Photo: Flickr/Creative Commons, Manuel m. v.

With the legalization of recreational cannabis on Oct. 17, the Canadian Medical Association (CMA) has renewed its calls for the medical stream introduced in 2001 to be discontinued.

Speaking with CBC News Calgary in August, Dr. Jeff Blackmer, the CMA’s vice president of medical professionalism, said that the majority of its members have always had concerns about medical cannabis. He cited a lack of scientific evidence proving its efficacy, along with a lack of knowledge about dosing, when it should be taken and how it interacts with other medicines, as the primary reasons.

Some doctors say insufficient evidence about efficacy prevent them from prescribing medical cannabis. Photo: Flickr/Creative Commons, Cannabis Culture.

“With the legalization of [recreational] cannabis, a lot of physicians feel like if you’re a patient and you have certain symptoms or a certain condition that you think might benefit from the use of cannabis, this will allow you to access it on your own,” Dr. Blackmer told the CBC’s Rob Brown when outlining his reasons why the medical stream should be discontinued.

His remarks reflect the Canadian medical community’s generally lukewarm attitude towards medical cannabis. An estimated 270,000 Canadians are currently registered for a prescription for it under the Access to Cannabis for Medical Purposes Regulations (ACMPR), but just over 11,000 of the country’s more than 84,000 physicians – approximately 13 percent – have written a prescription for medical cannabis in the 17 years since it became legal.

Speaking at a medical conference earlier this year, Dr. Blackmer stated that eight of out nine Canadian physicians are uncomfortable discussing or prescribing medical cannabis to patients.

“There is definitely still some stigma around it,” says Sarah Dobbin, who works with Leamington, ON-based licensed producer Aphria as director of its medical division. “For a lot of physicians, the two main reasons we hear why they’re not comfortable prescribing are because a) they don’t feel sufficiently educated on it, and b) they feel there’s not enough research to prescribe.”

The lack of scientific evidence about cannabis’ efficacy is arguably the main stumbling block for physicians
when it comes to endorsing
cannabis for medical use.

The lack of scientific evidence about cannabis’ efficacy is arguably the main stumbling block for physicians when it comes to endorsing cannabis for medical use. Advocates, however, counter that they have amassed thousands of patient studies demonstrating its ability to mitigate the effects of everything from chronic pain to arthritis, anxiety and sleep disorders.

Aphria has registered more than 55,000 patients since it launched in 2014 – a “huge portion” of whom are still actively using medical cannabis, according to Dobbin. She says the company has amassed significant data on how patients are using cannabis, its effects, appropriate dosages, etc.

“Doctors are used to $10 million double-blind clinical trials and there simply isn’t that for cannabis,” says Dobbin. “We know that it’s working for [patients]. We just have to get the science behind it to support it.”

Questions remain about what impact the legalization of recreational cannabis will have. Photo: Flickr/Creative Commons, Beverly Yuen Thompson.

Aphria recently hired its first director of clinical research to analyze its patient data and develop and present research to the medical community.

“We’ve seen the evidence anecdotally,” she explains, “so we want to hire some talent from the research realm who can draw some concrete conclusions or uncover valuable research, so we can better understand why certain combinations work better for certain ailments and help us develop better products.”

At the same time, medical cannabis has evolved over the past two decades to include varied delivery mechanisms such as oils, sprays and soft gels. “It looks more like a pharmaceutical, which doctors are more comfortable with and used to prescribing,” Dobbin points out.

Medical cannabis advocates caution that eliminating the medical stream removes a crucial layer of clinical oversight which many patients, particularly those who might be new to cannabis, are seeking.

Aphria’s Dobbin says that requiring patients to purchase medical cannabis from the same store as recreational users does a huge disservice to patients who are regular users of medical cannabis.

“I think it would be a humongous waste of a lot of effort to do away with system,” she says. “These are valid patients and they shouldn’t feel like they could just order that medication from a recreational supplier. You would never make the insinuation that users of any other pharmaceutical drug should just go purchase it from a recreational stream. At the end of the day, they’re accessing a product that in most cases works extremely well for them.”