Clearing the smoke on cannabis

 

When the clock struck midnight on Oct. 17, 2018, recreational cannabis stores opened their doors to lineups of people waiting to legally purchase recreational cannabis in Canada for the first time.

In that moment, Canada officially became the second country in the world to universally legalize cannabis—signalling the start of one of our nation’s most significant social shifts of the year.

Amid the anticipation for legalized recreational cannabis, many medical cannabis users and authorizing physicians were left with uncertainty around what accessibility of medicinal cannabis and the associated processes would look like post-legalization. Would physicians still have a role in guiding medical users’ access to cannabis?

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· 15% of Canadians (~4.6 million people) aged 15 and older reported using cannabis in the past three months—relatively the same amount of people who reported using cannabis prior to legalization.

· 16% of Albertans aged 15 and older reported using cannabis.

· One in four cannabis users reported using cannabis for medical purposes only.

· Medical users with documentation tend to access their cannabis from legally authorized licensed producers (86%) as opposed to illegal sources (19%) or growing their own.

· Medical users are less likely to choose smoking as their method of consumption.

· 76% of users reported quality and safety as their top consideration when purchasing cannabis.

Source: Statistics Canada’s National Cannabis Survey, fourth quarter 2018; data collection from mid-November 2018 through mid-December 2018.

Today, the answer is yes. While the College does not have a position on cannabis, since 2014 we have provided physicians with support should they find the need to choose cannabis as a treatment option for patients. Physicians play an integral role in a patient’s choice to access medical cannabis. Through open and informed dialogue, physicians take a holistic approach and consider things like a patient’s current medication use and addiction risk factors in order to identify whether or not medical cannabis is a safe and viable treatment option. Physician involvement in a patient’s choice to access medical cannabis also helps ensure clear communication among practitioners in a patient’s circle of care.

There are very few strong, evidence-based reasons to use cannabis, but patients want the option as part of their treatment. We recognize that and have provided guidance to physicians on how this can be done as safely as possible. The College has three documents in place to help guide physicians to ensure the safety of patients: the standard of practice on Cannabis for Medical Purposes (CMP), the advice to the profession for CMP and the CMP Patient Medical Document. In preparation for legalization, the College updated the CMP Patient Medical Document, which tracks physician authorization and patient use of medical cannabis. We also enhanced the CMP advice to the profession, which is used to provide support and resources to physicians to ensure safety and professionalism when authorizing medical cannabis. The College chose not to update the standard of practice onCMP because the landscape of authorizing medical cannabis has remained the same, even with legalization of recreational cannabis.

So, what does all of this mean? Despite the societal changes that have come with the legalization of recreational cannabis, we expect all of our members to use good judgment in implementing cannabis into a patient’s treatment plan—just as they would with a drug or treatment.

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When it comes to physicians using any form of cannabis, our expectation for responsible use is already clearly outlined in our Code of Conduct: “As a physician, I will avoid misuse of alcohol or drugs that could impair the ability to provide safe care to patients.”

Cannabis legalization was one of Canada’s most talked about social changes in 2018. We’re still in early days, but it is critical for the College to keep ahead of changes in the world of cannabis so we can continue to offer the best guidance to our members.