As of April 1, 2014, federal regulations permit the use of cannabis for medical purposes.
Physicians may now receive requests from patients to sign a medical document that allows the patient to purchase cannabis from a licensed producer, grow their own and possess it legally. The lack of good quality evidence around the use of cannabis for medical purposes has made this a challenge for physicians. So what do you need to know before you decide to sign the medical document?
Physicians are not required to sign the medical document if they do not feel it is in the best interest of their patient or if it is not within the scope of their practice or expertise.
If you do choose to sign the medical document, there are rules you must follow.
Some key issues to consider are:
- Cannabis has abuse potential, and you must assess your patient’s risk of addiction
- Physicians need to be familiar with the risks and benefits of cannabis in order to obtain appropriate informed consent
- There are short-term studies that support the use of smoked or vaporized cannabis for HIV/AIDS associated-weight loss, multiple sclerosis-related pain and spasticity, neuropathic pain and chronic pain of various etiologies
- Potential risks of cannabis include:
- precipitation of psychotic symptoms
- impaired pulmonary function from inhalation
- impaired cognition and potential interactions with psychoactive drugs
- neurodevelopmental disorders following in utero exposure
- impaired driving while under the influence of marihuana
- impact on insurance and benefits coverage
- unauthorized diversion
- Health Canada states cannabis should not be used in patients:
- under the age of 18 years
- with severe cardiopulmonary disease or respiratory insufficiency
- with a history of psychiatric disorders or substance abuse or a family history of schizophrenia
- who are pregnant or lactating
- with severe renal or liver disease
If you decide it is appropriate for you to sign the medical document, you must register with the College as an authorizer of cannabis for medical purposes and submit a copy of each medical document to the College; this document must be completed and submitted annually. Once the patient is on a stable dose, the physician is expected to evaluate their patient at least every three months in order to assess efficacy and to monitor for adverse effects.
Before you make a decision, we recommend you familiarize yourself with the clinical evidence and both federal and provincial regulations, including the CPSA Cannabis for Medical Purposes Standard of Practice.
CPSA has also provided Advice to the Profession: Cannabis for Medical Purposes.