Medical marijuana prescribing by doctors felt to be unclear

Some Canadian doctors continue to have concerns about prescribing medical marijuana after new guidelines were released for family physicians.

Earlier this week, the College of Family Physicians of Canada released preliminary guidance to its 30,000 members on prescribing dried cannabis.

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The college said there’s no research evidence supporting use of medical marijuana for low-back pain or fibromyalgia. Its use can be considered for neuropathic pain, such as nerve-damage pain resulting from multiple sclerosis, from metastatic cancer or from diabetic neuropathy, when those conditions don't respond to standard treatments, the guidelines state.

In April, Health Canada changed its regulations and put the power to authorize medical marijuana use solely in the hands of doctors. Previously, both doctors and Health Canada were involved. Supplies of the herb are now provided by licensed growers.

"We have little scientific data to guide us," the college's Dr. Sharon Circone said. "We have extremely little guidance from Health Canada. This was sprung on us."

The Arthritis Society is also calling for more research on medical cannabis so people living with arthritis can make informed choices about their treatment and doctors have evidence-based information before authorizing use.

Physician Danial Schecter opened a referral-only medical clinic in July for patients who need cannabinoid medicines, including herbal cannabis and prescribed pills and sprays. About 80 per cent of his patients are under treatment for chronic pain.

Schecter said the college’s document includes good recommendations on carefully screening patients and monitoring them to make sure they don't have problematic drug use. He also has concerns.

"They are being quite restrictive in who can access medical cannabis," Schecter said. "In our practice, we see patients on referral who have a number of medical conditions including pain not related to neuropathy, several types of anxiety such as PTSD, gastrointestinal disorders, treatment-resistant insomnia and epilepsy."

Tracy Curley has had Type 1 diabetes since childhood. She’s legally allowed to use marijuana to treat diabetic neuropathy. The Toronto resident is now a patient advocate for medical marijuana and worries doctors are reluctant to authorize its use.

"It starts with appetite stimulant, right on to pain control, and I’m finding that it’s helping me to regulate my blood sugars as well," Curley said. "My quality of life in my 40s, being a medical marijuana user, is better than in my 20s."

The Arthritis Society plans to fund research into medical cannabis to try to understand its impact on arthritis pain and disease management.