What does cannabis legalization mean for physicians?

College of Physicians and Surgeons of Alberta CPSA, Medical Matters, Messenger 14 Comments

The date Oct. 17, 2018 and the legalization of cannabis will no doubt go down in Canadian history. But with this significant moment comes concerns that still have to be worked out. The CPSA has communicated a great deal over the past few years about cannabis for medical purposes, but you have likely noticed that we have not come out with a formal policy or standard on the consumption of cannabis for recreational purposes. There is a good reason for this and hopefully, I can provide you with some clarity on the subject.

Continue putting good patient care first

I don’t think I need to remind physicians that practising medicine while impaired is not acceptable and puts patients’ lives at risk. Impairment can come from a multitude of prescribed medications, alcohol or recreational drugs such as cannabis. For this reason, we don’t believe there is a need for a specific policy on cannabis consumption by physicians. Any cannabis with THC will cause a degree of impairment that could affect your ability to practise medicine and therefore should be avoided. It would be considered unprofessional to provide care to patients while impaired by any drug.

Many people are struggling with how to determine impairment after consuming cannabis and knowing how long after consumption the effects are still present. There are no really good answers to these questions, so my advice is to avoid consuming cannabis for recreational purposes if there is any chance you could be providing care to a patient. It’s just not worth the risk.

So what’s going to happen to cannabis for medical purposes after Oct. 17? While people won’t need authorization from a physician to possess or consume cannabis once it’s legal, I suspect we won’t see much change in the people who seek help from their physicians.

We may see a drop off of patients requesting cannabis authorization, but in many cases, people are struggling to find some form of treatment for their conditions and it’s important to continue providing the holistic care they need. Authorizing the use of medicinal cannabis without an appropriate assessment or follow-up is not good care, just as it wouldn’t be for any prescription medication.

There is support available if you need it

There will be many challenges ahead of us as legalization of cannabis occurs, but I know our profession will do well if we all focus on the CPSA Code of Conduct’s Expectations of Professionalism, especially the following line:

“As a physician, I will avoid misuse of alcohol or drugs that could impair the ability to provide safe care to patients.”

Last but not least, I want to remind all physicians that there is help if you need it. If you find yourself in a difficult place, suffering with an alcohol or drug use disorder, the AMA Physician and Family Support Program (PFSP) is available to support you, as is the CPSA Physician Health Monitoring Program (PHMP).

As society’s views on cannabis shift, so must the medical profession. But if we approach these types of situations with an open mind and continue to act in the best interest of our patients, we’ll adapt just fine.

Looking forward to your comments,

Scott

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Noel Corser

It certainly does feel like a “social experiment”, but it occurred to me that many of the issues are probably identical to the period(s) when Prohibition ended. Then, as now, a previously illegal but widely used (and abused) substance became suddenly legal again, and I’m guessing docs as well as patients/society-at-large faced the same questions. Any medical historians on the site, or an email away, who could help us learn from history (and avoid being doomed to repeat it)?

Scott McLeod

Hi Noel,

Thanks for the response. We don’t have anyone at the College such as that, but if anyone out there knows of someone please feel free to contact us.

Scott

Franklin

” avoid consuming cannabis for recreational purposes if there is any chance you could be providing care to a patient”

Can you clarify this? Do you mean to say that if there is any chance we will provide care to a patient for the rest of our lives that we should avoid cannabis for ever?

Scott McLeod

Hi Franklin,

The Canadian Armed Forces actually has some reasonable guidelines for this that I think are reasonable to follow. http://forces.gc.ca/en/about-policies-standards-defence-admin-orders-directives-9000/9004-1.page
I recommend you read this document because it provides some good information.

You will note that they restrict people from using it within 24 hours of duty and if you’re in a safety sensitive job such as aircrew, you must refrain from using cannabis within 28 days of duty.

Scott

Dr. Jim Watt

Here’s an interesting thought: Pre diabetics have rising Hgb A1c and smoking cannibis drops the values It’s possible some people will come out of the “diabetes” zone to prediabetic values without diet and exercise… well that ought to be a fascinating change in practice. What happens if you vape four puffs and then go for a Hgb A1c test the next day? Just curious…. obviously it’s nit a substitute for losing weight and exercise but unofficial empirical evidence showed it decreased the need for CPAP pressures down say from 11.5cm if H2O to about 10.0cm on a CPAP machine and… Read more »

Scott McLeod

Hi Jim,

Thanks for the comments. We need to be sure that we continue to use evidence based meidcine in our treatment plans. The reality is that there is very little good research in this area and we need to be careful as we move forward. There are many negative effects to the use of cannabis that need to be understood and appreciated.

Dr Tony Ford

I respectfully disagree. I believe we will see a significant drop in patients who request so called Medical Marijuana. I believe medicine as a profession has sadly allowed itself to be used to facilitate the legalization process by remaining demure on the therapeutic effectiveness. Patients will not need to feign disabilty nor claim relief to legally access marijuana anymore. Our job is done! Now just the process of feeling used and picking up the pieces a la the narcotic debacle. It seems somewhat strange to openly acknowledge that marijuana will impair your ability as a Physician but to recommend that… Read more »

Scott McLeod

Thanks for the comment Tony.

I actually hope your right and people will not be coming to physicians for access to cannabis, but I suspect we’ll continue to see it happen. For those physicians who decide they want to continue to work in this space, it’s essential they look after their patients needs beyond just authorizing cannabis. This is not a benign substance and good care is essential. My concern comes from some practice behaviours that are not actually properly diagnosing patients or following them as required.

Scott

Nav Rattan

Once Cannibis become legal. Will physicians still require rom the CPSA a permit or sanction to prescribe?

Scott McLeod

Thanks for writing in Nav. The CPSA will still be monitoring the authorization of cannabis. Nothing will change from the way it is now. Scott

Chris Hoskins

Most condominiums have non smoking rules. They will try to do the same for cannabis.Will be tricky when an occupant has a doctors note saying they need it for medical purposes not necessarily prescribed

Scott McLeod

Hi Chris,

Thanks for raising this. Municipal bylaws must be followed and it’s important for physicians not to be authorizing its use just because people want to use it in their apartment or in a public place.

Scott

Dr. Michal Broniewski

OK, I understood and undestand, that medical practice and drugs usage shoudn’t go together. I hope everybody of us, physicians, understands it.
But what about a help for family physicians who will meet patients with questions: Doctor what about using Cannabis for my pains/cramps eplepsy?
Where we can get a reliable support?

Scott McLeod

Hi Michal,

I’m going to get one of our experts to provide you with a response. They can provide you a better answer. Please stand by for more.

Scott