The seven recommendations from the Cannabis Act review healthcare professionals should know

Six years after the Cannabis Act legalized cannabis, the federal government released the first review of its impacts, from an independent expert panel. The review covered a wide range of issues, including the effects of legalization on health, the role of healthcare professionals and pharmacists, and Indigenous health. Here are seven key recommendations those in healthcare should know about:Patients should be able to get medical cannabis in person at pharmaciesThe report argues that pharmacies should be able to distribute cannabis products to people who have medical authorization from a healthcare professional. This change would be an “important improvement to the medical access regime,” it says, as pharmacists could consult with patients and discuss potential side effects and drug interactions. It would also help patients who face mail delivery delays and product shortages.Other countries, including Australia, France, Germany, Israel, Italy and the United Kingdom, have their pharmacies fill prescriptions for cannabis.Some pharmacists and pharmacy regulatory authorities the group talked to said they worried this change would cause people to think that cannabis was a prescription medication that meets the same safety, quality and efficacy standards as prescription medications do. The legislative review group said this could be solved with better patient education. Read: Cannabis use linked to anxiety diagnoses, worsened anxiety disorders: Ontario studyHealthcare professionals need more resources around cannabis Patients told the group that they wanted more reliable information and healthcare professionals who were supportive and knowledgeable about cannabis. Some said that since their healthcare professionals didn’t seem knowledgeable, they would turn to cannabis clinics and get authorizations there, even though they didn’t have a relationship with those places. Without guidance from healthcare professionals, most of the 203,000 Canadians who are registered under the medical access program get advice on what to take from the internet, family and friends and workers in cannabis stores. At the same time, healthcare professionals said they felt that there wasn’t enough clinical evidence around many uses of cannabis. The report suggests that Health Canada should support developing national clinical guidance documents for healthcare professionals and update Information for Health Care Professionals: Cannabis (marihuana, marijuana) and cannabinoids, which it published in 2018. More importantly, Health Canada should create a knowledge hub that offers up-to-date evidence and information on medical cannabis to healthcare professionals and the public. It also suggested creating more education for health care professionals around this, pointing to some programs such as UBC’s Cannabis Education for Health Care Providers Toolkit. Read: Canadians using cannabis for medical purposes often don't get it from medical sourcesHealthcare professionals should have to disclose their financial relationships with companies that grow and sell cannabisSome healthcare professionals who are authorizing cannabis for medical purposes are also getting funding from the cannabis industry, the report said. That wouldn’t be considered acceptable with other prescription medications. The report says healthcare professionals like doctors, nurse practitioners and pharmacists should have to disclose their financial relationships with licence holders.Read: Significant numbers of marijuana users continue use during pregnancy mistakenly thinking it's safeHealth Canada should create a scientific advisory committee for THCCannabis is seen as outside of evidence-based medicine by many healthcare providers, plus it doesn’t have to go through the standard drug approval processes, the report said. To counter this, it recommends Health Canada move away from a separate medical access program and consider cannabis through standard drug approval pathways instead. The first step would be the rapid advancement of a pathway for cannabis health products containing cannabidiol, which was the subject of a recent Health Canada review. It also says Health Canada should establish a scientific advisory committee on the risks and benefits of THC for medical purposes. And it should encourage research on THC and combining it with other cannabinoids to grow the evidence base around this, with agencies such as the Canadian Institutes of Health Research.Read: Pharmacist-led venture launches Canada’s first direct-to-consumer consulting service for medical cannabisThere should be more investment in research around cannabisThe report highlighted various issues with legalization and First Nations, Inuit and Métis. Included in those was the fact that research on the impact of cannabis on First Nations, Inuit and Métis was insufficient and outdated. It also says Health Canada and Indigenous Services Canada should work with Indigenous Peoples and communities to create and fund research on cannabis and its effects on Indigenous Peoples and communities.It noted that the research should be distinction-based, culturally appropriate, and led, owned, and used by First Nations, Inuit and Métis communities. Research around cannabis didn’t increase with legalization, and there are still substantial gaps. Health Canada should identify and fund key research priorities. The report suggested priorities would include therapeutic cannabis use, prevention and treatment programs, and higher-potency cannabis products, which are increasingly popular. Read: Is this the death of medical cannabis in Canada?Legalization didn’t impact how much youth smoked—but Canadian youth still smoke too much Before legalization, there were concerns that youth use of cannabis would increase. That didn’t happen, but youth use also didn’t decrease and cannabis is still accessible to kids. In addition, Canadian youth have some of the highest rates of cannabis use in the world. Use among young adults has increased, with four in 10 Canadians aged between 20 and 24 reporting using cannabis in the past year. That’s a concern, the report says, because research shows exposure to cannabis can disrupt normal brain development up to age 25. The report said the expert panel is concerned that cannabis use will become normalized among youth as a result of legalization. Health Canada should set targets for reducing cannabis harms and cannabis use in youth and young adults, and it should monitor progress around these, the report said. It also encouraged increased efforts to reduce the use of cannabis in youth. Suggestions included implementing prevention programming like evidence-based school prevention programs and vigilantly enforcing laws that prohibit promoting and selling cannabis to youth. Read: Youth who had cannabis-induced psychosis support standard dose recommendationKids are getting poisoned by cannabis at an alarming rate Reports of cannabis poisoning in children have increased, the report said. Ontario and Alberta reported a significant increase in emergency department visits for cannabis-related poisonings between 2015 and 2021, and hospitalization data from all provinces and territories except Quebec showed the rate of cannabis-related poisonings increased from 0.5 per 100,000 in 2015 to 6.4 per 100,000 in 2021.Health Canada has tried to educate Canadians about the risks of children ingesting cannabis and how to store it safely. However, the group says it should “redouble its efforts” in this area. Read: Researchers urge more limits on edibles after finding jump in kid cannabis poisonings

The seven recommendations from the Cannabis Act review healthcare professionals should know

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