Authorising Cannabis Use in Primary Care

Summary of 2021 Recommendations for Physicians Authorising Cannabis Use in Primary Care

In 2021, the CFPC updated their guidelines for prescription of Cannabis in Primary Care. This is a need-to-know topic that we highlighted in The Other 105 topics. Read our summary for the take away points:

Recommendation 1: Cannabis should be considered for unrefractory neuropathic pain or

palliative cancer pain, but not for majority of pain encountered in primary care setting.

Recommendation 2: Two-step process recommended to identifying suitable candidates

for authorized cannabis therapy:

1) Adequate trial of pharmacologic and non-pharmacologic treatment options

2) Adequate trial of pharmaceutical cannabinoids

Recommendation 3: Therapeutic THC products should also contain CBD.

Recommendation 4: As of now, cannabis should not be used to treat anxiety, PTSD, or

insomnia.

Recommendation 5: Extra precautions should be taken when considering prescribing

cannabis to vulnerable populations, including patients with substance use disorder or

those on sedatives.

Recommendation 6: Physicians should follow provincial and territorial regulations when

authorizing cannabis use.

Recommendation 7: Physician assessment prior to authorization should include detailed

mental health, substance use, and pain history.

Recommendation 8: Diagnostic and statistical Manual of Mental Disorders, Fifth Edition

(DSM-5) recommended to assess for cannabis use disorder prior to initiating therapy.

Recommendation 9: Regular monitoring of response to treatment recommended, with

discontinuation in patients where therapy determined ineffective.

Recommendation 10: Individual patient recording of route of administration and dosing

recommended, and caution advised given individual differences in response and

tolerance.

Recommendation 11: Assessment and monitoring of patients recommended to identify

problematic use and toxicity. Individual tapering suggested when applicable.

Recommendation 12: Screen for withdrawal syndrome and treat when identified.

Recommendation 13: Pertaining to Class 5 licence restrictions, patients should:

•  Wait at least 6 hours before driving after inhaled use

•  Wait at least 8 hours before driving after oral use

• Be aware that daily use may cause serum THC levels to surpass legal limits even in the absence of feeling impaired

•  Avoid combination with alcohol

Recommendation 14: Discussion and use of harm-reduction strategies recommended

when authorizing cannabis.

Recommendation 15: Authorizing physician should assume primary care of patient

including regular follow-up.

Recommendation 16: With respect to dosing, “Start low and go slow”.

CFPC Guidance in Authorising Cannabis Within Primary Care 2021.