Doctors divided over cannabis legalization as deadline nears

Canadian doctors remain divided about whether recreational cannabis should be legalized, with those opposed holding deep reservations over addiction and mental health, according to a survey of family physicians.

At the cusp of the Oct. 17 deadline for legalization, 47 per cent of general practitioners oppose legalization, 32 per cent support it and 21 per cent remain neutral, according to the survey of 235 family doctors conducted by MD Analytics.

“It’s interesting that (the results were) so polarized,” said Rahim Shah, vice-president of client services at MD Analytics, a medical and pharmaceutical marketing-research firm. “The other interesting thing is that regionally, we didn’t notice any significant differences. That level of support, that level of opposition was relatively consistent across the country.”

And the results appear to mirror the concerns raised by the Canadian Medical Association in recommendations to government related to the legalization of recreational cannabis.

The CMA, in its 2016 submission to the federal task force on legalization, didn’t stake a position on whether or not cannabis should be legalized, but urged that government adopt a “broad, public-health policy” approach, which it has maintained through its January recommendations to Health Canada on implementing Bill C-45.

Concerns that the CMA spelled out relate to health effects linked to marijuana, especially in smoked form, such as addiction, cardiovascular and pulmonary illness, and mental illness, particularly psychosis.

However, while doctors might be divided on the appropriateness of legalization, they do understand a lot of people are already using cannabis, so their “top priority” should be patient safety, said Dr. Eric Cadesky, president of Doctors of B.C.

Cadesky, a family physician, said a lot of doctors’ concerns come from unknowns. Physicians know a lot about the damage cannabis can do to developing brains, for instance, but don’t know much about prescribing it.

“There are other treatments we know well, are well-studied and we know how to give them,” said Cadesky, who didn’t take part in the survey. “We don’t know that about cannabis.”

And as cannabis becomes more available, Cadesky said doctors need to learn more about the therapeutic benefits of cannabis, as well as its potential harms, including the risks involved with smoking it.

Shah said the results of his firm’s survey do seem to align with the fears raised by the CMA related to abuse of the drug and the expectation that they’ll see more patients with mental-health concerns.

In the survey, some 88 per cent of the family doctors opposed to legalization anticipated an increase in patient visits related to dependence, compared with 58 per cent among doctors who support it.

On the question of whether doctors can expect more patient visits related to psychotic symptoms, 87 per cent of doctors opposed to legalization said yes compared with the 61 per cent of supporting doctors who said no.

Doctors who support cannabis legalization also expect fewer patients will come to them for prescriptions as patients experiment with substituting prescription drugs with cannabis.

Some 60 per cent of doctors who support legalization expect fewer visits from patients seeking prescription medication for anxiety or stress, 54 per cent expect fewer visits related to obtaining drugs for chronic pain and 41 per cent expect to see fewer patients looking for medications related to panic attacks.

“Those that supported legalization tend to view recreational cannabis as a viable treatment option,” Shah said.

However, pro-legalization physician Dr. Lydia Hatcher of Hamilton, Ont., said fears will dissipate once doctors learn more about cannabis.

“I’m absolutely pro, with caution, from a recreational perspective,” said Hatcher, who is trained as a family doctor, but runs a medical practice focused on chronic pain and psychotherapy.

Hatcher acknowledged that there are risks involved with recreational cannabis, they’re not as great as people think they are and Canada is still better off allowing legal, safe sources of cannabis for the large number of people already using it recreationally.

“We’ve got to educate physicians, and I think as we educate physicians they will get much more comfortable (and) will understand the medical uses better,” said Hatcher, who is also an associate professor in clinical practice of family medicine at McMaster University in Hamilton.

Shah said MD Analytics conducted the survey for its own purposes, tapping an online panel of medical experts it has established for research purposes and will likely use it as a baseline study to measure the attitudes of doctors over time.

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