The Review Course in Family Medicine
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
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
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.