Medical and Recreational Cannabis: Preparing for a New Era
Kate Kneisel, B.A. and Robert Kitcher, M.A., R.P.
These are the Appendices of a Quinte Counselling Services Inc., Employee Assistance Program, Fall 2017 Newsletter article available in hard copy and on the Qxplore Group website at: www.qxplore.com/fall-2017 . The Extended Version of the Newsletter article is at www.qxplore.com/cannabis-extended .
APPENDICES
Appendix A: Information for Health Care Professionals on Medical Cannabis from Health Canada
This document provides detailed evidence-based information on the endocannabinoid system, clinical pharmacology including tolerance, dependence and withdrawal symptoms, dosing, potential therapeutic uses, precautions, warnings, adverse effects, and overdose and toxicity.
Source: Health Canada Information for Health Care Professionals
Cannabis (marihuana, marijuana) and the cannabinoids.
Date of latest version: February 2013.
Appendix B: Information on Lower-Risk Cannabis Use from Centre for Addiction and Mental Health (CAMH)
The Lower-Risk Cannabis Use Guidelines (LRCUG) released in June 2017 note that “cannabis use is common, especially among adolescents and young adults… and is associated with risks to both immediate and long-term health.”
These include:
- cognitive, psychomotor and memory impairments
- hallucinations and impaired perception
- impaired driving and injuries (including fatalities)
- mental health problems (including psychosis)
- dependence
- pulmonary/bronchial problems, and
- reproductive problems.
Appendix C: 2015 “High Times” article on the relevance of cannabis strain
Escondido N. Understanding the Effects of Indica versus Sativa. High Times. Feb 25 2015.
This 2015 “High Times” article offers an alternative hypothesis to the long-held belief that different strains of the cannabis plant (indica vs. sativa) are responsible for their varying effects when consumed. The authors suggest that the variations may actually be due to a plant’s terpenes, the organic chemical compounds produced by many different plants and generally carry aromatic or flavonoid properties.
Several terpenes are mentioned, including Myrcene (also present in hops), Caryophyllene, Terpinolene, Pinene and Limonene. Some of these contribute flavor or aroma, while others may contribute varying physical or mental effects. The terpenes contained in specific cannabis strains – a strain’s specific “terpography“ is also reported by some medical producers such as Tweed. [See also Appendix E]
http://hightimes.com/grow/understanding-the-effects-of-indica-vs-sativa/
Appendix D: Education on all aspects of cannabis from the MedicalJane website
The MedicalJane website out of Los Angeles is an excellent educational resource for all aspects of cannabis. They note on their company directory: “Since its founding in 2012, Medical Jane has grown to be a respected voice for patients, caregivers, and advocates of legalized cannabis. Built on the principle and ideology of always putting the needs of medical marijuana patients and their families first, Medical Jane offers an open and free collection of learning tools and educational resources through its website at MedicalJane.com.”
Appendix E: A link to Health Canada-Authorized Licensed Producers of Medical Cannabis
This link provides access to a map showing all cannabis producers licenced by Health Canada under the Access to Cannabis for Medical Purposes Regulations (ACMPR). It provides contact numbers and products provided, including dried marijuana, fresh marijuana, cannabis oil, or starting materials. It is updated regularly.
Appendix F: Cannabis product information from two licensed producers
The approach of the following two established producers of medical cannabis generally reflects that of their counterparts, but visit the individual websites for specific information.
Tweed provides the proportions of THC – CBD, but consumers can also decide which strain is best for their needs using The Mettrum SpectrumTM. This is a colour coding system is designed to simplify the dialogue around medical cannabis by categorizing Mettrum strains according to THC potency, as well as CBD levels.
https://www.tweedmainstreet.com/collections/available
Another federally regulated licensed producer, CannTrust™, provides detailed information on indications and contraindications, dosage, route of administration and product selection for both physicians and their patients.
https://canntrust.ca/licensed-producer-patient-information
Appendix G: 2014 McGill conference on medical marihuana
Talk by Dr. Mark A. Ware MD, MRCP(UK), MSc
In this 2014 lecture on cannabis, Dr. Ware reviewed the evidence for the therapeutic potential of cannabis and cannabinoids, discussed the mechanics of the new Marihuana for Medical Purposes Regulations, and explored mechanisms to monitor patients using cannabis for medical purposes.
Dr. Ware is Associate Professor in Family Medicine and Anesthesia at McGill University and is the Director of Clinical Research of the Alan Edwards Pain Management Unit of the McGill University Health Centre. He practices pain medicine at the Montreal General Hospital and the Montreal Neurological Institute.
Dr. Ware has received research funding from the CIHR and is a Chercheur-boursier clinician senior of the FRSQ. He teaches clinical pain management, including pharmacology, complementary approaches to chronic pain and the neurobiology of pain. His educational work is focused on improving pain education at all level of the medical curriculum (undergraduate, postgraduate and continuing medical education).
He is also Executive Director of the non-profit Canadian Consortium for the Investigation of Cannabinoids (CCIC).
Appendix H: About the nonprofit Canadian Consortium for the Investigation of Cannabinoids (CCIC)
The Canadian Consortium for the Investigation of Cannabinoids (CCIC) is a federally registered Canadian nonprofit organization of basic and clinical researchers and health care professionals established to promote evidence-based research and education concerning the endocannabinoid system and therapeutic applications of endocannabinoid and cannabinoid agents.
The CCIC is committed to engaging health care practitioners regarding therapeutic issues surrounding cannabinoids through access to on-line learning tools. This will serve to foster continued professional development of its members. The general public may also access general information on cannabinoids and links to other credible organizations.
The site offers links to educational videos, product and regulatory information. Some of the information, specifically on the prescribed synthetic dronabinol, has not been updated to reflect its removal from the market.
Appendix I: March 2014 Bulletin on Synthetic Cannabinoids from the Canadian Community Epidemiology Network on Drug Use
CCENDU (Canadian Community Epidemiology Network on Drug Use). Bulletin Synthetic Cannabinoids in Canada March 2014
Synthetic cannabinoids are manufactured chemicals that are sprayed on plant material and marketed as various branded products (e.g., “Spice,” “K2” or “IZMS”) that are often sold as legal alternatives to cannabis.
Although synthetic cannabinoid products are often identified as “legal highs” or “herbal incense” this does not make them safe.
http://www.ccsa.ca/Pages/default.aspx – Search “Synthetic cannabinoids”
Appendix J: Basic regulatory information on medical marijuana for Canadian doctors from the Canadian Medical Protective Association
“Medical marijuana: Considerations for Canadian doctors. Canadian Medical Protective Association”
Originally published May 2014 / Revised August 2016
Following the phased-in introduction of the Marihuana for Medical Purposes Regulations (MMPR) in 2013 and 2014, medical regulatory authorities (Colleges) put in place policies on medical marijuana. The federal marijuana regulations were recently updated with the introduction of the Access to Cannabis for Medical Purposes Regulations (ACMPR) on August 24, 2016, which repeal the MMPR.1 The College policies reflect the concerns that have been expressed by some in the medical community. Among those concerns are the absence of scientific evidence on the benefits of medical cannabis and the challenging role being given to physicians and other healthcare providers when a patient requests access to medical marijuana.
Appendix K: A patient navigation service to help people access medical cannabis
Medical Marijuana Services (MMS) website states:
Medical Marijuana Services (MMS) was established in October 2013 as a patient navigation service to help applicants obtain marijuana as a legal form of medicine under the Health Canada’s ACMPR (Access to Cannabis for Medical Purposes Regulations). MMS works closely with doctors to ensure the highest member care. Our compassionate doctors are happy to provide professional assessments of your illness and explain how marijuana will work for you. We offer our members a consultation with a marijuana friendly doctor via Telemedicine.
Patients with any of the medical conditions below are eligible for medical marijuana under the Access to Cannabis for Medical Purposes Regulation (ACMPR).
- ADHD
- Arthritis (and Rheumatoid Arthritis)
- Brain injury
- Cancer
- Chronic nausea
- Chronic Pain
- Crohn‘s disease and colitis
- Diabetes
- Eating disorder
- Gastrointestinal
- Head injury
- Hepatitis
- HIV/AIDs
- Irritable Bowel
- Kidney failure / Dialysis
- Migraines
- Multiple sclerosis
- Nausea
- Parkinson’s
- Post traumatic Stress Disorder
- Severe arthritis
- Sleep disorders
- Spinal cord injury/disease
https://medicalmarijuanaservices.ca/patients
Appendix L: Lower-Risk Cannabis Use Guidelines from CAMH aimed at people who use cannabis
This short brochure provides education and guidance such as:
Did you know?
Driving while high have doubles or triples the risk of driving related accidents and injuries, both non-fatal and fatal.
Do not drive or operate other machinery or mobility devices for at least 6 hours after using cannabis.
Abstinence is advised for individuals with predisposition for, or a first-degree family history of, psychosis and substance use disorders, as well as pregnant women (primarily to avoid adverse effects on the fetus or newborn) are likely to be at higher risk for cannabis-related adverse effects.
http://www.camh.ca/en/research/news_and_publications/reports_and_books/Pages/default.aspx
Kate Kneisel is an award-winning content producer – she has written hundreds of articles on health and medical topics, and also writes on topics of interest in the community. Kate graduated from Trent University with a BA in English. She recently moved back into Belleville from a farm in Prince Edward County. To find out what Kate has been writing over the last 25 years, visit www.yourmedicalcopywriter.com
Bob Kitcher M.A., RP is the Managing Director of the Qxplore Group of companies which includes Quinte Counselling Services, Quinte Assessment and Treatment Group, and Qxplore Inc.
Assessment, Psychological, Psychotherapy, Social Work, and Counselling services provided by Quinte Assessment and Treatment Group and Quinte Counselling Services are described at www.qxplore.com