PSG Marijuana For Medical Purposes

College of Physicians and Surgeons of British Columbia
Professional Standards
and Guidelines
Marijuana for Medical Purposes
Preamble
This document is a standard of the Board of the College of Physicians and Surgeons of British
Columbia.
Colleges Position
Few reliable published studies are available on the medical benefits of marijuana. The amount
of active ingredients in marijuana varies significantly, depending on the origin and method of
production of the substance.
Physicians are advised that they should not prescribe any substance for their patients without
knowing the risks, benefits, potential complications and drug interactions associated with the
use of that agent. Physicians may be the subject of accusations or suggestions of negligence,
including liability if the use of marijuana produces unforeseen or unidentified negative effects.
Currently in Canada, 1 the only legal source of marijuana for medical purposes is that provided by
a licensed producer, which can be supplied to patients upon receipt of a medical document
provided by a physician. The authorization document must be completed annually if the patient
continues to receive marijuana for medical purposes.
Dried cannabis is generally not appropriate for patients who 2:
a. are under the age of 25
b. have a personal history or strong family history of psychosis
c. have a current or past cannabis use disorder
d. have an active substance use disorder
e. have cardiovascular (angina, peripheral vascular disease, cerebrovascular disease,
arrhythmia) or respiratory disease
f.
are pregnant, planning to become pregnant or are breastfeeding
See Marihuana for Medical Purposes Regulations SOR/2013-119

See College of Family Physicians of Canada Authorizing Dried Cannabis for Chronic Pain and Anxiety
September 2014
Professional Standards and Guidelines Marijuana for Medical Purposes

May 5, 2015
The College recognizes that there are sometimes circumstances in medical practice where
exceptions to strong relative contraindications may be appropriate. When physicians utilize a
therapeutic agent despite strong relative contraindications, the standard of care mandates
detailed documentation of their rationale.
The College considers the medical document authorizing patient access to marijuana to be
equivalent to a prescription. Physicians must not charge patients or licensed producers of
marijuana for completing the medical document, or for any activities associated with completing
the medical document, including, but not limited to: assessing the patient; reviewing his/her
chart; educating or informing the patient about the risks or benefits of marijuana; or confirming
the validity of a prescription in accordance with the Marihuana for Medical Purposes
Regulations.
Given the paucity of evidence to support the use of marijuana for medical purposes, physicians
who choose to provide a document related to the authorization of marijuana for medical
purposes shall:
1. Document that conventional therapies for the condition for which the authorization of
marijuana for medical purposes was provided have been attempted to assist the patient
in the management of his/her medical condition and have not successfully helped the
patient.
2. Assess the patient for addiction and/or risk of addiction. For the latter, use a validated
addiction risk tool and retain a copy in the patient record.
3. Discuss with the patient the risks of using marijuana and record in the patients medical
record that a discussion occurred.
4. Review the patients PharmaNet information prior to issuing an authorization for
marijuana for medical purposes and in any reassessment of patients receiving marijuana
for medical purposes.
5. Retain a copy of the document provided for the authorization of marijuana for medical
purposes in the patients medical record.
6. Include processes to identify any misuse/abuse/diversion by the patient in any
reassessment of patients receiving marijuana for medical purposes.
7. Not sell or dispense marijuana for medical purposes to any patient.
8. Not complete a document for the authorization of marijuana for medical purposes for a
patient unless
a. the physician has a longitudinal treating relationship with the patient, or
b. the physician is in direct communication with another physician or nurse
practitioner who has a longitudinal treating relationship with the patient and
both are in well-documented agreement with the issuance of a document for
the authorization of marijuana for medical purposes.
Although the authorization of marijuana for medical purposes is valid for up to one year,
patients using marijuana for medical purposes should be clinically reassessed as to the
appropriateness of treatment by their physician at least once every three to six months.
It is important to ensure that patients understand that potential side effects of marijuana, such
as sedation or cognitive impairment, can impact their safety. Health Canada has stated that
May 5, 2015
driving, operating heavy equipment, or other activities involving alertness and coordination may
be unsafe for up to 24 hours following a single consumption, depending on the dosage, the
delivery route, and the patients age and other health factors. It is important to discuss with
patients that their reactions to the substance and to different formulations are individual, and
that it is important to go slowly with the treatment until a stable, effective dose is reached. A
similar caution should be provided to any patient in a safety-sensitive occupation such as health
professionals and the supervision of children.
Through its library service, the College is providing registrants with access to appropriate
reference material to guide them in making informed decisions on the risks and benefits of
marijuana for medical purposes as they seek to provide appropriate evidence-based care to
their patients.
Physicians may seek advice on this issue by contacting the College and asking to speak with a
member of the registrar staff.
References
For more information on medical uses of marijuana, visit:
Canadian Medical Association
CMA Response: Health Canadas Medical Marihuana Regulatory Proposal Submitted to

the Office of Controlled Substances Health Canada (February 28, 2013)
https://www.cma.ca/Assets/assets-library/document/en/advocacy/Proposed-MedicalMarihuana-Regulations_en.pdf
Health Canada
Medical use of marihuana (Last updated December 2014)

http://www.hc-sc.gc.ca/dhp-mps/marihuana/index-eng.php
Information for health care professionals: cannabis (marihuana, marijuana) and the
cannabinoids (Last updated August 2014)
http://www.hc-sc.gc.ca/dhp-mps/alt_formats/pdf/marihuana/med/infoprof-eng.pdf
Marihuana for medical purposes regulations (December 2014)

http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/_2013/2013-79bk-eng.php
About the Marihuana Medical Access Program (June 20, 2013)

http://www.hc-sc.gc.ca/dhp-mps/marihuana/about-apropos/index-eng.php
Canada Department of Justice
Marijuana for Medical Purposes Regulations

http://www.laws-lois.justice.gc.ca/PDF/SOR-2013-119.pdf
College of Family Physicians of Canada
Authorizing Dried Cannabis for Chronic Pain or Anxiety (September 2014)

http://www.cfpc.ca/uploadedFiles/Resources/_PDFs/Authorizing%20Dried%20Cannabis
%20for%20Chronic%20Pain%20or%20Anxiety.pdf

May 5, 2015
College of Physicians and Surgeons of Ontario
Marijuana for Medical Purposes (March 2015)

http://www.cpso.on.ca/Policies-Publications/Policy/Marijuana-for-Medical-Purposes
Approved by Executive Committee May 1, 2015

Effective May 5, 2015

May 5, 2015
Questions and Answers

Marijuana for Medical Purposes
Who may complete a document for authorization of marijuana for medical purposes?
Only an authorized health-care practitioner as defined in the Marihuana for Medical Purposes
Regulations may complete a document for the authorization of marijuana for medical purposes.
In British Columbia, the only authorized health-care practitioners are physicians.
Are persons able to access marijuana for medical purposes by applying directly to Health
Canada?
Under the previous Marihuana Medical Access Regulations (MMAR) a person could access
marijuana for medical purposes by applying to Health Canada. Under the Marihuana for Medical
Purposes Regulations that replaced the MMAR, a person needs to obtain a document for the
authorization of marijuana for medical purposes from an authorized health-care practitioner.
Am I obliged to complete an authorization of marijuana for medical purposes document if my
patient requests an authorization?
Physicians are not obligated to complete an authorization of marijuana for medical purposes if
they feel it is medically inappropriate for a patient or if they are not familiar with its treatment
or use.
How much marijuana for medical purposes can be dispensed to a patient at a time?
The new Regulation limits the total amount of marijuana that can be administered (dispensed)
to a patient in a 30-day period to no more than 30 times the daily quantity specified in the
medical document or 150 grams, whichever is less. In published tracking data for over 5,000
patients in the Dutch cannabis program (2003-2010), the average dose of dried cannabis was
0.68 grams daily (range 0.65 grams to 0.82 grams). In Israels medical marijuana program
average daily use was 1.5 grams (2011-2012).) For more information see Health Canada
Marihuana for Medical Purposes Regulation Daily Amount Fact Sheet (dosage). Given the
tentative nature of the scientific evidence on indications, efficacy, and safety, physicians are
advised to utilize the lowest dose required to achieve realistic therapeutic goals.

May 5, 2015

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College of Physicians and Surgeons of British Columbia

are pregnant, planning to become pregnant or are breastfeeding

See Marihuana for Medical Purposes Regulations SOR/2013-119

Professional Standards and Guidelines Marijuana for Medical Purposes

CMA Response: Health Canadas Medical Marihuana Regulatory Proposal Submitted to

Medical use of marihuana (Last updated December 2014)

Marihuana for medical purposes regulations (December 2014)

About the Marihuana Medical Access Program (June 20, 2013)

Canada Department of Justice

Marijuana for Medical Purposes Regulations

College of Family Physicians of Canada

Authorizing Dried Cannabis for Chronic Pain or Anxiety (September 2014)

Professional Standards and Guidelines Marijuana for Medical Purposes

College of Physicians and Surgeons of Ontario

Marijuana for Medical Purposes (March 2015)

Approved by Executive Committee May 1, 2015

Professional Standards and Guidelines Marijuana for Medical Purposes

Questions and Answers

Professional Standards and Guidelines Marijuana for Medical Purposes

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