CANADA
THE CLINICAL PRACTICE GUIDELINE PROGRAM
From From The College, a publication of the College of Physicians and Surgeons of Manitoba
The CPG Program is now fully operational with individual physicians and physician committees currently reviewing 60 existing guidelines in need of revision and preparing a first draft of 2 new guidelines. Some of the existing guidelines may be left unchanged while others may be edited to improve clarity or may be altered extensively to include new knowledge.
New guidelines in the future will be published in a new format approved by the committee to ensure that information required in a good guideline is included in the abstract and that guidelines are user-friendly. The criteria that the committee will generally apply in considering topics for new guideline development are:
prevalence of the clinical problem
burden of illness imposed by the problem
cost
variability in practice
potential for a guideline to improve efficiency
level of evidence available in the literature
As data used to score particular topics on these criteria may be incomplete, the process for setting priorities should provide an excellent opportunity for important unmeasured factors to be considered, perhaps by using expert estimates in lieu of data. The committee also may proceed with guidelines when the scientific evidence is clear that an alternative to current practice is preferable, even if it appears that clinicians or patients may initially resist.
The College’s current policy with respect to the frequency of updating the guidelines every 5 years will continue. However, should the committee become aware of new evidence, which indicates that a guideline should be updated sooner, an earlier review will be carried out. The college Web sites will be updated as the committee approves new guidelines.
MEDICAL MARIJUANA
From College Newsletter, a publication of the College of Physicians and Surgeons of Saskatchewan
A regulatory scheme for medical use of marijuana exists because of the recent Ontario Court of Appeal decision, Regina v. Parker, [2000] O.J. No. 2787.
Federal Health Minister Allan Rock announced new regulations governing possession and production of marijuana for medical purposes. The regulations contain 2 major components: authorization to possess marijuana and licenses to produce marijuana. The regulations establish a framework to allow the use of marijuana by people who are suffering from serious illnesses; where conventional treatments are inappropriate or not providing adequate relief of the symptoms related to the medical condition or its treatments, and where the use of marijuana is expected to have some medical benefit that outweighs the risk of its use. The regulations were published in the Canada Gazette, Part 11, July 4, 2001.
The College of Physicians and Surgeons has not yet issued any guidelines regarding this issue. Members should be aware that although the regulations are now in effect, there is much controversy regarding them. The College of Physicians and Surgeons recommends that physicians review the literature regarding marijuana for medicinal purposes, and the concerns raised by the CMA in an open letter to members from Dr. Peter Barrett, dated August 3, 2001.
CMPA has outlined their advice to physicians on what to do when your patients apply for a license to possess marijuana for medical purposes in “An Information Sheet for You To Keep.”
The College suggests that the prescribing of medical marijuana for medicinal purposes should occur in a manner similar to the prescribing of any other drug. A physician should only support a request for medical use of marijuana if the physician is familiar with the drug, its risk and benefits.
The regulations define the circumstances and manner in which access to marijuana for medical purposes will be permitted.
If a patient is authorized to use marijuana, that patient is not subject to the laws that make possession of marijuana a criminal offence. If a patient is authorized to cultivate marijuana, the patient is not subject to the laws that make cultivation of marijuana for one’s own use a criminal offense.
