The Marijuana Medical Access Regulations (Regulations) came into effect on July 30, 2001 as an amendment to the Narcotic Control Regulations. The Regulations provide seriously ill Canadian patients access to marijuana (at the same time that it is being researched as a possible medicine) by defining the circumstances and the manner in which access for medical purposes will be permitted.

The Regulations contain two main components: “authorization to possess” and “licences to produce”. The authorization to possess, and licence to produce marijuana for medical purposes will be granted under the following three categories:

Category 1:
Patients who have terminal illnesses with a prognosis of death in 12 months or less.

Category 2:
Patients who suffer from specific symptoms associated with some serious medical conditions. Symptoms are part of a schedule to the Regulations. See table:

Medical Condition	Symptom(s)
Cancer, AIDS, HIV infection	Severe nausea
Cancer, AIDS, HIV infection	Cachexia, anorexia, weight loss
Multiple Sclerosis, spinal cord injury or disease	Persistent muscle spasms
Epilepsy	Seizures
Cancer, AIDS, HIV infection, Multiple Sclerosis, spinal cord injury or disease, severe forms of arthritis	Severe pain

Category 3:
Symptoms associated with medical conditions other than those in categories 1 and 2. Specific statements from two medical specialists are required to support an application in this category.

Authorization to Possess
Authorization to possess marijuana for medical purposes will be issued by Health Canada. The requirements for the authorization will be dependent on the category for use.
All applications will have to be submitted by a medical practitioner on behalf of the patient. Depending on the category, supporting documentation from other medical specialists may be required. A list of therapies tried or considered will have to be submitted with the reasons why they were found to be medically inappropriate.
An authorization to possess marijuana for medical purposes will specify a maximum quantity of marijuana equivalent to a 30-day treatment supply. Additional requirements will be imposed when proposed dosage exceeds a quantity of 5 gm/day.

Licence to Produce
Licences to produce will be issued by Health Canada to either the patient or a representative designated by the patient. A patient may also be permitted to produce for his or her own personal use. The licence also allows for storage and transportation of marijuana to the patient. A criminal record check is required for anyone designated by the licence to produce marijuana.
A representative cannot be designated by more than one patient, however a site can be used for the production of marijuana under a maximum of three separate licences.

A licence also authorizes the maximum number of plants that can be produced and this is dependent upon the patient’s daily dosage as defined by the physician. The protection from loss or theft of the plants or dried marijuana will be the responsibility of the holder of the licence.

Impact on Pharmacy
Community and hospital pharmacists are not
directly affected as the regulations currently address personal possession and production of marijuana only. Medical practitioners are most affected due to the requirement that their authorization must be obtained on applications.

Pharmacists should be aware however, of patients using marijuana for medical purposes in the event of drug interactions or adverse events. Therefore pharmacists should make themselves aware of the various medical conditions where marijuana may be required, as many of these conditions involve complex medication therapies.
Understanding the safety and effects will be important when discussing the use of marijuana for medical purposes with either the physician or patient. There is a possibility that marijuana may eventually be distributed through pharmacies much like other controlled drugs and narcotics.

Hospital pharmacists may also encounter situations where a patient having an authorization to possess marijuana is admitted to hospital. This situation should be discussed with medical staff and administration. Along with the steps needed to be taken for patients using medication that is not distributed through the hospital system, particular storage and security issues may arise with these patients.

More detailed information and a copy of the regulations can be accessed under “Marijuana” on the Health Canada website at www.hc-sc.gc.ca