BIG PHARMA MARIJUANA PART 2 - Prescription procedure
MED-MAR: THE ART OF LEGALLY PRESCRIBING AN ILLEGAL DRUG
The use of marijuana goes back thousands of years, with its earliest use as a medical substance being traced as early as 28 BC in Taiwan. Today, while it remains an illegal narcotic, governments around the world are setting up the regulations allowing for its legal use as a medicinal substance for patients who qualify. Canada has followed suit, first with the MMAR, now with the new MMPR regulations.
On April 1, 2014 , the legislative framework established by the MMPR significantly changed Canada's approach to medical marijuana. It is now up to licensed private corporations to assume the responsibility of growing and distributing prescribed medical marijuana, while licensed patients are no longer allowed to grow their own or purchase it from small-scale producers; a reversal that is being challenged as unconstitutional before the courts.
The MMPR also shifts the burden of granting patients a prescription for medical marijuana from Health Canada to Canadian physicians. Not only are physicians now tasked with the ethical concerns of prescribing an illegal substance, but they are also expected to do so at no cost; the argument being that writing a prescription - or a 'medical document' as it is called under the MMPR - is an insured service in Canada. So many physicians just throw their hands up and simply refuse to write medical marijuana prescriptions altogether.
Dr. Peter Gooch, a physician in Cowichan Valley, BC is among the handful of doctors across Canada who is willing to prescribe medical marijuana. He has been doing so since the early days of the MMAR. Gooch spends on average 30 minutes with his marijuana-seeking patients and charges $150 for his services. He agreed to go on the record with his experience.
"The biggest problem is that most physician are reluctant to deal with this at all, he says. "Mostly because they don't understand. For those who are willing to do the work, I don't think it's a big problem. But now that the Ontario College of Physicians has published its position that you are not allowed to charge for this service, I don't think many physicians will be particularly interested. That's my worry".
According to Gooch, many physicians argue that a medical marijuana patient license or medical document is not really a prescription at all since medical marijuana is an illegal drug and as such it is not listed in the pharmaceutical database. They therefore see it more as an opportunity to charge a fee for the ‘medical document' and spend the necessary time educating their patients on the use of medical cannabis.
"When I started this 3 years ago it was under the previous MMAR program," he says. "At the time, there was a great deal of paperwork required. Patients had to have their picture taken and sent to Health Canada and so on and so forth. The process took a whole bunch of time and it was complicated. Also, there was and still is a significant number of elderly people who come in to get their license to use cannabis before they've ever tried it or even seen the substance. So a great deal of work is required to get them up to speed so they can go home, order medical marijuana from a licensed producer and use it."
As the anointed gatekeepers of medical marijuana, physicians are also challenged by the dearth of scientific information available to guide them as to which strain or dosage to prescribe individual patients.
"It's a hard decision because there is no standardized form of cannabis available to the public, "says Gooch, "except for the pill that big pharma makes that in my opinion doesn't work particularly well, and the Sativex spray which is enormously expensive and no one can afford. It's hard even to know what strain to suggest because at the moment our knowledge base is pretty small mostly because we haven't been able to do the science as we haven't been able to access the material, because it's always been illegal. Now, there's tons of science going on and within a very short time I'm sure well see the double blind trials that show conclusively that the substance has enormous medical advantages for a lot people."
This assertion is backed by the findings of a marijuana research project recently conducted in California under the auspices of UC San Diego psychiatrist Igor Grant.
"The results were surprising,' he said in an interview with PBS. "I kind of expected, well, we're going to have a few studies that say yes and a few that will say no, and then at the end of the day we'll still be arguing," Grant said. "But in fact every single study showed benefit."
Medical marijuana is not for everyone however, in fact, according to Gooch, issues such as anxiety are exacerbated in certain people by the use of marijuana while in other people it's relieved.
"Bottom line though and I keep reminding patients about it, is that cannabis is safer than aspirin. It cannot kill you, there is no lethal dose. And side effects are time-limited. Nothing is going to cause any serious issue if you just wait when you’ve taken too much. Which happens mostly with edibles, because when you're inhaling something whether by vapourizing or by smoking you know when to stop as because you feel the effects, whereas once you’ve eaten something it's too late by the time it starts to work you can’t change how much you’ve taken.
What eventually led to the MMAR's demise, was the fact that it allowed licensed patients to grow their own medical marijuana or purchase it from small-scale producers or 'designated growers'. This created a huge opportunity to game the system, which many took advantage of.
"There was a huge flood at that time, I was booked 2 months in advance. People were coming in and fabricating stuff ...in fact I am pretty sure they were sending in their uncles and aunts and cousins and what nots with some illness backed by paperwork to get a license to grow. Since the price of illegal marijuana was $200 an ounce at the time, it was economically viable to have a legal grow operation and the more plants you could get the more you could sell to the black market."
While Gooch says he drew a line in the sand and refused to prescribe more than 10 grams of medical marijuana a day, many physicians did not. A fee of $100 per gram was often charged with many patients ending up paying $2,000 for a 20-gram a day prescription which allowed them to grow 100 plants. It was a free-for-all, there was no physician control at all.
"99% of the cases in that category were fake. I know for a fact that in Vancouver, some HIV patients and prostitutes would be paid $2,000 a month to have someone else grow for them, they never saw any marijuana, they just saw money. The grower though was making huge sums of money, $300,000 to $400,00 a year. So when the government stepped in, it was the designated growers, they were trying to eliminate."
One of the positive results of this medical marijuana free-for-all, according to Gooch was that the price of illegal marijuana fell from $2,300 a pound to less than $1,000 a pound because it was not needed anymore.
"As far as i was concerned this was a good thing; it was wonderful. If people were growing their own this would remove the illegal market because there was no need for it. Personally, I think people should be allowed to grow but there should be a clear limit on the number of plants that they are allowed to grow. There is no justification for 50 to 100 plants."
One of the hoops a patient has to jump through to be granted a license for medical marijuana is proving that all other medicinal options have been exhausted. Considering that there were over 362 pharma recalls between 2004 and 214, this prerequisite is hardly standard when it comes to pharma drugs.
According to Gooch , this is because the ‘Ivory Tower' medicine men, for want of a better word, don't see medical marijuana as a first line approach to anything.
"In their mind, the only reason you would prescribe medical marijuana is when all else in normal medical practice has failed, or medication is intolerable to the patient. I think within 5 to 10 years we are probably going to find medical marijuana part and parcel of the treatment of certain kinds of cancer, certainly with chemotherapy. We are in the early stages of a huge change, the political will is moving toward lightening up on this hysteria that we have been bombarded with for the last 50 years. That this drug is dangerous, that it's going to lead your children into cocaine and heroin use, which is absolute nonsense. The gateway theory has been shot down so many times it's absurd. As far as I am concerned, alcohol is the gateway to all bad behaviour.
As for the medical marijuana clinics that are popping up like mushroom across the country, offering a slew of related services to justify their bloated fees.
"I've been approached by groups just like that who want to advertise, attract patients, do all the paperwork and send me patients by Skype for a $350 fee. I am not interested. I dont need it, and I don't want it. The $150 I am charging is plenty enough and I am the cheapest guy anywhere, it's just not free. I work hard at doing this appropriately and ethically. There are some physicians who have not been ethical and have prostituted themselves for the money. I am not of those I want to do this ethically and I want to be fair to the patients."
Related Medical Marijuana Articles
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MED-MAR OP/Ed: a looking glass into the future
MED-MAR - Part 2: The art of legally prescribing an illegal drug
MED-MAR - Op/Ed: Isn't it ironic?
MED-MAR - Part 3: Medical marijuana, food, and the final frontier
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