Prescribing Medical Cannabis

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. 

Expectations for HEALTHCARE PROVIDERS

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 patient may choose from any provider on Health Canada's list of authorized medical cannabis providers to obtain an order/prescription form (medical document).  
5.  The healthcare provider will complete and sign the order/prescription form (i.e. medical document(s)) from the patient's choice of provider.  Health Canada does also provide a sample form. 
6.  The healthcare provider will then fax the form directly to the patient's choice of authorized medical cannabis provider.

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.

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 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 Safety to help guide employers in managing employees using medical cannabis:  Workplace Strategies: Risk of Impairment from Cannabis