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Marihuana Medical Access Regulations - K. Shaw, MD, Deputy Registrar

Physicians should be aware that Health Canada has recently published the Regulations Amending the Marihuana Medical Access Regulations (MMAR). These were published in the Canada Gazette, Part II on June 29, 2005.

There are a number of regulatory amendments based on input received from stakeholders since the MMAR came into force in July 2001, as well as due to comprehensive review and consultative process that occurred in 2003 and 2004. The amendments were pre-published in the Canada Gazette, Part I on October 23, 2004 for a 30-day comment period. None of the comments submitted led to changes to the regulatory proposal. These amendments include provisions for the following key changes:

  1. Streamlining the process for obtaining an authorization to possess marihuana for medical purposes by:

    1. reducing the number of categories of symptoms under which a person may apply for authorization to possess from 3 to 2, by merging existing categories 1 & 2;

    2. eliminating the need for an applicant to see a specialist for the sole purpose of having the Medical Declaration signed;

    3. revising the Applicant's Declaration to acknowledge acceptance of risks associated with the use of marihuana for medical purposes;

    4. revising the physician's Medical Declaration to include only those elements essential to confirm that the applicant suffers from a serious medical condition and that conventional treatments are inappropriate or ineffective;

    5. requiring authorized persons to submit a new photograph for identification purposes with every fifth renewal, rather than every second;

  2. Streamlining application processes for amending and renewing an authorization to possess;

  3. Providing explicit authority for the Minister of Health to communicate limited authorization and licence information to Canadian police in response to a specific request received from Canadian police in the context of an investigation under the Controlled Drugs and Substances Act or the MMAR;

  4. Providing limited authority for a pharmacy-based distribution system of dried marihuana that is produced by a licensed dealer on contract with Her Majesty in right of Canada, to authorized persons without a prescription from a physician. This will allow the conduct of a pilot project to assess the feasibility of distributing marihuana for medical purposes through the conventional pharmacy-based drug distribution system.

Saskatchewan physicians should note that these changes affect their ability to support an application for authorization for the use of medical marihuana in the following ways:

  1. The previous categories 1, 2 and 3 have been changed to categories 1 and 2.

Category 1 is now the following:

Medical Condition Symptoms
Multiple sclerosis; spinal cord injuries; or spinal cord disease Severe pain, persistent muscle spasms
Cancer, AIDS, HIV infection Severe pain, cachexia, anorexia, weight loss, and severe nausea
Severe arthritis Severe pain
Epilepsy Seizures

OR Applicants who suffer from a symptom treated within the context of providing compassionate end of life care.

Category 2 is for applicants who suffer from symptoms of a medical condition other than those described in Category 1.

It is noted that those applicants who wish to apply for medical marihuana in Category 1 would use Form B1, and a medical practitioner needs to support the application. (Definition of medical practitioner: a person who is authorized under the laws of the province to practice medicine in that province. The medical practitioner for the purposes of completing this application is either a general practitioner or a specialist who specializes in the area of the medical condition, e.g. an oncologist in the area of cancer treatment.)

Category 2 applicants must apply using Form B2, and a medical practitioner may make application. (The definition of medical practitioner is as above.) An assessment of the case by a specialist is required if the medical practitioner is not already a specialist.

The second major change that affects physicians is the fact that they are no longer required to provide a specific dosage of marihuana, but rather provide a proposed daily amount that is less than or equal to so many grams. Health Canada has a fact sheet, called The Daily Amount Fact Sheet (Dosage) that will assist physicians and patients regarding the daily amounts of marihuana for their condition. Further information for healthcare professionals and The Daily Amount Fact Sheet can be accessed at:
www.hc-sc.gc.ca/dhp-mps/marihuana/how-comment/medpract/help-aide/daily-quotidienne_e.html or by calling toll free: 1-866-337-7705.

The College would encourage physicians to access the Medical Use of Marihuana site at Health Canada to obtain copies of the application forms and further information as necessary.

The College of Physicians and Surgeons Policy on Medical Marihuana dated February/02 will be amended at an upcoming Council meeting. The main body of information in the policy is correct with the exception of the last paragraph which refers to Category 1, 2 or 3. That will be amended to indicate the definition of a medical practitioner with respect to supporting the application for the newly revised Categories 1 and 2, and an amendment to indicate that an assessment by a specialist is necessary for assisting applicants with Category 2 requests if the medical practitioner is not a specialist.

Additional information is available on Health Canada's web site at:
www.hc-sc.gc.ca/dhp-mps/marihuana/index_e.html.

The other amendments to the MMAR are set out in the Regulations, which are available on the Canada Gazette web site at:
http://canadagazette.gc.ca/partII/2005/20050629/pdf/g2-13913.pdf or
http://canadagazette.gc.ca/partII/2005/20050629/html/index-e.html.