As Canada prepares to legalize marijuana,
the country’s doctors have a lot of concerns about the nitty-gritty of
the law and how it will impact their practice, and patients.
Jeff
Blackmer, vice-president of medical professionalism for the Canadian
Medical Association, said it doesn’t matter whether physicians support
legalization because that horse has left the barn, but “we need to
figure out what we do when it is.”
To that end, the CMA surveyed physicians
on a broad range of practical issues, the results of which were
presented at a meeting of the group’s general council on Wednesday in
Vancouver.
Currently
in Canada, marijuana can be prescribed and used for medicinal purposes,
but possession for recreational use is still a criminal act (at least
in theory.)
Physicians are divided on
how pot should be regulated: 43 per cent believe there should be a
single regulatory regime (meaning no distinction between medicinal and
non-medicinal use), while 39 per cent back a dual regime.
“Will
the new law mean we won’t have to prescribe any more?” Dr. Blackmer
asked. “That depends.”
Physicians were also asked where marijuana should
be sold once it is legal: 56 per cent said in “existing non-health-care
structure,” meaning liquor stores; 47 per cent said in “legal
storefronts” like dispensaries; 29 per cent in pharmacies ; and 16 per
cent by mail. (The total exceeds 100 per cent because more than one
choice was allowed.) Physicians were almost evenly divided on whether
marijuana users should be able to grow their own.
Dr. Blackmer said the message in those choices is that “marijuana is recreational in nature.”
The
survey also asked at what age Canadians should be able to purchase
legal marijuana: 45 per cent of physicians said over the age of 21,
compared with 35 per cent who said age 18 or 19.
Dr.
Blackmer said there is a scientific basis for having a higher legal age
than cigarettes and alcohol because of marijuana’s effect on the
developing brain.
Where there was
little disagreement was whether government should regulate THC levels in
non-medicinal marijuana, with 72 per cent saying “yes.”
In
a brief discussion of what the CMA should do next, conference delegates
expressed a variety of concerns about legalization, ranging from the
impacts of marijuana smoking on pregnancy through the need for more
addiction treatment.
“Marijuana is here
to stay,” said Janice Wong, a Vancouver physician. “But we as the CMA
must ensure government is aware of the ramifications of use of this
psychoactive substance.”
Pam Mansfield,
a physician from Moncton, N.B., said one of the most concerning things
is the levels of psychoactive substances like THC and CBD in marijuana
are unregulated and unknown, so people don’t know what’s in their weed. Chris Milburn, a physician from Sydney, N.S., said doctors are too complacent about marijuana use by their patients.
“The more I learned about marijuana, the less I liked it,” he said. “This is not a legitimate medical treatment.”
But
Ashley Miller of St. John’s said she is not convinced that marijuana is
as harmful as other recreational drugs, such as alcohol.
She
said the role of physicians is to give patients the best information
possible to reduce harm, and pleaded with the CMA to provide practical
evidence that will aid in daily practice.
Dr.
Miller said a lot of her patients use marijuana and they have practical
questions like: “What’s safer: Vaporization vs. smoking vs. edibles.”
Atul
Kapur of Physicians for a Smoke-Free Canada said the reality is that
“more high-school students toke than smoke” so, despite the fact that
marijuana is being legalized, the CMA should advocate for strong public
health campaigns, as they have done with tobacco.
“The goal of legislation is not to increase prevalence and use, it’s to decrease harm,” Dr. Kapur said.
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