B.C. doctors are being divided into two camps – the ones who will prescribe medical marijuana to their patients and the majority who won't.
And that split, driven wider by new federal rules for authorizing the drug's use, has triggered a rush of doctor shopping by those seeking prescription pot.
"It's now bedlam out there," said Dr. Bill Cavers, president-elect of Doctors of B.C. (formerly the B.C. Medical Association), who puts the blame squarely at the feet of Health Canada.
"I don't envy the patients who feel they benefit from medical marijuana because now it's getting more difficult to access it."
Under the old system, physicians merely signed a form that verified their patient had one of the medical conditions for which marijuana can be used. Final approval was up to Health Canada.
Now, responsibility has been downloaded to doctors, who sign what amounts to a prescription to buy weed from a regulated commercial producer.
Cavers said many doctors won't sign – even ones who were previously authorizing medical pot for the same patients – because of the added responsibility and liability they now face, as well as strong cautions from the B.C. College of Physicians and Surgeons.
He said doctors prescribe no other drug where there is no official, government-sanctioned scientific data or professional guidelines governing its appropriate use, recommended dosage, monitoring or potential dangerous interactions.
"It places physicians in a very, very difficult position," Cavers said, who added there are also questions about the strength and consistency of the cannabis, even from regulated producers. "We are a very unhappy group."
Doctors of B.C. has not yet taken a formal position, but Cavers is urging doctors' organizations and provincial colleges to pressure Ottawa to rethink the rules.
"It's absolutely imperative that we move this conversation past the opinions into actual data as to what it works for, how much is to be used and for what period of time," he said.
Until those studies are ready, Cavers said, Health Canada should revert back to the old system of doctors simply verifying an eligible diagnosis, rather than being forced to act as gate-keepers.
Despite the concerns of professional bodies, significant numbers of B.C. doctors are "far more liberal" in their willingness to prescribe pot, he said.
Cavers said he's heard of doctors charging fees ranging from $25 to $185 to sign off on medical marijuana prescriptions.
Such fees for non-insured services are allowed, although the B.C. College of Physicians and Surgeons cautions doctors shouldn't "exploit" patients for personal advantage and should consider factors such as ability to pay.
Pot-friendly doctors have begun clustering into groups and clinics, some going so far as to offer their services online, reviewing patients' documents via Skype and authorizing pot use.
"I think it's unprofessional," Cavers said of web-based pot clinics that offer to help patients circumvent their regular doctors.
Sensible BC director Dana Larsen said the specializing groups of doctors typically charge a few hundred dollars to sign off.
"It's either providing a really useful service or profiteering off sick people, depending on how you look at it," Larsen said. "Maybe both."
Newly diagnosed patients have no legal access to marijuana without a doctor's permission and they must buy from new commercial producers.
But other legacy users continue to legally grow their own medical pot after a court injunction last month froze Ottawa's plan to terminate their licences.
Abbotsford lawyer John Conroy said a full trial over medical pot users' right to grow their own will likely go ahead next February.
He said doctors are being too rigid in refusing to prescribe cannabis.
"I'm trying to figure out why they're so scared of it," Conroy said. "There's no lethal dose yet they're prescribing all kinds of things on a daily basis that can kill people.
"There are 38,000 [medical marijuana] patients out there now. Is the sky falling in?"