http://bmj.com/cgi/content/full/323/7304/68/b
BMJ 2001;323:68 ( 14 July )
From the end of this month, Canada
will become the first country to allow the growth and use of marijuana
for personal use by people with terminal illness and serious medical conditions.
Dr Judy Gomber, director general
of the federal health department’s office of controlled substances, announced
the new federal regulations, emphasising that the government was not encouraging
the use of cannabis and would not provide it. It is, however, making it
available under certain conditions for people who have found that conventional
treatments do not work and whose doctors have decided that its medical
benefits outweigh its risks.
But the past president of the Canadian
Medical Association, Hugh Scully, said that the association does not support
the move and believes it is premature for the health department to expand
broadly the medical use of marijuana "before there is adequate scientific
support." He thinks that most doctors will be reluctant to participate
in the process devised by the Canadian government.
Under the new regulations, a doctor
must sign the application form, but it is the patient who applies for permission
to use the drug. Dr Gomber said: "It’s not an approved medical drug."
Three categories of patient can apply:
those with a terminal illness and a life expectancy of less than 12 months;
those with serious conditions such as multiple sclerosis, cancer, HIV or
AIDS, severe arthritis, and epilepsy; and those who have obtained declarations
from two medical specialists that marijuana would help them.
Approved applicants and marijuana
growers will receive a photo identification card, specifying possession
and production limits, to show police. An unspecified number of federal
inspectors will also be employed. An estimated 400 000 Canadians already
use marijuana for medical reasons.
The applicants may grow the plant
themselves and designate a grower from whom they will obtain seeds, but
growing marijuana is otherwise illegal in Canada, so just how this will
be done is uncertain. Quantities will be limited to a 30 day supply at
the designated dose, which will be set by the doctor.
Dr Gomber said that doctors and patients
will have to collaborate to discuss dosage, but it is unclear how that
will be set, given the vagaries of cannabis plants’ potency and the uncertainties
surrounding its effectiveness. The federal health department, however,
plans to issue a guide for doctors, presumably to help in this process.
The department also plans to carry
out government sponsored clinical trials, which will receive free marijuana
from its own provider, and has committed $C7.5m (£3.5m; $5m) over
five years for research on the substance.
Two studies in last week’s issue
of the BMJ cast doubt on the efficacy of cannabinoids (7 July, p 13, 16),
and an editorial called for more research on their use (pp 2-3).
But Mary Lynch, director of research
at the pain management unit of the Queen Elizabeth II Health Sciences Centre
in Halifax, Nova Scotia, said that the studies’ conclusions should be regarded
with caution. Not enough human research had been done to draw any significant
conclusions, she said, and she was "very enthusiastic about the future
of cannabinoids."
She praised Canada’s approach to
medicinal marijuana and said that it would help to make Canada a world
leader in cannabinoids research.
David Spurgeon Quebec