High times ahead: How will cannabis legalization affect physicians?

Health Law Update

November 28, 2017

Jonathan P. Rossall, QC, LLM, Partner, McLennan Ross LLP (L) and Nathaniel Brenneis, Associate, McLennan Ross LLP (R)

This past April 13, the federal government finally released Bill C-45, the “Cannabis Act,” to considerable fanfare and buzz. Bill C-45 proposes a regulatory framework for legalizing cannabis for recreational purposes in Canada. The federal government has indicated that it expects Bill C-45 to receive Royal Assent no later than July 2018. In the meantime, researchers, entrepreneurs and policy-makers across Canada are scrambling to prepare for the effects of this new law.

What’s in the Bill?

Bill C-45 generally adheres to the recommendations that the Task Force on Cannabis Legalization and Regulation published in its final report in December 2016. We have previously written on the Task Force’s recommendation in the January-February 2017 issue of Alberta Doctors’ Digest in our story: I get high with a little help from my … prime minister.

The predominant themes of Bill C-45 are to promote and protect public health and safety, to prevent youth from accessing cannabis and to deter cannabis-related criminal activity.

Some highlights of the legislation include the following:

  • Bill C-45 will prohibit anyone from selling cannabis to any person under the age of 18.
  • Adults will be permitted to possess up to 30 grams of dried cannabis in a public place.
  • Adults will also be permitted to cultivate up to four cannabis plants per residence.
  • Bill C-45 contemplates the sale of cannabis in a variety of different forms including dried cannabis, cannabis oils, fresh cannabis, cannabis plants and cannabis plant seeds. Cannabis edibles are currently prohibited, but these have been flagged for regulation.
  • Licensed cannabis producers under the current medical regime will be automatically grandfathered in as licensees under Bill C-45.

Bill C-45 will not be the conclusive word on cannabis regulation, however. The statute is designed so that it requires individual provinces and territories to enact legislation to fill in the gaps and address the public health and safety objectives across the country. Provincial and territorial governments will also be responsible for licensing and overseeing the distribution and sale processes. This includes the abilities to increase the minimum age requirement, lower the amount of cannabis permitted for personal possession within their jurisdiction, create additional rules and requirements for the growth of cannabis plants at home and restrict locations where cannabis may be consumed.

How will the bill affect doctors?

What does Bill C-45 mean for physicians? At first glance, not a whole lot. As recommended by the Task Force, the current regulatory regime will remain in place. This means that the Access to Cannabis for Medical Purposes Regulations (ACMPR) will continue to govern the production, distribution and sale of cannabis for medical purposes. The role of health care practitioners is unchanged by the introduction of Bill C-45 and physicians will essentially continue to serve as the sole gatekeepers for patients who want to use cannabis to treat their ailments.

As with the previous regulations, an individual who requires cannabis for medical purposes must first get a medical document from an authorized health care practitioner. Specifically, under the ACMPR, the medical document must contain similar information to a prescription, including:

  • the patient's name and date of birth
  • a period of use of up to one year
  • a daily quantity of dried marijuana expressed in grams
  • the authorized health care practitioner's license information

While the pending legalization has not brought any new policy developments, it may be signaling a cultural shift amongst physicians.

Many uncertainties and potential dangers still surround the use of cannabis. As a whole, the medical community remains divided and non-committal to using cannabis as a form of treatment. Recent reports suggest, however, that Alberta doctors are becoming increasingly open to the idea of prescribing cannabis to their patients.

According to the latest stats published by the College of Physicians & Surgeons of Alberta (CPSA), the number of doctors prescribing cannabis in the first four months of 2017 increased 50%. At the end of 2016, 329 doctors in Alberta were registered to authorize cannabis use as a treatment for 5,254 patients. By April of this year, 495 doctors were filling prescriptions for close to 10,000 Albertans.

Regardless of what motivated these newly registered physicians to start prescribing, this trend is likely to continue as legalization nears and cannabis becomes a larger part of everyday Canadian life. The Canadian Medical Association, Alberta Medical Association and CPSA encourage physicians to maintain a cautious approach while policymakers come to grips with how the new regime will affect the old regime.

After all, many unanswered questions remain. For example, how will the relative percentages of CBD and THC be regulated? Will cannabis be covered under patients’ health insurance? Will it be included on Alberta’s hospital formulary systems? Will it be monitored by the CPSA Triplicate Prescription Program?

We will be closely tracking these issues as the July 2018 deadline approaches.

The Alberta Medical Association stands as an advocate for its physician members, providing leadership & support for their role in the provision of quality health care.