Despite Ontario having largest number of federally approved users, doctors are cautious
Saturday, July 12, 2003
The Ottawa Citizen
Ontario leads Canada in the number of people who can legally smoke medical marijuana, but the 240 certified users in the province are a long way from having easy access to the drug despite the federal government's new distribution plan.
The Canadian Medical Association and the Canadian Medical Protective Association both remain adamantly opposed to the use of medical marijuana and are telling doctors not to get involved in any aspect of it.
"There is a possibility that if a physician acts as a distributor, they might be sued if something goes wrong. We recommend they shouldn't distribute marijuana unless they truly believe the benefits outweigh the disadvantages," said Dr. Douglas Bell, managing director of the protective association's physician services group.
In Ottawa, several doctors interviewed said they would refuse to distribute marijuana if asked by the federal government. Most say the medical benefits of marijuana are unproven, despite anecdotal evidence from users who say it works wonders for them. They say doctors are not in the business of distributing drugs, and the trouble involved in keeping something whose medical benefits are dubious at best is not worth it.
"Do I want to be a drug dealer? No. I have absolutely no interest in distributing pot. I'll have people breaking into my clinic," said family physician Dr. Joshua Abiscott.
"I am not going to do it," added Dr. Barry Dworkin, also a family physician and assistant professor of family medicine at the University of Ottawa.
"The general thing is doctors look at this and say 'I am not in the marijuana business.' They are not comfortable in acting as government distributors when they don't know what the actual effects are."
Dr. Dworkin says cesamet, a pill similar to marijuana, is as effective for pain, nausea and vomiting and he doesn't understand why people don't use it.
But Dr. Michael Yachnin, another family physician, says if he is convinced marijuana will help a terminally ill patient, he will distribute the drug.
"If I had a patient that I thought needed it and it had to come through my office, I would distribute it," Dr. Yachnin said. "If it would help people, why not?"
Those who use medical marijuana, or have family members who need it, say the problem with the federal distribution plan is that most doctors don't believe in the medicinal benefits of marijuana -- and in Ottawa, it is hard to find a willing doctor to recommend its use.
Rick Reimer, a former Ottawa lawyer who got permission three years ago to legally smoke marijuana because of multiple sclerosis, says the specialist treating him refused to sign his form, forcing him to buy the drug on the black market.
He got permission before the federal government introduced the regulations now in effect, but he has only recently found a Pembroke doctor who has signed his form and agreed to take delivery of the drug from Health Canada.
Mr. Reimer says one answer to the problem is compassion centres -- clubs that sell marijuana to sick people. There are such centres in B.C., Montreal and Toronto, but not in Ottawa. The problem, however, is that people who run them are constantly harassed by the police, who consider them lawbreakers.
"They are trying to provide marijuana for medical users, but the trouble is they sometimes get busted," Mr. Reimer said.
Forced into action by an Ontario court deadline, federal Health Minister Anne McLellan announced Wednesday a plan to supply marijuana to chronically ill Canadians. The drug will be distributed by courier to patients' doctors in pre-packaged 30-gram bags and limited to an amount a physician says is required for a patient. The going price will be $5 a gram. As well, the government will sell marijuana at $20 a packet of 30 seeds so sick people can grow on their own.
Jirina Vlk, a Health Canada spokeswoman, said the narcotic will not be distributed to every doctor -- only those who have signed on and support medical use of marijuana. She said of the 582 people who have been certified to use marijuana legally, 240 are in Ontario, 95 in B.C., 54 in Alberta and 49 in Quebec. The rest are spread out across the remaining six provinces. Ms. Vlk said in Canada, 322 doctors have signed on to the medicinal use of marijuana and of this, 136 are in Ontario, 57 in B.C., 36 in Quebec and 29 in Alberta.
To be classified as a medical user of marijuana, a person applies to a doctor, who must certify the drug is beneficial to the patient. The doctor signs a form, including a controversial section that says he or she agrees "the benefits to the applicant from the recommended use of marijuana would outweigh any risks associated with that use."
It is this section that has aroused concern among doctors and the Canadian Medical Protective Association, which provides insurance and legal help for doctors facing malpractice suits.
To make such a commitment without any scientific evidence medical marijuana works and has no long-term effects opens physicians to lawsuits down the road.
Another section of the form requires physicians to affirm they have considered the risks associated with higher doses, including risks to the patient's "cardiovascular, pulmonary and immune systems and psychomotor performance" as well as potential drug dependency -- and have concluded that the benefits of using the drug outweigh the risks associated with that dosage.
"Physicians are being asked to attest something as true when they don't know that," the protective association's Dr. Bell said.
"We are advising doctors not to partake in this particular program because
we feel very strongly that this is a substance that we do not have the
proper evidence-based scientific studies to show its effectiveness," added
Dr. Dana Hanson, president of the Canadian Medical Association.
Copyright © 2003, The Ottawa Citizen