MEDICAL CANNABIS (marihuana, marijuana)

IntroductionThe College’s ConcernsInformation for PATIENTSExpectations for PHYSICIANSOther Resources

Last update: October 17, 2018

Introduction


It is important for patients and health practitioners and to understand the risks, implications and steps required surrounding the use of cannabis for medical purposes in Saskatchewan.  This page will provide information to help guide patients and physicians through the process in a medically safe and legal manner. 

Key informational documents:

For more updated information on cannabis legalization and regulations, see the Government of Saskatchewan and Government of Canada websites.

NOTE:  The College does not keep lists of physicians providing specific services, including prescribing medical cannabis.  Physicians can only prescribe medical cannabis if they are the primary treating physician for the condition for which it is being prescribed.


The College's Standards 

CPSS Regulatory Bylaw 19.2(a) Standards for Prescribing Marihuana states that: "The College of Physicians and Surgeons supports the evidence-based practice of medicine, and believes that physicians should not be asked to prescribe or dispense substances or treatments for which there is little or no evidence of clinical efficacy or safety. The College of Physicians and Surgeons believes that there have not been sufficient scientific or clinical assessments to provide a body of evidence as to the efficacy and safety of marihuana for medical purposes. Despite that, the College of Physicians and Surgeons recognizes that the Medical Marihuana Access Regulations have established a process by which physicians can prescribe medical marihuana and patients can access a legal source of prescribed marihuana. This standard has been developed to establish the minimum standards which physicians must meet in order to prescribe marihuana for their patients."

The College’s concerns are similar to the concerns which have been expressed by the Canadian Medical Association, the College of Family Physicians of Canada, the Federation of Medical Regulatory Authorities of Canada and other organizations. 

Health Canada disclaimer on its website:

"Cannabis is not an approved therapeutic product, unless a specific cannabis product has been issued a drug identification number (DIN) and a notice of compliance (NOC).  The provision of this information should not be interpreted as an endorsement of the use of this product, or cannabis and cannabinoids generally, by Health Canada." 

Source: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html



Information for PATIENTS


NOTE: Prior to seeking a prescription for cannabis for medical purposes, patients should read Health Canada’s consumer information webpage at http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/cons-eng.php.  Patients should also be aware of the legal implications associated with the use of cannabis for medical purposes as outlined in The Cannabis Act and The Cannabis Regulations, and read the Government of Canada’s published information regarding the use of cannabis for medical purposes.

Obtaining a Prescription for Cannabis for Medical Purposes

Patients must first obtain a medical document from their primary treating licensed health care practitioner (physician or nurse practitioner who is the main health practitioner responsible for treating your condition and symptoms) in order to purchase and use cannabis for medical purposes.  The College does not keep a list of physicians who prescribe cannabis for medical purposes.

To do so:

  1. 1.  Meet with your primary treating Health Care Practitioner to discuss whether medical cannabis could treat your symptoms. Your health care practitioner will review your medical history, conduct an appropriate physical examination and may require you to undergo medical testing to assess your condition if this is indicated.
  2. 2.  Your primary treating Health Care Practitioner may then decide to prescribe medical cannabis as a treatment for your condition (or he or she may recommend a different course of treatment) if he or she feels that it is clinically appropriate.
  3. 3.  To comply with the College’s bylaw, you will be asked to sign a treatment agreement outlining your medical and legal responsibilities with regards to your prescription for medical cannabis.
  4. 4.  Your primary treating Health Care Practitioner will complete and sign the medical document(s) you will need to access your prescription for medical cannabis from your choice of providers (unless you choose to produce for your own medical purposes, in which case it is sent to Health Canada). 


Purchasing or Producing Cannabis for Medical Purposes

The Canadian Government’s regulations related to medical cannabis allow you, as a patient, to obtain medical cannabis in one of three ways:

1. submitting the medical document directly to a licensed commercial provider;

a.  The licensed provider will open a file for you.
b. You will need to fill our your provider's Registration Application Form (available from your provider) in order to obtain your Registration Document (8-1/2" x 11" certificate).  The Registration Document is your proof of official registration as a medical cannabis patient.
c.  Once approved, you will be able to purchase cannabis from this provider only in accordance with the authorized amount of your prescription.
d. Most licensed providers will provide with your order a wallet-sized card which can be carried to present in lieu of the registration document.
e. If the patient wishes to change provider or split a prescription, the registration with the former provider should be cancelled and new medical documents sent to each of the new providers of the patient's choice, with the appropriate dosage from each source indicated on the form by your physician.  

2. registering with Health Canada to produce a limited amount of cannabis for your own medical purposes; or,

3. registering with Health Canada to designate someone else to produce the cannabis for you. You are not limited to using dried cannabis, and can obtain dried or fresh cannabis, cannabis preparations and derivatives such as oil.

In all three cases, a medical document specifying the prescribed daily quantities must be provided with the application.

Medical Cannabis, Safety-Sensitive Occupations and Driving Privileges

Health Canada states that “using cannabis or any cannabis product can impair your concentration, your ability to think and make decisions, and your reaction time and coordination. This can affect your motor skills, including your ability to drive. It can also increase anxiety and cause panic attacks, and in some cases cause paranoia and hallucinations.” (http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/cons-eng.php)

“Although no studies have been carried out to date examining the effects of cannabis or psychoactive cannabinoid exposure on psychomotor performance in individuals using these substances solely for medical purposes, it is well known that exposure to such substances impairs psychomotor performance and patients must be warned not to drive or operate complex machinery after smoking or eating cannabis or consuming psychoactive cannabinoid medications (e.g. dronabinol, nabilone, nabiximols).” (http://www.hc-sc.gc.ca/dhp-mps/marihuana/med/infoprof-eng.php#chp771

The Saskatchewan Government has published a webpage on Cannabis and Driving and Health Canada has a page entitled Don't Drive High.

More information is available in the following document published by the Canadian Centre for Occupational Health and Safetto help guide employers in managing employees using medical cannabis:  Workplace Strategies: Risk of Impairment from Cannabis


Expectations for PHYSICIANS


Prior to prescribing

Familiarize yourself with:

1.  Health Canada information

Information for Healthcare Professionals
The Cannabis Act (effective October 17, 2018)
Cannabis Regulations  (effective October 17, 2018)

2.  CPSS Regulatory Bylaw 19.2 Standards for Prescribing Marihuana which establishes expectations for physicians who prescribe cannabis for their patients
3.  The Information for Patients section on this page
4.  Other useful resources are listed at the bottom of this page.

Prescribing Cannabis
 
Some of the 
expectations outlined in the College’s bylaw are described below.

1.  A physician may only prescribe cannabis for a patient for whom the physician is the primary treating physician for the condition for which the cannabis is prescribed.
2.  Prior to prescribing cannabis, a physician must review the patient’s medical history, review relevant records pertaining to the condition for which the marijuana is prescribed and conduct an appropriate physical examination and reach the appropriate diagnoses, with a detailed treatment plan.
3.  A physician who prescribes cannabis may only do so after the patient signs a written treatment agreement*, which contains the following:

(a)  A statement by the patient that the patient will not seek a prescription for cannabis from any other physician during the period for which the cannabis is prescribed; 
(b)  A statement by the patient that the patient will utilize the cannabis as prescribed, and will not use the cannabis in larger amounts or more frequently than is prescribed; 
(c)  A statement by the patient that the patient will not give or sell the prescribed cannabis to anyone else, including family members; 
(d) A statement by the patient that the patient will store the cannabis in a safe place; 
(e)  A statement by the patient that if the patient breaches the agreement, the physician may refuse to prescribe further cannabis. 

4. Complete and sign the medical document(s) for the patient's choice of provider using Health Canada's sample form, or the licensed producer's individual form. 

NOTE: The prescription may be split between two or more providers up to the total recommended dosage, but a separate medical document must be filled out for each provider indicating the partial quantity that can be obtained from each provider.

*Sample forms are available below for your convenience.

Dosing Guidelines

While Saskatchewan has not yet established a formal dosing standard, the College recommends following the College of Physicians and Surgeons of British Columbia’s Professional Standards and Guidelines available at https://www.cpsbc.ca/files/pdf/PSG-Cannabis-for-Medical-Purposes.pdf

Federal dosing guidelines are also available here

Fees

Physicians are reminded that providing an authorization for medical cannabis is similar to providing a prescription and a separate fee should not be charged to the patient. The appropriate billing for a visit may be submitted to the Medical Services Branch of the Government of Saskatchewan, provided that the service fulfils all the requirements detailed in the physician billing guide

Medical Record Keeping

1) PATIENT RECORD: The physician’s record for the patient must include the requirements for all medical records and, in addition, contain the treatment agreement signed by the patient.  

2) PHYSICIAN RECORD: Prescribing physicians must retain a single record, separate from other patient records, which can be inspected by the College, and which contains: 

(a) The patient’s name, health services number and date of birth; 
(b) The quantity and duration for which cannabis was prescribed; 
(c) The medical condition for which cannabis was prescribed; 
(d) The name of the licensed producer from which the cannabis will be obtained, if known to the physician. 

Sample Forms:

Treatment Agreement

Medical Document


PHYSICIANS:
For more information on prescribing medical cannabis, call 
1-306-244-7355 or email cpssinfo@cps.sk.ca.



Recommended Resources

Government of Saskatchewan

Cannabis in Saskatchewan 
Cannabis Resources for Healthcare Providers 
Cannabis Use in Saskatchewan 
The Cannabis Control Act (Saskatchewan)

Health Canada

Information for Healthcare Professionals  (PDF format) 
The Cannabis Act (effective October 17, 2018)
Cannabis Regulations  (effective October 17, 2018)
Cannabis in Canada - Get the facts
Medical Document Authorizing the use of Cannabis for Medical Purposes under the Access to Cannabis for Medical Purposes Regulations


Canadian Medical Protective Association (CMPA)

Medical marijuana: Considerations for Canadian doctors 

Canadian Medical Association

CMA Statement Authorizing Marijuana for Medical Purposes (Update 2015)

College of Family Physicians of Canada (CFPC)

Simplified guideline for prescribing medical canabinoids in primary care (February 2018)
Medical Marijuana Position Statement (2013)

Canadian Pharmacists Association

Cannabis for Medical Purposes Evidence Guide
Medical Cannabis Q & A

Canadian Public Health Association
Cannabasics - New Cannabis Toolkit to Educate Health Professionals

Pharmacy Association of Saskatchewan
The Pharmacy Association of Saskatchewan (PAS) has prepared an interpretation of the ACMPR and the CPSS Bylaws (April 2017). 
Click here to download.


RxFiles
Medical Cannabis Q&A - Patient Booklet - NEW 
     - Black and white version - NEW
Cannabinoids/Medical Cannabis - Newsletter, Chart, Q&A, Consent/Agreement - NEW




Medical Research

Introduction ∙ The College’s Concerns ∙ Information for PATIENTS ∙ Expectations for PHYSICIANS ∙ Other Resources

The National Academies of SCIENCES ∙ ENGINEERING ∙ MEDICINE: The Health Effects of Cannabis and Cannabinoids (January 2017)

Summary
Committee Conclusions 
Full text

 

Other Resources

Canadian Family Physician

Systematic review of systematic reviews for medical cannabinoids (February 2018)

Canadian Centre on Substance Abuse

Guide to Facilitate Discussions about Youth Cannabis Use in Your Community (English)
Guide pour faciliter les discussions sur la consommation de cannabis chez les jeunes dans votre communauté (Français)

Canadian Public Health Association
A centralized list of cannabis resources.
https://www.cpha.ca/resources?topic=73


Society of Obstetricians and Gynaecologists (SOGC)

The SOGC urges Canadians to avoid cannabis use during pregnancy and breastfeeding.

https://sogc.org/files/Cannabis%20campaign_web.pdf

Saskatchewan Medical Association
http://www.sma.sk.ca/resources/60/cannabis-information-resources-for-physicians.html


Information for Employers

Accommodating Medical Marijuana