MEDICAL CANNABIS (marihuana, marijuana)

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

Last update: October 23, 2019

Introduction

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

NOTE: The College does not keep lists of healthcare providers who prescribe medical cannabis. Healthcare providers can only prescribe medical cannabis if they are the primary healthcare provider 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 CPSS, The Canadian Medical Association, The College of Family Physicians of Canada, and The Federation of Medical Regulatory Authorities of Canada all have similar concerns.

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.

How to obtain a prescription for medical cannabis

The College does not keep a list of healthcare providers who prescribe cannabis for medical purposes.

1. Meet with your primary healthcare provider to discuss whether medical cannabis could treat your symptoms. Your healthcare provider will review your medical history, conduct an appropriate physical examination and may require you to undergo medical testing to assess your condition.
2. Your primary healthcare provider may decide to prescribe medical cannabis as a treatment for your condition (or, he or she may recommend a different course of treatment).
3. To comply with the College’s bylaw, you will be asked to sign a treatment agreement outlining your medical and legal responsibilities regarding your prescription for medical cannabis.
4. Your primary treating healthcare provider will complete and sign the medical document(s) in order for you 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).

NOTE: Your Physician is not obliged to provide you with a prescription for Medical Cannabis. The decision to prescribe medical Cannabis is at the discretion of the physician, and the College expects that physicians act in the best interest of the patient when deciding if this type of treatment is appropriate or not.

Purchasing or Producing Cannabis for Medical Purposes

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

1. Obtaining medical cannabis from a licensed commercial provider;

a. The patient will choose a provider from Health Canada's list of approved medical cannabis providers.
b. The patient will complete the approved provider's Registration Application Form.
c. Once the patient has an account set up with his approved licensed provider, and has a prescription from his healthcare provider, he or she will be able to purchase medical cannabis only from this provider, in accordance with the authorized amount of the prescription.
d. The patient will receive a Registration Document (certificate and/or wallet-sized card). The Registration Document is proof of official registration as a medical cannabis patient and must be carried to present.
e. If the patient wishes to change provider or split a prescription, the registration with the former provider should be cancelled. A 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.

In all three cases, a medical prescription from your healthcare provider is necessary. The prescription must specify the prescribed maximum daily quantity allowed.

Potential Side Effects and Cautions while using medical cannabis

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.” See Health Canada General Warnings at 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 performanceand 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 Safety to 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 healthcare providers who prescribe medical cannabis for their patients.

3. The Information for Patients section on this page

How to prescribe medical cannabis

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

1. The patient will identify who is his primary healthcare provider. This provider must be familiar with the patient's medical history and the condition for which the cannabis is being prescribed.
2. The primary healthcare provider must review the patient’s medical history and relevant records, and conduct an appropriate physical examination. Prior to prescribing medical cannabis, a medical diagnosis, a list of other treatments attempted, and a detailed treatment plan should be documented in the chart.
3. A healthcare provider who prescribes medical cannabis may only do so after the patient signs a written treatment agreement*, which contains the following:

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

4. The healthcare provider will complete and sign the medical document(s) for the patient's provider using the provider's specific form or a sample form, from Health Canada.

Dosing Guidelines

The CPSS has not yet established a formal dosing standard, however 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

Healthcare providers are reminded that providing an authorization for medical cannabis is similar to providing a prescription. No separate fee should be charged to the patient. The appropriate billing for a visit may be submitted to the Medical Services Branch of the Government of Saskatchewan as per the physician billing guide.

Medical Record Keeping

1) PATIENT RECORD: The healthcare provider’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) HEALTHCARE PROVIDER RECORD: Prescribing healthcare providers 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

Sample medical document that can be completed by physicians or nurse practitioners

Information for Employers

Accommodating Medical Marijuana

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

Saskatchewan Medical Association
Cannabis - Clinical Information/Resources for Physicians

Society of Obstetricians and Gynaecologists (SOGC)
The SOGC urges Canadians to avoid cannabis use during pregnancy and breastfeeding.
Legal cannabis not worth risk for pregnant women

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 (must register to log in)

Canadian Medical Protective Association (CMPA)

Medical cannabis: Considerations for Canadian doctors

College of Family Physicians of Canada (CFPC)

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

MEDICAL CANNABIS (marihuana, marijuana)

Introduction

The College's Standards

Information for PATIENTS

Expectations for PHYSICIANS

Recommended Resources

Canadian Centre on Substance Abuse

Canadian Medical Association

Canadian Medical Protective Association (CMPA)

Canadian Pharmacists Association

College of Family Physicians of Canada (CFPC)

College of Physicians and Surgeons of Saskatchewan (CPSS)

Government of Saskatchewan

Health Canada

Information for Employers

Medical Research

Canadian Medical Protective Association (CMPA)

College of Family Physicians of Canada (CFPC)