Medical marijuana revisited
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* Michael A. Dworkind

Fletcher concludes in his *CMAJ* editorial that because cannabis has not been through the regulatory approval processes required of pharmaceutical medications, doctors should not “be lulled into prescribing” medical marijuana.1

Currently, cannabis is commonly used in the treatment of many medical conditions. Health Canada’s “Category 1” and “Category 2” conditions include multiple sclerosis, HIV/AIDS, epilepsy, cancer, severe arthritis, spinal cord disease/injury, Crohn colitis, fibromyalgia, migraines, posttraumatic stress disorder, and many others.2

With Health Canada predicting 400 000 Canadians will be using medical cannabis over the next decade,3 more Canadian physicians will need to respond to the growing therapeutic need.

As a palliative care physician, I have patients desperately asking me for legal access to medical marijuana to help control pain, improve appetite, reduce nausea, increase energy and reduce insomnia and anxiety. Patients deserve safe and legal access to this ancient herbal treatment without the fear of criminal sanctions.

Physicians do need to be better educated about the dose–response effects and risk–benefit profiles of various cannabis products over and above the currently available pharmaceutical THC (delta-9-tetrahydrocannabinol) options (i.e., Cesamet [nabilone]). However, I believe that physicians should not be dissuaded from authorizing their patients to obtain legal access to medical cannabis.

Across Canada, there are medical cannabis dispensaries known as compassion clubs that are already providing patients with access to high-quality cannabis products. Under the proposed new Marihuana for Medical Purposes Regulations,4 dispensaries will be required to further test their products for cannabinoid levels and contaminants, which will standardize and secure the process even more. This will undoubtedly improve the quality of life of many patients with chronic disease.5

## References

1.  Fletcher J. Marijuana is not a prescription medicine. CMAJ 2013;185:369.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxODUvNS8zNjkiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTg1LzEyLzEwNjcuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Health Canada MMAR Application Form B1. Ottawa (ON): Health Canada; 2007. Available: [http://medicalmarijuana.ca/for-patients/health-canada-forms](http://medicalmarijuana.ca/for-patients/health-canada-forms) (accessed 2013 Apr. 22)
    
    

3.  Marihuana for medical purposes regulations: regulatory impact analysis statement. Ottawa (ON): Health Canada; 2012. Available: [http://gazette.gc.ca/rp-pr/p1/2012/2012-12-15/html/reg4-eng.html](http://gazette.gc.ca/rp-pr/p1/2012/2012-12-15/html/reg4-eng.html) (accessed 2013 Apr. 22)
    
    

4.  Marihuana for Medical Purposes Regulations. Canada Gazette [Ottawa, ON]. 2012 Dec. 15. Available: [http://gazette.gc.ca/rp-pr/p1/2012/2012-12-15/html/reg4-eng.html](http://gazette.gc.ca/rp-pr/p1/2012/2012-12-15/html/reg4-eng.html) (accessed 2013 Apr. 22).
    
    

5.  Inclusion of medical cannabis dispensaries in the regulatory framework. Ottawa (ON): Canadian Association of Medical Cannabis Dispensaries; 2011. Available: [www.camcd-acdcm.ca/wp-content/uploads/CAMCDSubmissionJuly2011.pdf](http://www.camcd-acdcm.ca/wp-content/uploads/CAMCDSubmissionJuly2011.pdf)