Introduction:
Physicians are aware that some patients may be prescribed medical marijuana for a number of conditions based on regulations provided by Health Canada.
Physicians should familiarize themselves with the medical and legal aspects of this process before considering offering this treatment.
Ideally, patients should be prescribed medical marijuana only by their primary physician. If the latter is unwilling to do so, a referral to another physician who prescribes marijuana could be made. Patients may also access physicians directly for this purpose.
In any case, any assessment of a patient for consideration of medical marijuana should only be done in person. A video or other electronic means are not considered appropriate.
Except under exceptional circumstances, only New Brunswick patients should be treated.
Physicians are reminded that an assessment leading to a prescription for medical marijuana is an insured service, just as any other prescription is an insured service. There should be no additional fee to the patient for the assessment, or any other aspect of the prescription or associated documentation.
Initiation of Treatment:
Any acceptance of medical marijuana by a patient should be based on fully informed consent. This should focus on the potential risks of dependence, as well as the risks of medical marijuana on activities such as driving.
Physicians should make decisions based on prevailing guidelines and experience. Treatment should only be initiated with the lowest dose possible and incremental increases managed cautiously.
If the patient is seen in consultation it is mandated that the consultant provide a report to the referring physician. In any case, the patient’s primary physician, and others as necessary, should be advised of the initiation of treatment. If the patient declines to authorize the passage of this information, the physician should consider the wisdom of initiating a prescription for medical marijuana in those circumstances. While the patient is entitled to restrict the exchange of their Personal Health Information, the risks of treatment by other physicians when they are unaware that the patient is taking medical marijuana are significant enough to warrant this information being passed on. It is noted that in the case of prescription drugs, such information would be shared in any case.
The initial prescription should be for no longer than three months duration.
Follow-up:
After initiation of treatment, it is expected that the physician will be available for regular follow-up for as long as the patient continues under this treatment.
Physicians who prescribe medical marijuana for a specific clinical condition are considered to have assumed responsibility for that condition.
Physicians must not only schedule routine follow-up, but be directly available to the patient for any issues that arise.
Physicians should also be willing to consider information provided by other parties, such as family members and friends, regarding the patient’s use of medical marijuana.
Conflict of Interest:
Because of the limited number of physicians who are prescribing medical marijuana, and the way such is delivered to the patient, outside of the usual pharmacy system, there appears to be a significant risk for potential conflicts of interest or the perception of such.
Such a conflict could occur when there is any influence on the physician’s prescribing choices based on factors other than the patient’s clinical state. Similarly, any financial arrangement which creates a benefit to the physician from prescribing decisions would also constitute a conflict. Finally, any direction or encouragement of a physician to a particular source of marijuana is ethically improper. To avoid any perception of such, physicians should avoid situations that create a suggestion of an improper relationship between the physician and the potential source of medical marijuana. This will include direct referrals from the physician to the supplier and vice versa. This could include geographic proximity between the supplying agency and the physician’s practice. This could also include any public statement or information which appears to connect the physician to the supplier in any kind of financial relationship.
The best general advice, then, is to avoid any circumstances which could raise questions regarding the integrity of the physician’s approach to prescribing medical marijuana.
4/14; amended 9/17
