Medical Marijuana

General Overview

• Access to Cannabis for Medical Purposes Regulations (ACMPR) can access fresh or dried marijuana or cannabis oil

  • Requires healthcare practictioners to indicate the quantity (grams) of dried marijuana that they authorize for the patient and period of use

  • The licensed producer will then provide that quantity of fresh or dried marijuana or cannabis oil that is equivalent

• Each provincial College has suggested guidelines and policies

  • Quebec CMQ physicians should not provide patients with a medical document to access medical marijuana unless part of a research project.

• Sign a declaration rather than write a prescription

  • State that the patient meets Health Canada criteria allowing access to marijuana

  • Physicians cannot prescribe a drug without safeguards in place (evidence on effectiveness, safety, indications, dosing and precautions)

Factors to Consider

• Evidence supporting analgesic effect of cannabis is weak

  • Trials of short duration, small sample sizes, incomplete outcome measures

  • Higher evidence for harm than for benefit

    • Adverse events include: CNS effects/confusion/sedation/"high"/dysphoria, speech disorders, dizziness, ataxia, numbness, impaired concentration or memory, hypotension, psychiatric, hallucination, psychosis

  • Smoked cannabis was compared against placebo (not other cannabis formulations or standard analgesics)

• Smoke is a hazardous delivery system

  • Smoke contains chemicals potentially carcinogenic or harmful to heart or other organs

• Cannabis can already be prescribed as 

  • Oral capsule (Nabilone) - indicated for chemotherapy induced N/V

  • Inhaled spray (Sativex) - spasticity or neuropathic pain from MS or cancer

CFPC Recommendations

• Some evidence are for refractory (third/fourth-line) chemotherapy induced N/V, spasticity due to MS or spinal cord injury, neuropathic or palliative cancer pain

• No evidence for pain conditions such as fibromyalgia or low back pain

  • May only consider in neuropathic pain if failed to respond to standard treatments (adequate trial of pharmacologic, nonpharmacologic, and pharmaceutic cannabinoids)

• Dried cannabis is NOT appropriate for 

  • Anxiety/insomnia

  • Age <25yo

  • Personal or strong family history of psychosis

  • Active substance use disorder

  • Cardiovascular disease (angina, peripheral vascular disease, cerebrovascular disease, arrhythmias)

  • Respiratory disease

  • Pregnant, planning pregnancy, breastfeeding

• Caution in patients with

  • Concurrent active mood/anxiety disorder

  • Smoke tobacco

  • Risk factors for cardiovascular disease

  • Heavy use of alcohol, opioids, benzodiazepines, or other sedative medications

• Prior to signing a medical document authorizing dried cannabis for pain

  • Conduct a pain assessment

  • Assess for anxiety/mood disorders

  • Assess for substance use disorder

  • Inform of harm reduction strategies

• Regularly monitor

  • Function, quality of life, pain relief

  • Misuse, abuse

• Discontinue therapy if not effective or causing harm

• Not be allowed to drive for at least 4 hours after inhalation, 6 hours after oral ingestion, 8 hours if experiences euphoria