Cannabis (marijuana) has been a hot topic recently as Canada has legalized recreational use of cannabis as of October 17, 2018. The legal framework for medical cannabis was previously outlined in the Access to Cannabis for Medical Purposes Regulations under the Controlled Substances Act. This legal framework has stayed the same after the legalization of recreational cannabis, but, it is now outlined in the Cannabis Regulations under the Cannabis Act.
You may have heard of medical cannabis and are wondering if it is right for you. In this article, I will give an overview of what cannabis is, the risks and side effects of use, the legal framework for medical cannabis, who can prescribe medical cannabis, and insurance coverage.
Cannabis (marijuana) is a generic term used to describe the various psychoactive preparations of the plant Cannabis sativa. The two most biologically active compounds in cannabis are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the major psychoactive compound in cannabis and it affects how you think, act, and feel and causes the “high” which is experienced when consuming cannabis. CBD does not appear to have any psychotropic effects and may reduce pain and other symptoms. There are many types, or strains, of cannabis. Each strain has a specific THC to CBD ratio. Thus, different strains will have effects than others.
Medical cannabis may be helpful for some health conditions, including:
Nausea and vomiting from chemotherapy for cancer;
Low appetite and weight loss for people who have AIDS;
Muscle stiffness for some multiple sclerosis or spinal cord injury patients;
Chronic pain, in particular, nerve pain, or pain at the end of life.
Other therapeutic uses of cannabinoids are currently being studied including the treatment of asthma and glaucoma, as an antidepressant, appetite stimulant, anticonvulsant and anti-spasmodic.
Many patients are interested in medical cannabis to treat chronic pain as it is a safer option than many opiates. It is impossible to overdose on cannabis and it is far less addictive than opiates.
As with any medication, there are risks in using medical cannabis. It can interact with many other medicines and can be dangerous with certain medications. Therefore, it is recommended that you speak with your health care provider before introducing medical cannabis as part of your treatment plan. You should also speak with your health care provider if you have any personal or family history of substance use disorder or mental health disorders as cannabis can aggravate these conditions.
Side effects of cannabis include dry mouth, red eyes, anxiety or paranoid thoughts, increased heart rate, dizziness, drowsiness, nausea and vomiting. Long-term use of cannabis can cause cannabinoid hyperemesis syndrome (CHS) which is characterized by severe nausea and vomiting, thirst, belly pain, and diarrhea. If you smoke cannabis, the smoke can damage your lungs, causing you to cough or wheeze. You may also develop lung infections like bronchitis.
If you get a prescription for medical cannabis, you can access cannabis by:
Buying it directly from a federally licensed seller;
Registering with Health Canada to produce a limited amount of cannabis for your own medical purposes; or
Designating someone to produce it for you.
You can also buy cannabis at a provincial or territorial retail outlet or through provincial or territorial authorized online sales platforms.
Under the Cannabis Act, if you are authorized to use medical cannabis, you can store as much cannabis as you want at home. In public, you may have the lesser of 150 g or a 30-day supply of dried cannabis (or the equivalent cannabis product) in addition to the 30 g allowed for non-medical purposes. You must be prepared to prove that you are legally allowed to possess more than 30 g in public if requested by law enforcement.
In terms of who can prescribe you medical cannabis, it is recommended that you start the conversation with your family doctor. It is up to each physician to decide whether or not to provide a prescription to a patient for medical cannabis. Cannabis is not a Health Canada approved therapeutic product. According to the College of Physicians and Surgeons of Ontario (“CPSO”), physicians are not obligated to prescribe cannabis if it is outside of their clinical competence or if they do not believe it would be clinically appropriate for the patient. Physicians are not obligated to refer patients to prescribing physicians where they do not believe it is clinically appropriate for the patient.
If you have had the discussion with your family doctor and they are unwilling to prescribe you medical cannabis, and you are still interested in trying it, you can make an appointment with a medical cannabis clinic. Many of them do not require a referral from a family doctor as many of them have physicians and nurses on staff who can write the prescription.
Medical cannabis appointments with a physician are covered by OHIP. The medical cannabis itself and devices such as vaporizers are not coved by OHIP. Patients who are on ODSP may receive coverage for cannabis-related medical devices, such as vaporizers, and a discount on medical cannabis called “compassionate pricing”.
Medical cannabis is not covered by many insurance plans, although that is slowly changing. Most private plans will only cover medical cannabis used to treat a very specific list of conditions. You should check with your insurance provider to see if they will cover part the cost of medical cannabis.
Medical cannabis may be effective in treating certain medical conditions and in particular, it may be a good alternative to using opiates to treat pain. As with any medication, there are risks in using medical cannabis, so it is important to speak with your health care provider before starting to use cannabis to treat a medical condition. If your family doctor does not want to prescribe you medical cannabis, you can make an appointment with a medical cannabis clinic. Medical cannabis appointments with your physician are covered by OHIP, however, the medical cannabis and devices are not covered. Some private insurance plans cover medical cannabis if it is used to treat specific medical conditions.
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