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Authorising Cannabis Use in Primary Care

  • Writer: The Review Course in Family Medicine
    The Review Course in Family Medicine
  • Oct 1, 2021
  • 2 min read

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.


 
 
 

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