On October 17, 2018, Canada officially legalized marijuana. Though the country’s healthcare professionals have expressed concern about likely increased use of cannabis, they’ve also been relieved that they won’t be responsible for authorizing the substance.
“The medical profession, as a whole, has really struggled with the whole concept of medical cannabis. There’s definitely some physicians who feel comfortable in that area but most don’t,” said Dr. Jeff Blackmer, the Canadian Medical Association’s vice president of medical professionalism, to CBC News in August.
“If anyone can go down to the local dispensary and get cannabis, there’s really no need for a separate medical authorization system. You really don’t need to have people going to their doctors because anyone who has a medical condition and thinks they might benefit from it can go ahead and try it,” he said.
This discomfort about having to authorize medical marijuana — a treatment with few clear guidelines and a lack of peer-reviewed evidence — is prevalent among healthcare professionals. In a recent discussion among Figure 1’s case-sharing community, these concerns were voiced by physicians around the world.
In the words of one family medicine physician:
“I practice evidence-based medicine. Anecdotes are not evidence. And until the evidence is there with clear guidelines in terms of dose, monitoring, effect, etc, I will not prescribe it. Until I have evidence to back up marijuana as a treatment choice I am not willing to shoulder the risk of prescribing unproven treatment.”
A pediatrician agreed:
“For a medicine with a side-effect profile like marijuana I can’t prescribe it because there’s no dosing and no ingredient list if someone has a reaction. Yes, it’s medicinal, but unlike something like ginger, which basically has no side-effects, I don’t feel comfortable assuming this responsibility.”
A minority of doctors were satisfied with the medical cannabis system, including this Canadian family medicine physician:
“In Canada, medical marijuana is legal across the country, with regulated providers. They offer standardized oral dosing of a variety of strengths as well as different ratios of THC and CBD components. One can easily tailor the dose and track it. Policies exist on how when to use. Works well with little side effects in many conditions. I utilize it with many patients, physical and psychiatric.”
The official stance of the Canadian Medical Association is that the legalization of marijuana must be accompanied by a broad public health policy with a focus on “preventing drug abuse and dependence; the availability of assessment, counselling and treatment services for those who wish to stop using; and harm reduction to increase the safety for those who are using.”
This case is featured in the most recent issue of The Differential, our regular email roundup of fascinating medical cases shared on the Figure 1 network. To get this newsletter and other specialty-specific editions, healthcare professionals can sign up for a free Figure 1 account here.