O Cannabis: What You Need to Know About Medical Marijuana in Canada
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.
What is Cannabis?
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.
Risks and Side Effects
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.
Medical Marijuana under the Cannabis Act
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.
Obtaining a Prescription
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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You can now buy CBD oil over the counter
We’ve been hearing about CBD for a long time, and now Australians can get their hands on it without a prescription.
Low-dose cannabidiol (CBD) is now available in pharmacies nationally following approval from the Therapeutic Goods Administration (TGA). Low-dose CBD has been shown to benefit both paediatric and adult patients, but this over-the-counter prescription is only available to adults.
Previously, CBD was only available with a difficult-to-get doctor's prescription.
Why is this a big deal?
“The shift to over-the-counter is a huge stepping stone in reducing stigma and encouraging wider societal acceptance around medical cannabis,” Cannabis Doctors Australia (CDA Clinics) founder and clinical director, Dr Ben Jansen, told news.com.au in a statement.
“Stigma is slowly continuing to change as education and information start to outweigh ignorance and mistruths. 80 year of false stigma takes time to change.”
CBD is also known as medical marijuana. Image: iStock Source:BodyAndSoul
What is CBD?
Let's clear this up straight away. Although it is extracted from the cannabis plant, CBD is not marijuana. You aren't going to get high from it.
THC is the compound in marijuana that delivers the high, whereas CBD is a non-psychotropic.
The confusion stems from the fact that CBD, which often comes as an oil, is known as medicinal marijuana.
What does it do?
This beneficial chemical compound has numerous health benefits. It helps alleviate pain, which is one of the reasons it's popular with cancer patients, and can also help treat anxiety and insomnia.
“Low-dose CBD will benefit most patients, especially individuals experiencing chronic pain, anxiety, insomnia, arthritis and inflammatory issues – to name a few,” Dr Jansen said.
“However, if patients find their symptoms persist further, they should seek further advice from a doctor or experienced cannabis doctor. Some patients may find that they need a higher dose or a different CBD product that is only available via a prescription.”
CBD oil has numerous health benefits. Image: iStock Source:BodyAndSoul
Are there side effects?
The TGA notes that studies show CBD is “rarely associated with severe adverse events, and that non-serious adverse events appear significantly lessened at lower dosages.”
It's one of the reasons why legal CBD will only be available at a maximum of 150 milligrams per day.
Common side effects can include diarrhoea, a dry mouth and nausea. Sedation is considered a very uncommon side effect.
“These side effects are possible, not probable, and usually self resolve once your body has gotten used to taking a CBD product,” CDA Clinics said.
“This is why it is recommended to take CBD oil with food.”
Is it safe to drive after taking CDB?
Yes, according to the NSW Government. CBD doesn't give you a marijuana high, so it's considered safe to drive on.
CBD oil is usually ingested orally. Image: iStock Source:BodyAndSoul
How do you take it?
CBD is usually sold in an oil form and it is taken orally, under the tongue. To help its absorption, it's a good idea to eat something with a high-fat content before taking it, such a spoonful of yoghurt, cheese or avocado.
“As CBD is lipophilic, meaning it has an affinity for fat, it can be very helpful to eat something with fat in it when administering CBD, so your body absorbs it at a higher rate, ultimately making it more effective,” CDA Clinics said.
After your fatty bite, they recommend placing a drop of CBD oil on a spoon, putting it underneath your tongue and waiting 90 seconds before swallowing.
Patients are advised to “‘start low and go slow’, gradually increasing one’s dose until it is effective”.
How do you know it's working?
This requires playing the long game. Cannabidiol can take hours to absorb after its ingested, “then the CBD needs days to weeks to have its effects build up and start to work”.
“We recommend at least one week at an effective dose to see effects,” CDA Clinics advised.
“However, this can vary person to person, depending on their age, sex, gender, weight, hydration, other medications and use of alcohol.”
To reap the most benefits, they recommend regular dosing.
There is some serious science behind the benefits of CBD. Image: iStock Source:BodyAndSoul
Can anyone get it?
Over-the-counter CBD will only be available to adults. Topical creams or vaping products will still require a doctor's prescription.
Before you make a beeline for your nearest pharmacy, take a breather. While CBD is now legally allowed to be sold over the counter, no CBD oils have been approved for sale yet. It's estimated that it will take at least six months.
According to the former president of the Pharmacy Guild of Australia, Kos Sclavos, manufacturers are working at a “lightning” rate to get their products approved.
It is subsidised?
The Pharmaceutical Benefits Scheme (PBS) won't subsidise CBD “until more years of data and assessment can be completed”, Dr Jansen said.
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