Edited by Mirabella Chan
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Are any of these questions one’s you have been asked before in the pharmacy?
“I’m having trouble sleeping but I don’t want to take prescription medications – do you think that CBD oil stuff would help?”
“I live with chronic pain but the opioids I take to manage it give me unwanted side effects – do you know if CBD would help with my pain?”
“I read online that CBD could help with my IBS – is that true?”
“I bought this oil at the cannabis store across the street – how much should I take to help with my anxiety?”
“Will my CBD oil interact with any of my prescription medications?”
Chances are you’ve been asked at least one of these questions since cannabis became legal for recreational use in Canada. Did you feel comfortable answering your patients’ questions? Maybe you found yourself looking for guidance online or struggling to interpret the many studies that have been published recently.
Before beginning my fourth-year clinical rotation at Hybrid Pharm, I felt the same way. I didn’t know how to summarize the evidence that was published, I didn’t know how to dose CBD oil, and I didn’t feel confident evaluating potential drug interactions between prescription drugs and cannabis products.
Hybrid Pharm is an independently owned pharmacy located in Ottawa, Ontario that specializes in medicinal cannabis. They are the only independently owned pharmacy that provides access to medical cannabis, and they serve patients all over the province. With an in-house doctor who specializes in medical cannabis, getting a prescription is easily accessible and is done in a 20-minute phone consult. By increasing accessibility of medical cannabis, Hybrid Pharm is increasing the quality of care that medical cannabis users are receiving. Once the doctor has assessed that cannabis is therapeutically appropriate for the patient, Hybrid Pharm owner, pharmacist and cannabis expert, Rahim Dhalla, contacts the patient to discuss drug interactions, dosing, appropriate dosage forms, potential side effects and onset of therapeutic effect. The pharmacist consult is essential for the safe and effective use of medical cannabis products. It is not uncommon to have patients reaching out to Dr. Dhalla for more reliable medical advice because their previous provider (medical or recreational) was unable to support them with the personalized medical advice they were seeking.
So, what are the most common ailments medical cannabis is being used to treat? Pain, insomnia, and anxiety are the most common disorders that patients turn to medical cannabis for, and patients will often have more than one of those three conditions. Other ailments that medical cannabis and its components are being used to treat include epilepsy, pelvic pain disorders (endometriosis and vulvodynia), autism spectrum disorder, chemotherapy induced nausea and vomiting, PTSD and some dermatological conditions including eczema, psoriasis and acne.
Why should we, as pharmacists, care about being able to answer our patients’ questions about cannabis? After all, it is easily accessible in retail settings so it must be safe, right? Well, Rahim Dhalla argues that “cannabis is medicine, just like any other medication we dispense and counsel on in the pharmacy.” Additionally, cannabis has many drug-drug and drug-condition interactions that can vary depending on the strength, method of consumption and product. In 2020, Statistics Canada’s Canadian Cannabis Survey reported that 76% of individuals using cannabis for medicinal purposes were purchasing their cannabis from recreational outlets without medical documents. With this percentage in mind, we should be thinking more about the number of patients who are at risk of adverse effects and drug interactions.
How do we talk to patients about cannabis and what can we do to make it safer for them to use? How do we educate ourselves so that we are more comfortable advising patients on how to safely and effectively use cannabis products as medicine? I have listed a few tips below to help you get started:
1. Challenge your Biases
If you feel uncomfortable talking about cannabis or find yourself thinking about it as a “gateway drug” or something that only “stoners” use, take some time to figure out where those beliefs may stem from and challenge them. A great resource to learn more about the history and prohibition of cannabis is a documentary called Grass is Greener on Netflix.
2. Learn the Basics
Before you can confidently start talking to patients about cannabis, it is important that you understand the basics: the endocannabinoid system, pharmacology, mechanism of action, different cannabinoids, drug interactions, onset of effect, side effects – anything you would be expected to know about any other drug you would dispense at your pharmacy. Two great resources to solidify your knowledge of the basics of cannabis in pharmacy are the Cannabis Pharmacy book and the Information for Healthcare Professionals: Cannabis and the Cannabinoids by the Government of Canada.
3. Look at the Evidence
Since the legalization of medical cannabis in 2001 and, more recently, the legalization of recreational cannabis in 2018, new studies, trials and reviews are constantly being published about cannabis and its medical uses. It is crucial that we continue to watch for and read this evidence as it is presented so we can further assist our patients in their personal journeys with medical cannabis use.
4. Talk to the Experts
Before evidence is published, the experts in the field are the ones who see the successes and the patterns in novel medical treatments. The same goes for cannabis; before things are published, the experts are going to be the ones who have witnessed and can speak on the benefits and how to mitigate risks when using medicinal cannabis.
5. Listen to your Patients
Listen to your patients who use cannabis or its components. Ask them what they use, how often they use it and what they use it for. Inquire about their experience and ask them if they feel supported by their healthcare providers with respect to their cannabis use.
Cannabis has been approved for medical use for over 20 years and now it is widely available through recreational outlets. We know many patients using cannabis for medical purposes are accessing cannabis through recreational storefronts. As healthcare providers, it is our responsibility to support and encourage patients to access cannabis through medical channels if they are using it for medical reasons. To do so, we must embrace this as a part of our practice so patients can receive the most comprehensive care possible!
HybridPharm. Pharmacy, Emerging Therapies & Wellness Services | Hybrid Pharm Ottawa. https://hybridpharm.com/. Published April 6, 2022. Accessed April 19, 2022.
Klumpers LE, Thacker DL. A brief background on cannabis: From plant to medical indications. Journal of AOAC INTERNATIONAL. 2019;102(2):412-420. doi:10.5740/jaoacint.18-0208
Montero-Oleas N, Arevalo-Rodriguez I, Nuñez-González S, Viteri-García A, Simancas-Racines D. Therapeutic use of cannabis and cannabinoids: An evidence mapping and appraisal of systematic reviews. BMC Complementary Medicine and Therapies. 2020;20(1). doi:10.1186/s12906-019-2803-2
Dhadwal G, Kirchhof MG. The risks and benefits of cannabis in the Dermatology Clinic. Journal of Cutaneous Medicine and Surgery. 2017;22(2):194-199. doi:10.1177/1203475417738971
Health Canada. Government of Canada: Canadian Cannabis Survey. Canada.ca. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2020-summary.html#a2. Published August 12, 2021. Accessed April 19, 2022.