I Get High With a Little Help From My…Prime Minister?

In the fall of 2014, Alberta Doctors’ Digest published a Health Law Update story entitled “I Get High With a Little Help From My … Doctor?” It focused on one of the hot topics for discussion at the Canadian Medical Association (CMA) Annual General Meeting in Ottawa that year: the prescription of medical marijuana by Canadian doctors.

The discussion was a response to the federal government’s restructuring of Canada’s medical marijuana system in the early part of 2014, which essentially made the physician the gatekeeper for accessing medical marijuana. Patients needed to obtain a prescription from their physician which, in turn, would be submitted to one of an increasing number of federally licensed growers. This caused significant discomfort for many physicians who simply were not satisfied that the science supported the use of this drug. Fast forward to December 2016. Now the medical profession is taking shots at the federal government’s expressed intention to legalize the possession and use of marijuana by 2019.

Canadian Medical Association Marijuana Survey Results
The new controversy stems from the release of a federal task force’s recommendations regarding legalization. Prior to the release of the recommendations, the CMA had conducted an electronic poll of physicians regarding non-medical use of marijuana. The results were diverse, and they conflicted in part with the ultimate determinations of the task force, as in the following examples.

  • Doctors thought it was a bad idea to have marijuana sold in pharmacies and they wanted the federal government to ensure the quantity of THC was labelled and even regulated.
  • 65% of doctors disagreed with using mail service to distribute non-medical marijuana and 57% disagreed with using pharmacies for distribution. 56% thought existing non-health care structures like liquor stores should sell it and 47% thought legal storefronts (dispensaries) were suitable for the purpose.
  • Doctors were equally split on whether people should be allowed to grow their own non-medical marijuana.
  • 80% said people should only consume non-medical marijuana in their homes, 36% said it was ok in designated public places and 43% said people should be able to smoke it wherever tobacco is permitted.
  • 45% of doctors said Canadians over the age of 21 should be able to buy legal marijuana and 35% said the age should be 18 or 19.
  • 72% said government should regulate THC levels in non-medical marijuana.

Federal Task Force Recommendations
The recent federal task force recommendations include a proposal to allow those 18 years and over to access marijuana for non-medical reasons. Doctors are still split on the adequacy of this age threshold. Many argue against it because of evidence that cannabis use can cause changes to the brain which, according to researchers, continues to develop until roughly age 25. The CMA (perhaps relying in part on the survey results) has in turn recommended a compromise limiting legal purchase to those 21 and older. Of course, the difficulty with setting the age limit higher is the risk that this will continue the existence of the illicit market, with no regulation on the sale of a poorly controlled product.

A related issue of concern to physicians (and others) is potential impact of legalized use of marijuana on driving patterns and, particularly, the current inability of police forces across the country to adequately detect the presence of excessive levels of THC in a driver’s blood. Physicians seem united in backing the science that demonstrates the impact even small amounts of THC can have on reaction times and general driving ability.

Here’s one interesting side note in the discussion. The current thinking of the Liberal government in terms of taxation is to pro-rate the amount of tax payable on purchased marijuana based on the potency of the drug – the more THC present in the product, the higher the tax payable.

There are potential health dangers to marijuana use, so there does seem to be a consensus in the medical community on one thing: the need for a comprehensive and well thought-out public education program aimed at new and existing users. Dr. Jeff Blackmer, CMA vice-president of medical professionalism, recently underlined this need:

“I don’t think there’s any Canadian … who smokes cigarettes who thinks it’s good for them … We’ve not done nearly as good a job educating people, particularly young people, about some of the potential dangers of marijuana use.”

It will be interesting to watch how this all unfolds in 2017.

This article was originially published in the Alberta Doctor's Digest.