The Canadian Medical Association has suggested the following general guidelines for prescribing medical cannabis:
No research evidence exists to support medical cannabis as a treatment option for the pain conditions seen in primary care (e.g. conditions like lower back pain, level III). The CMA recommends that dried medical cannabis should be considered only for patients with neuropathic pain which has persisted through standard level I treatments.
Doctors who are considering authorizing medical cannabis for neuropathic pain might consider:
Some doctors have found that dried cannabis therapy isn’t appropriate as a treatment for anxiety or insomnia, level II. It has also been found to not be appropriate for patients who:
Some doctors agree that authorizing patients to use dried medical cannabis should be done with caution for patients who:
The CMA urges doctors to follow the regulations laid out by their governing provincial medical regulators and always refer to these regulations when considering prescribing medical cannabis.
It is recommended that doctors assess and monitor all patients using medical cannabis for signs of potential abuse or misuse of the medicine.
Monitoring a patient can involved examining a patient’s response to medical cannabis treatment while considering if and how the patient’s quality of life and ability to function are affected and whether the treatment provides pain relief. Some doctors have chosen to discontinue their authorization to use medical cannabis if the therapy is not effective or if they suspect it is causing the patient harm.
Many doctors go through the following procedures before signing a medical document and authorizing a patient to use medical cannabis:
Patients should not drive after using medical cannabis. Some doctors advise patients not to drive after using medical cannabis for different intervals depending on the means of ingestion:
Some patients disagree with their doctors about authorization to use medical cannabis, dosing, or other medical-cannabis-related issues. In such cases, doctors might find it practical to manage the disagreement using evidence-based statements presented unambiguously.
Many doctors find it practical to advise the patients they have authorized for medical cannabis about harm reduction strategies.
According to regulations, the doctor who authorizes a patient to use medical cannabis for a given condition must be primarily responsible for following up the patient regularly and managing the treatment of the condition for which medical cannabis was prescribed. A doctor who seeks second opinions regarding medical cannabis as a treatment for one of his or her patients should only refer to facilities which meet or exceed the standards for quality of care applied to specialized pain clinics. In either case, regulations indicate that the authorizing doctor should communicate with the family doctor in order to provide comprehensive patient care.
Many doctors who authorize patients to use medical cannabis find the best practice for dosing is to “Start low and go slow,” meaning the patient should start with a low dosage and only increase it gradually.
Some doctors choose to specify the percentage of THC on the medical documents they fill out even though it is not required by the ACMPR. They choose to specify THC content because it allows them to indicate the dosage they want for their patients just as they would do with other analgesics.
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Some doctors provide patients with the following advice to promote responsible use and effective medical cannabis treatment.
The following tendencies have been observed in patients who exhibit symptoms of cannabis use disorder. The patient may have cannabis use disorder if he or she:
Doctors commonly discontinue authorization for a patient to use medical cannabis if the patient:
The side effects of medical cannabis can include:
The long term use of medical cannabis in implicated in causing the following conditions:
Symptoms of cannabis withdrawal
Many doctors give the following considerations priority when medical cannabis is used in palliative care treatment:
Historically, doctors have chosen to use medical cannabis treatment to address the following aspects of palliative care:
Using medical cannabis may provide a measure of relief in both cases listed above. However, medical cannabis has not been shown to control anticipatory nausea as effectively as the symptoms listed above.
The effectiveness of medical cannabis in stimulating appetite and promoting weight gain in patients with cancer cachexia have not be studied conclusively. It has only been shown anecdotally that smoking cannabis can stimulate appetite in such cases.
The Access to Cannabis for Medical Purposes Regulations (ACMPR) allow medical cannabis to be used to address weight loss, anorexia, and cachexia associated with cancer found in patients who have not responded to conventional treatments or who would not be considered to benefit from conventional treatments.
The ACMPR also authorizes medical cannabis to be used by HIV/AIDS patients suffering from weight loss, anorexia, and/or cachexia which is associated with their illness if the patient has not responded well to conventional treatments or would not be considered to benefit from conventional treatments.
Medical cannabis may be of benefit in the advanced forms of pain associated with cancer.
Nabiximols (brand name Sativex® ) is conditionally approved as an adjunctive analgesic during the highest tolerated dose of strong opioid therapy for persistent background pain in adults who are experiencing moderate to severe pain caused by advanced cancer.
The ACMPR allows the use of medical cannabis in the context of the following MS-related symptoms in patients who have not benefited from conventional treatments or would not be considered to benefit from conventional treatments:
Select studies have shown medical cannabis may have the following effects in patients with ALS:
Select studies have found that medical cannabis may alleviate neuropathic pain associated with injury of the spinal cord.
Medical cannabis must be treated and tested to ensure it is a safe, consistent treatment for patients. The following considerations must be taken by LPs:
5 grams of medical cannabis per day may have negative effects on a patient’s cardiovascular, pulmonary, and immune systems as well as psychomotor performance. It could also potentially lead to a dependency.
The College of Family Physicians of Canada indicate that physicians should note on the medical document that patients should use strains containing 9% THC or less. The CFPC also indicates that doctors should request information regarding the % THC composition should be sent directly to the doctor’s practice and that the doctor should be notified of any change in the % THC concentration of a product given to a patient.
The cost of medical cannabis for a patient is between $5.00-$40 per day + shipping. Shipping typically takes 2-5 days.
The CMA provides the following recommendations to doctors for prescribing medical cannabis:
CMA does not recommend any form of smoking any plant. Vaporizing is suggested over other forms of ingestion.