The Latest on Medical Cannabis
Julie L. Lossing MN NP
The Latest on Medical Cannabis:
Cannabis, as its popular nickname suggests, grows freely almost everywhere. In Ontario ditches this summer look closely and you may find it flourishing among thistles, wild flowers, weeds. Like other substances now mainstream, such as aspirin and morphine, cannabis has been used therapeutically for millennia; more recently in the 1800s when Queen Victoria relied upon it to relieve ailments. Falling into disrepute decades ago when the opium trade was curtailed, cannabis began to be treated as a controlled drug. Health Canada has never provided a rationale for including it on their list of controlled substances.
Simply put, cannabis was in the wrong place at the wrong time.
What then is the difference between medical cannabis and marijuana? Marijuana is used purely as a recreational pastime. Currently, no governmental controls exist to ensure marijuana is free of contaminants and illicit distribution almost guarantees toxicity to some degree. In contrast, medical cannabis production in Canada parallels strict quality controls consistent with pharmaceutical standards. The government regulates medical cannabis under the Marijuana for Medical Purposed Regulation (MMPR). End product is free of impurities and strains have become reliably consistent, ensuring uniform therapeutic results.
So why bother learning about medical cannabis if we (NPs) are not permitted to authorize use?
The fact is that such prohibition may change–and soon. In the meantime, many NPs work in multidisciplinary teams alongside providers who can and do authorize cannabis use. NPs can also refer patients to specialized cannabinoid clinics for assessment and authorization. Understanding potential therapeutic benefits and being aware of potential contraindications positions our profession to disseminate un-biased information, thus enhancing access to care.
The term “authorize” is used instead of “prescribe” because cannabis, strictly speaking, is not a pharmaceutical agent. Physicians simply authorize use by completing a straightforward form or by using their EMR prescription function–as long as specific wording is employed–and then send the authorization directly to a chosen producer, (they also may recommend a daily dose). Unorthodox as it may seem, patients themselves, benefiting from the expert guidance of government-accredited producers, choose a strain based on symptomology and therapeutic goals. In practice, trial-and-error is often used to arrive at an appropriate strain for individual use.
To virtually eliminate hazardous by-products derived from plant combustion (smoking), Health Canada recommends vaporizing and inhalation of cannabis mist. Another route for administration is oral, using soon-to-be-offered cannabis oil.
Either way, self-dosing to alleviate symptoms puts medical cannabis patients in the driver’s seat. This is true patient-centered care!
According to Health Canada, the average patient uses 1 to 3 grams per day at a cost of approximately $7-8 per gram. Many producers operate compassionate programs. Medical cannabis use has been growing exponentially; at present 40,000 Canadians self-administer medical cannabis to relieve symptoms. Consequently, it is quite likely our profession will encounter patients already authorized or who want to try cannabis as a therapeutic option.
Patients who may benefit include–but not limited to–those suffering from PTSD, chronic pain, nausea and anorexia related to chemotherapy, multiple sclerosis, bowel disorders. Contraindications include use in pregnancy and breastfeeding, for those predisposed to psychotic illness and in cases of severe liver or renal disease. Health Canada and other qualified expert sources recommend careful authorization in those younger than 18. Some physician groups go further and recommend patients younger than 25 avoid treatment altogether. Most authorized patients trial pharmaceutical agents and, experiencing untoward side effects or inadequate response or even complete failure, arrive at cannabis treatment as a last resort.
Medical cannabis is here to stay. Educating ourselves on benefits, potential contraindications and conditions where use may relieve unbearable symptoms represents best practice care.
Julie L. Lossing MN NP
Canopy Growth Corporation (2016). Tweed and Bedrocan Canada. Product overview for Health care Practitioners http://canopygrowth.com/
Health Canada. (2014, December 23). Drugs and health products: Medical use of Marijuana. Retrieved from Health Canada: http://www.hc-sc.gc.ca/dhp-mps/marihuana/index-eng.php
Mack, A. &. (2001). Marijuana as Medicine? The science beyond the controversy. Washington, D.C.: National Academic Press.