MEDICAL CANNABIS (marihuana, marijuana)

IntroductionThe College’s ConcernsInformation for PATIENTSExpectations for PHYSICIANSOther Resources


Introduction


Medical cannabis (as it is now referred to by Health Canada) has been the source of some confusion for patients and physicians following a series of changes to federal government regulations and to prescribing procedures over the last few years. 

As of August 24, 2016, Health Canada’s new Access to Cannabis for Medical Purposes Regulations (ACMPR) have come into effect.  The College of Physicians and Surgeons of Saskatchewan has since updated its Regulatory Bylaw 19.2 Standards for Prescribing Marihuana  to reflect these changes.

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.


The College's Concerns

 

Health Canada disclaimer on its website:

“Cannabis is not an approved therapeutic product and the provision of this information should not be interpreted as an endorsement of the use of this product, or cannabis generally, by Health Canada.” 
(
http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/cons-eng.php)


The College is concerned about the potential for abuse under this new system. The system does not permit the College to track the prescribing of cannabis, unlike what is available for drugs of possible abuse under the Prescription Review Program

Physicians are being placed in a difficult position by being expected to make decisions whether to provide a “medical document” to patients when there is insufficient information available about risks, benefits, dosages, strengths, etc. to allow physicians to practice evidence-based medicine. Cannabis is a substance which is not subject to any of the regulatory controls which are required of all other drugs to become approved for medical use in Canada. 

The College is also concerned about potential conflicts of interests for physicians who are involved in authorizing the use of cannabis by 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. 


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.

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 and may require you to undergo medical testing to assess your condition.
  2. 2.  Your primary treating Health Care Practitioner may then decide to prescribe medical cannabis as a treatment for your symptoms (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 you will need to access your prescription for medical cannabis. 


Purchasing or Producing Cannabis for Medical Purposes

The Canadian Government’s regulations related to medical cannabis were changed in August 2016 to allow patients to obtain medical cannabis in one of three ways:

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

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

3. registering with Health Canada to designate someone else to produce the cannabis for them. The patient is not limited to using dried cannabis, but 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 has stated 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


Expectations for PHYSICIANS


In September, 2016, the College adopted a bylaw, Regulatory Bylaw 19.2 Standards for Prescribing Marihuana, which establishes expectations for physicians who prescribe cannabis for their patients.

Prior to prescribing

Read:

1.  Health Canada’s new Access to Cannabis for Medical Purposes Regulations  (August 2016)
2.  CPSS Regulatory Bylaw 19.2 Standards for Prescribing Marihuana (September 2016)
3.  Other useful resources are listed at the bottom of this page.

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

1.  A physician may only prescribe marijuana for a patient for whom the physician is the primary treating physician for the condition for which the marijuana is prescribed.
2.  Prior to prescribing marijuana, 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.
3.  A physician who prescribes marijuana 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. 

*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.


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.

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.



Other Resources


GUIDES AND STANDARDS



Health Canada

Information for Health Care Practitioners
http://www.hc-sc.gc.ca/dhp-mps/marihuana/med/infoprof-eng.php   

Sample medical document that can be completed by physicians or nurse practitioners: http://www.hc-sc.gc.ca/dhp-mps/alt_formats/pdf/marihuana/info/med-eng.pdf


Canadian Medical Protective Association (CMPA)

Guidance document for physicians: Medical marijuana: Considerations for Canadian doctors

College of Family Physicians of Canada (CFPC)

Medical Marijuana Position Statement

Canadian Medical Association

The Canadian Medical Association produced a document in 2015 which has not been updated to include the most recent changes to the Federal Government Regulations: CMA Statement Authorizing Marijuana for Medical Purposes (Update 2015)

 

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.


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 Centre on Substance Abuse

Guide to facilitate discussions about marijuana and its effect on youth and families.  Available in both English and French.
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)



Information for Employers

Accommodating Medical Marijuana