Who should prescribe medicinal cannabis?

Who can prescribe medical cannabis varies substantially according to what country – or even what province or state – in which you live.

Let’s take the U.S., for example. In Pennsylvania, physicians must complete four hours of continuing education before they can register as a prescriber.¹ New York State also has a requirement for four hours of continuing education but a broader range of health professionals are eligible to register as prescribers: physicians, nurse practitioners and physician assistants under the supervision of a registered physician.² In other states, such as Maryland, there are no educational requirements and any licensed physician with a valid Controlled Dangerous Substances Registration Number is eligible to register with the state medical cannabis commission.³

A more controlled approach to medical cannabis prescribing is taken in Australia. Physicians can apply to allow their patients to access medical cannabis through a Special Access Scheme or register to become an authorized prescriber. In Tasmania, only specialists can be prescribers, as “to ensure patient safety, it is essential that these products are only prescribed by medical specialists who are experts in their field and have the appropriate level of training.”⁴ In New South Wales, there’s a little more lee-way, in that the prescriber can be a specialist or a general practitioner supported by a specialist.⁵

In Canada, the Access to Cannabis for Medical Purposes Regulations applies nation-wide and enables physicians and nurse practitioners to recommend cannabis for individual patients. With the exception of Alberta⁶, there is no registration process or requirement to consult with a specialist in the disease of diagnosis. In theory, the documentation of diagnosis justifying treatment with cannabis should be produced by a family doctor or specialist who has followed the patient for at least a year. However, given the gaps in peer-reviewed research on its efficacy, adverse effects and dosage⁷, the shortage of medical education opportunities and the lack of specialist support, many clinicians are not comfortable recommending cannabis.

A Canadian Medical Association spokesperson has been quoted as saying cannabis “was imposed on us by the government” and is something “the majority of physicians do not want to have anything to do with it.”⁸ As a result, clinics have sprung up that specialize in connecting patients with doctors favourable to cannabis.

Medical cannabis has captured the attention of the public and many practitioners and it’s unlikely demand for it will diminish. Developing and disseminating research evidence on medical cannabis can generate much-needed clinical guidelines and a variety of continuing education opportunities and approaches. In turn, these should ensure primary care providers have the training and skills they need so they can confidently and safely recommend cannabis to patients, with or without specialist support. With its strong foundation in evidence-based medicine and leading-edge research, the Michael G. DeGroote Centre for Medicinal Cannabis Research is positioned to play a critical role in this important work. In doing so, it will make an important contribution to health care in Canada.