Pharmacy U

The changing role of medical cannabis. Where do pharmacists fit in?

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By Michael Boivin BSc. Phm.

 

The number of Canadians using cannabis has increased significantly over the last several decades (source: Statistics Canada). Currently, more than 1 in 6 Canadians report using cannabis in the last 3 months. The fastest growth of new cannabis users is among people over the age of 45 years. This may create concerns as this group can have multiple comorbidities and polypharmacy.

Pharmacists are ideally positioned to address common questions and concerns of patients using medical cannabis. Here are seven key points to help you counsel your patients on cannabis use:

  1. Cannabis is not a first-line therapy – Much of the evidence supporting cannabis is not as robust as for other prescription medications. Patients should be encouraged to try medications indicated for their condition prior to trying cannabis.
  2. Cannabis is not a silver bullet – There are many websites claiming that cannabis can cure a large number of conditions. Cannabis has not been shown to cure any disease but can reduce symptoms associated with chronic diseases, such as pain, spasms or insomnia.
  3. Cannabis is commonly used as an adjunct – Many patients are hoping that the use of cannabis will lead to the elimination of their other medications. For the most part, cannabis is added to their current regimen. The goal is to provide additional symptom relief over current therapy.
  4. Smoking cannabis should be discouraged – Cannabis smoke contains the same harmful chemicals from smoking tobacco (i.e. polyaromatic hydrocarbons, carbon monoxide, tar). For most patients using cannabis for chronic conditions, oils are generally preferred due to their long duration of action, ease of use and the need for less frequent dosing.
  5. Many patients will require some THC – There is a common misconception where CBD is for medical use and THC is for recreational use. Most of the research demonstrating positive effects with cannabis have been with herbal cannabis or prescription cannabinoids with some THC.  For most medical cannabis patients, they should be managed with cannabis containing CBD with the lowest dose of THC to mitigate symptoms.
  6. Vaping injuries in the United States have not yet occurred with vaporizing herbal cannabis – There have been some concerns with vaporization due to the number of deaths and severe respiratory conditions that have occurred throughout the United States. Many of the cases have occurred in young healthy individuals vaporizing products containing THC.  The products that have led to the most concern have been illicit vaporization pens containing liquid that is vaporized.  As of November 2019, the only legal cannabis for vaporization is dried cannabis flower. Pharmacists must stay abreast of the changes in this space.  An alternative would be taking cannabis orally, but patients should avoid smoking.
  7. The evidence with cannabis can be conflicting – The published articles can be conflicting. Some authors will state that the evidence supports cannabis, where other authors will state there is no evidence to support cannabis use. This can lead to confusion. Pharmacists must consider the potential risks and benefits for an individual patient. The evidence is continually changing, and it is important for pharmacists to keep current to provide the best possible care to their patients.

Michael Boivin is a pharmacist consultant, CommPharm Consulting Inc.