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.


Author Details

The latest scientific evidence on this topic was reviewed by the Centre's leadership team. This evidence brief is written by Corinne Hodgson, DHealth, assessed for accuracy by Medical Advisor Dr. Ramesh Zacharias, MD, a clinician with expertise in chronic pain. There are no conflicts of interest. Questions regarding this piece should be directed to Dr. Ramesh Zacharias (zacharias@hhsc.ca).


References
  1. Pennsylvania Medical Marijuana Program. http://www.health.pa.gov/My%20Health/Diseases%20and%20Conditions/M-P/MedicalMarijuana/Pages/FAQ.aspx#physicians
  2. New York State Medical Marijuana Program. Practitioner Information. https://www.health.ny.gov/regulations/medical_marijuana/practitioner/
  3. Natalie M. LaPrade Maryland Medical Cannabis Commission, Government of Maryland. Provider Registration. http://mmcc.maryland.gov/Pages/physicians_regis.aspx
  4. Medical Cannabis Controlled Access Scheme Fact sheet. Department of Health and Human Services, Tasmanian Government. http://www.cpsa.ca/standardspractice/cannabis-for-medical-purposes/
  5. New South Wales Government, Department of Health. Application for Authority to Prescribe and Supply a Cannabis Product for Human Therapeutic Use. http://www.health.nsw.gov.au/pharmaceutical/Documents/cannabis-appln.pdf
  6. College of Physicians & Surgeons of Alberta. Cannabis for Medical Purposes. Issued April 3, 2014. 
  7. Improving Medical Marijuana Management in Canada. March 2016. Prepared for Canadian Pharmacists Association by KPMG. https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/March2016_Improving_Medical_Marijuana_Management_in_Canada_vf.pdf
  8. Omand G. Why doctors don’t want to be the gatekeepers of medical marijuana. MacLeans. March 5, 2017. http://www.macleans.ca/society/health/why-doctors-dont-want-to-be-the-gatekeepers-of-medical-marijuana/