College of Physicians and Surgeons of Ontario Marijuana for Medical Purposes
Updated March 2015
This month, the CPSO updated their policy in regards to the MMPR which must be practised and followed by all physicians given the right to legally prescribe medicinal marijuana.
The physician must only prescribe if they believe it’s clinically the most appropriate treatment option and must not provide care beyond the scope of their clinical competence. The risks associated with the use of marijuana such as addiction, chronic bronchitis, and a trigger or worsening of mental illness such as schizophrenia must be considered and taken seriously. As precautionary measures, physicians must provide general guidance such as a patient risk assessment. Each patient will be assessed based on their personal risk of addiction and substance diversion, factors for psychotic/mood disorders, and other health issues that may be altered/elicited through the use of dried marijuana.
Current evidence strongly suggests a correlation between a variety of issues with marijuana use and with children/young adults. Severe risks include suicidal ideation, illicit drug use, and long-term cognitive impairment. Due to the severity of these risks, physicians are not permitted to prescribe under the age of 25 unless all other options of alleviation have failed. The relief must also be substantial enough to the patient to counteract the severe potential risks associated.
In order to prescribe to a patient, the physician needs valid consent in accordance to their legal obligations and the CPSO’s Consent to Medical Treatment policy. As with most medications, patients must be advised by their physician about the potential risks and benefits, as well as any other information relevant to the using of marijuana. The patient must also be informed of the extent and quality of the evidence surrounding the use of marijuana for medical purposes.
Marijuana is available in a variety of strains which differ in not only THC/CBD levels but in potency and chemical composition. The strain prescribed must match the specific patient due to their sensitivities to the psychoactive and therapeutic effects. Due to this being difficult to determine, only a low dose of marijuana must be prescribed. Within that dose, strains must be low in THC, the psychoactive compound responsible for the more negative noted side effects associated with marijuana. From that point, the physician must use discretion in increasing the quantity/strength until the patient receives the desired symptom management without adverse cognitive impairment.
Managing the Risk of Abuse, Misuse, and Diversion
Like most narcotics, the risk of abuse of the drug poses a threat, therefore physicians are advised to follow the same guidelines for managing the possibility of abuse, misuse, and diversion set out in the Prescribing Drugs policy. Consistent monitoring is required to examine for emerging risks or complications. Given a scenario where the risks outweigh the benefits, the physicians must discontinue the use of the marijuana for the safety and well-being of the patient.
A written treatment agreement is also required between the physicians and the patients stating that the patient will not seek marijuana from another physician or source. The agreement also states the patient will only use the drug as prescribed and will store the product in a secure manner. The patient also must not sell or give away the product. If any of these terms are breached, the physician has the right to discontinue the prescription of marijuana to the patient.
The medical document must serve the same purpose and be viewed as an equivalent to a prescription, which is an insured service. The medical document contains but is not limited to: the patients name, physicians name, CPSO #, daily dose, duration of use, among other information – and once completed are submitted to an LP to be dispensed. Physicians are not permitted to charge patients or licenced producers for the written completion of the document or any activities associated. Activities associated includes risk assessments, education, support and/or monitoring.
This update means the end of clinics within Ontario charging patients with outrageous pricing for a medical document. More stringent policies have also been placed upon putting the patient’s well-being first in using medical marijuana to make sure that this method of treatment will benefit them and their personal circumstance best. The updated policy treats marijuana more like other prescribable drugs currently on the market with the same restrictions and responsible dosing.