a signed consent form that discusses the risks and benefits of medical marijuana.
7. Review two computer databases for previous drug use.
8. Provide the College with a copy of the marijuana authorization form within three days of completion of each one.
9. Check the two prescription databases each time a new marijuana authorization is written, and;
10. Be able to identify misuse/abuse of medical marijuana.
All of this - according to the College - must be done before the patient can even test drive marijuana as a possible treatment. One wonders how many grams of cannabis College advisors smoked before publishing these proposed rules. How many family doctors will go to the trouble of getting involved in the business of medical marijuana? My guess is not many. These rules send the message to young doctors that marijuana is more dangerous than powerful narcotics such as morphine or oxycodone. These rules pressure doctors to prescribe, preferentially, such narcotics if for no other reason than it is something they are familiar with and are comfortable doing. Yet alarming numbers of Canadians die each year from taking narcotics such as morphine.
There are other factors that will affect the outcomes of these administrative decisions... What is the cost of "medical" compared to "street" dope? The cost of medical marijuana is not covered by any insurance plan (marijuana does not have a Drug Identification Number - DIN - and all drugs covered by insurance must have this) so the full price must be borne by the purchaser. Authorizing documents must be mailed or couriered to the producer, and the dispensed marijuana is couriered to the patient monthly at the patient's expense.
Street marijuana sells for $240/ounce or less. That is $8.70/gram. Medical marijuana currently sells for $7.50 - $12/gram depending on strength. Street marijuana does not have the added transportation costs nor the costs associated with going to the doctor.
So many Canadians have tried, or use, marijuana recreationally. It is not difficult for anyone to find an illegal source. It only requires a few questions of a few friends.
In the end there would be no compelling reason for any Canadian to apply for access to medical marijuana in Alberta unless they had, most unusually, financial coverage or excessively high dosage requirements and costs.
The proposed new regulations of the College of Physicians and Surgeons of Alberta require that doctors write the total daily dose of marijuana and the duration of the authorization in days, weeks or months. They do not ask the strength of the product requested - different authorized producers offer marijuana strains of varying strengths (2.5% to 17% THC) and with varied chemical compositions. What is the College smoking indeed? (Health Canada regulations also do not require authorization of a particular strength of product.)
The College could simply have required that doctors apply the same degree of caution and thorough documentation as when prescribing potent, and potentially addicting, narcotics, such as morphine, when authorizing medical marijuana. It could have required doctors to provide a copy of each authorization written, in the same way it requires copies of prescriptions for narcotics. The proposed regulations appear to be entirely contrary to the spirit of the new federal regulations which seek to provide reasonable access to a potentially useful medical tool.
The new College regulations are not the end of the debate, but another beginning. Meanwhile, patients who used marijuana for medical purposes illegally prior to 1999, when the federal government created "medical marihuana" [this is the way the federal government spells it], will do so again.
(2013 Calgary mayoral candidate - "Mayor-juana")