On October 17, 2018, Canada became the second country to legalize the recreational use of cannabis.1 While the new legislation only authorizes recreational use for those 18 years or older with specific restrictions controlling the production, distribution, sale, and possession of cannabis, Canadians were still divided in their support of the legalization in the months leading up to the date.1,2How do pharmacists feel?
Pharmacists proudly wear the title of medication experts, however 75% of Canadian pharmacists admitted to never asking about cannabis when reviewing a patient's medication to assess for drug interactions and 82% said that they don't know about the Canadian cannabis guidelines.3 Although cannabis for medical purposes has been legal since 2001, Canadian pharmacists generally feel unprepared the handle the influx of questions that will follow the legalization of recreational cannabis.3Finding our place
Personally, I think pharmacists should embrace this new legislation as an opportunity to show the value of our profession to patients, rather than being too afraid to admit that we don't know all the answers right now. Here are some of the ways that I envision pharmacists applying their expertise to help patients using cannabis both recreationally and medically.
1. Harm Reduction
1. Harm Reduction
Legalization will likely increase people's comfort and openness to sharing their cannabis use with healthcare providers. Coupled with the idea of pharmacists being the most accessible healthcare provider, pharmacists are in a good position to screen for a cannabis-use disorder. Similar to principles we use in harm reduction for alcohol or opioid dependence, we can provide patients with practical tips for reducing the harms of cannabis5,6:
- Avoid driving for 4-5 hours after use
- Shift away from smoking to other routes (i.e. vapourizers, edibles)
- Delay use until after 25 years old since the brain is still developing
- Avoid frequent (daily or near-daily) use
- Store cannabis safely and away from children
2. Drug Interactions and Managing Side Effects
Using the current understanding of cannabis drug interactions, pharmacists are able to provide evidence-based answers to patients wanting to know how cannabis fits in with their prescription and non-prescription medications. In addition to using our unique knowledge of drug metabolizing enzymes, we can use our clinical judgment to examine the significance of cannabis side effects overlapping with prescription drug side effects.
Using the current understanding of cannabis drug interactions, pharmacists are able to provide evidence-based answers to patients wanting to know how cannabis fits in with their prescription and non-prescription medications. In addition to using our unique knowledge of drug metabolizing enzymes, we can use our clinical judgment to examine the significance of cannabis side effects overlapping with prescription drug side effects.
Common unwanted side effects of cannabis include uneasiness, sedation, muscle twitches, and impaired memory or confusion.6 We can help patients manage these short-term side effects by encouraging them to reduce the tetrahydrocannabinol (THC) content of the strains being used or reduce the frequency or amount of cannabis being used.6 It is important to communicate with patients that the long-term side effects of cannabis remain unknown.6
3. Filling in Knowledge Gaps
One main barrier to conducting extensive research on cannabis is that it is not widely legalized. At present, what we know about cannabis for medicinal and recreational use is based on evidence gathered from small short-term studies. Despite this, pharmacists should be knowledgeable about the current information and be willing to share it with patients. Looking to the future, legalization in Canada can create an opportunity for further research in areas that are lacking - long-term side effects, optimal strains and dosages for medical uses, and impacts of legalization on society.
If you'd like to brush up on the current evidence on cannabis and its medical use in time for the recreational legalization, consider the course Medical Cannabis IQ: The Fundamentals on Advancing Practice or other continuing education courses offered by the Canadian Pharmacists Association.
One main barrier to conducting extensive research on cannabis is that it is not widely legalized. At present, what we know about cannabis for medicinal and recreational use is based on evidence gathered from small short-term studies. Despite this, pharmacists should be knowledgeable about the current information and be willing to share it with patients. Looking to the future, legalization in Canada can create an opportunity for further research in areas that are lacking - long-term side effects, optimal strains and dosages for medical uses, and impacts of legalization on society.
If you'd like to brush up on the current evidence on cannabis and its medical use in time for the recreational legalization, consider the course Medical Cannabis IQ: The Fundamentals on Advancing Practice or other continuing education courses offered by the Canadian Pharmacists Association.
Chantel
References
- Government of Canada. Cannabis Legalization and Regulation. Accessed October 15, 2018: http://www.justice.gc.ca/eng/cj-jp/cannabis/
- Navigator. Cannabis in Canada. Accessed October 15, 2018: http://www.navltd.com/wp-content/uploads/2018/03/Cannabis-In-Canada_03_2018.pdf
- Pharmacy5in5. "Recreational cannabis will be legal on Wednesday". Message to Pharmacy5in5 Mailing List. October 15, 2018. Email.
- Government of Canada. Understanding the New Access to Cannabis for Medical Purposes Regulations. Accessed October 15: https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/understanding-new-access-to-cannabis-for-medical-purposes-regulations.html
- Government of Canada. Cannabis in Canada: Get the facts. Accessed October 15, 2018: https://www.canada.ca/en/services/health/campaigns/cannabis/canadians.html
- Grindrod, K & Beazely, M. Cannabis 101. Accessed October 15, 2018: https://uwaterloo.ca/pharmacy/sites/ca.pharmacy/files/uploads/files/cannabis_infographic_2_sided.pdf
