Pharmacists are the undisputed experts on medication in our society. As such, patients trust their pharmacist with all types of questions about medication.
At times, these questions may extend to medications that pharmacists don’t dispense.
Marijuana for medicinal purposes is such a case.
While pharmacists are not dispensing medical cannabis, it’s reasonable to expect questions. Medical marijuana is still quite a new thing in Canada.
As such, patients may have questions regarding issues such as:
- risks and safety of medical cannabis
- any drug interactions
- contraindications
- the potential for addiction
These are only a few of the concerns that patients have around medical cannabis.
It also helps that pharmacy is an industry that is used to handling controlled substances.
Given this, it’s reasonable to believe in the future, pharmacists will dispense medical cannabis. Until that day comes, pharmacists are ideal to support patients around its use.
The Difference Between Medical and Recreational Cannabis
It makes sense that medical and recreational cannabis share similarities, especially given that they come from the same plant.
One key distinction between the two lies in the different strains available in each. Medical marijuana usually seeks to ease symptoms without inducing intoxication.
This is possible through the use of CBD or cannabidiol.
CBD is well known for its benefits such as reducing pain and inflammation. Yet it doesn’t have psychoactive effects on the brain, so there are no euphoric effects.
THC is the more active ingredient in recreational strains of marijuana as it does cause intoxication.
About Medical Cannabis
Medical cannabis is only available when prescribed by a doctor. As noted, it is usually a strain which is high in CBD and low in THC. In some cases however, such as a terminal illness, strains with high THC are used.
Medical cannabis is an alternative treatment that has seen success with certain conditions. It is often used for ongoing issues, such as chronic pain, migraine and anxiety.
Access to Medical Cannabis
Medical cannabis became available in Canada in 2001 through the Marijuana Medical Access Regulations which later on replaced by the Access to Cannabis for Medical Purposes Regulations.
The regulations allow anyone with a prescription from a healthcare provider to access medical cannabis. To do so, they must get their cannabis from a licensed producer in Canada.
There are also stipulations for these people to be able to possess and use cannabis. This was very important before the legalization of recreational cannabis in 2018.
How Medical Cannabis is Consumed
There are a variety of ways for patients to consume medical cannabis, including:
Smoking cannabis is not advised as smoking has a negative impact on personal health. However, the effects come on faster when smoked or vaped, usually within 2-10 minutes.
Ingesting medical cannabis slows this process, taking effect between 30 minutes to 4 hours after administration and lasting up to 8 hours after.
Pharmacists and Medical Marijuana
As with any medication, pharmacists play a big role in both safety, and information of the drug.
Most pharmacists in Canada have received training on medical cannabis. In Ontario, the Ontario College of Pharmacists mandated this training.
And all over Canada, provinces and territories are aiming to better educate pharmacists about medical cannabis.
Training includes information on how to answer patient FAQs about medical cannabis. Questions that may come up include dosing and interactions with other meds.
Counseling patients about potential drug interactions and side effects are also important.
It’s important to remember that patients may not always disclose the use of cannabis. If taken for a medical issue, some may feel it won’t affect other meds, especially since it’s readily available on a recreational basis.
In the case of recreational use, patients are even less likely to disclose their use. In relevant situations, it’s always good to ask patients if they’re consuming cannabis.
Some Frequently Asked Questions About Medical Cannabis (FAQs)
What is cannabis?
Cannabis, or marijuana, derives from the Cannabis plant.
The leaves and flowers of this plant contain many compounds, but the two best known are:
- Cannabidiol (CBD): This ingredient does not have psychoactive effects on the brain. It’s used for a variety of conditions such as nausea and vomiting, anxiety and chronic pain. CBD is also a natural anti-inflammatory.
- THC (Delta – 9- tetrahydrocannabinol): THC is the ingredient in marijuana that causes the feeling of being ‘high’. It’s not usually used in high doses in medical cannabis except in special situations such as advanced cancer. THC can help control symptoms such as pain, muscle spasms and lack of appetite. It’s also used to ease symptoms such as nausea in cancer patients.
Cannabis and Marijuana: What’s the Difference?
When it comes to medicinal use, cannabis is the term most used by producers and medical authorities. The term ‘marijuana‘ usually means the leaves, stems and dried flowers of the cannabis plant.
Does Cannabis Have Side Effects?
While side effects of cannabis are rare in adults, they can include:
- Nausea or vomiting.
- Headache and malaise.
- Mood disorders such as depression.
- Short- and long-term memory problems.
- Schizophrenia.
Can You Use Medical Marijuana During Pregnancy?
Medical marijuana is often marketed to expectant mothers for morning sickness. While not recommended, marijuana does have a couple of advantages during pregnancy, including:
- lower rates of gestational diabetes.
- reduced risk of preeclampsia.
Many pregnant women who use marijuana feel it helps with:
- Anxiety and/or depression.
- Difficulty sleeping.
- Pain or discomfort.
Despite this, marijuana is not considered safe during pregnancy, especially with high doses of THC.
There is also evidence that it can be harmful to the baby. For example, a 2019 Canadian study of 5639 mothers found it almost doubles the rate of premature birth.
Most studies on marijuana during pregnancy have been animal studies. This can make results unreliable when translated to human mothers.
And there are risks associated with contamination which can be bad for the baby, such as:
- Pesticides.
- Heavy Metals.
- Fungus or Bacteria.
In short, the risks far outweigh the evidence and medical marijuana is not safe during pregnancy.
Can you overdose on cannabis?
Contrary to popular belief, it is possible to overdose on cannabis.
This can be an issue with cannabis in edible form, which takes anywhere from 30 minutes to 2 hours for effects to show.
Given this, users often believe that the cannabis is not working and ingest more.
Symptoms of cannabis overdose can include:
- increased heart rate
- uncontrollable shaking
- a cold feeling
- fear or anxiety
- nausea and vomiting
- dilated pupils
- hallucinations
- confusion or disorientation
- shortness of breath
- paranoia
Anyone suspected of a cannabis overdose must get to the nearest emergency room.
Can you Mix Alcohol with Medical Marijuana?
It’s not rare to hear of people using weed and drinking alcohol at the same time. Because both drugs are easy to access, many people tend to think they’re harmless.
As a result, they often don’t see an issue with mixing them.
Yet combining marijuana and alcohol can cause issues.
How Alcohol and THC Mix
As noted THC, or tetrahydrocannabinol, is the psychoactive component that gives most people a ‘high’.
CBD, or cannabidiol is an anti-inflammatory compound that reduces pain and anxiety. CBD does not have psychoactive effects.
Alcohol is a depressant, which makes it a psychoactive drug. It tends to have an effect on a person’s mental state. Mixing psychoactive drugs like alcohol and THC can impair judgment.
But we’ve noted that medical marijuana often contains little THC. CBD is usually the most active ingredient.
So how do alcohol and CBD interact?
Mixing Alcohol and CBD
Many people believe it’s safe to mix alcohol and CBD, given CBD’s lack of psychoactive effects. Having CBD in cocktails and even beer has been a growing trend during the past several years.
But CBD has been found to act as a sedative; it helps with sleep and anxiety relief, calming us through mild sedation.
So while alcohol stimulates, it also depresses the central nervous system. CBD does much the same; it’s energizing in small doses, but it relaxes the body with its sedative effect.
Which means mixing alcohol and CBD is not the best idea.
It’s interesting to note that studies have found CBD protects against alcohol toxicity. In a 2013 study on rats, researchers found CBD before an alcohol binge reduced neurodegeneration by up to 50%.
The study found CBD to decrease alcohol in the blood, staving off damage to the brain and other organs. CBD was also found to reduce inflammation in the liver, allowing it to metabolize alcohol quicker.
But these studies are not conclusive. Until proven safe, mixing alcohol and weed is not recommended.
Is cannabis use safe for young people?
Cannabis is not recommended for people under 25. Those who do use cannabis early in life risk many complications, such as:
- risk of both structural and functional harm to the brain during development.
- long-term mental health problems such as addiction and/or depression.
- difficulties with relationships, school and employment.
Cannabis is not therefore recommended even as a short-term solution for youth.
Some Popular Uses for Medical Cannabis
Medical Cannabis and Depression
Medical cannabis is at times used to treat depression. Studies at the University at Buffalo’s Research Institute on Addictions (RIA) have focused on endocannabinoids, naturally occurring chemicals in the brain.
Endocannabinoids impact human emotions, cognition, and behaviour. In animal studies, endocannabinoid production has been shown to decrease with chronic stress.
This then leads to depression, but CBD or cannabidiol has shown some promise in easing depression without addiction.
At present, there are a host of promising studies on the use of medical marijuana to treat depression.
Medical Cannabis for Migraine
The human body has cannabinoid receptors in the GI tract, the brain and other areas. Cannabinoids bind to these cannabinoid receptors, soothing pain signals.
Several studies have looked at using medical cannabis for migraine. The results have often been promising.
Studies in the Journal of Pain found the severity of migraines lower by up to 50% in human subjects who use CBD. Another study by the University of Colorado found a 40% success rate for migraine relief.
And Washington State University reported lower migraine severity of up to 49%. Given the number of positive results, CBD is often used as a treatment for migraine.
Medical Cannabis for Chronic Pain
Over the years, medical cannabis has gained popularity as an alternative to traditional pain medications. The cannabis plant eases the pain as the external cannabinoids in it, namely THC, interacts with the CB1 (cannabinoid 1) and CB2 (cannabinoid 2) receptors.
A 2017 study involving patients with chronic-pain taking medical cannabis reported that the drug improved their pain management, sleep, and overall quality of life. As well, the National Academies of Sciences found that patients suffering from chronic pain were more likely to experience a significant reduction in pain when treated with medical cannabis.
Though it has shown promising results, much research is still needed. Caution is still advised when using medical cannabis to treat chronic pain.
Medical Vs. Recreational Cannabis in Canada
In October of 2018, Canada became the second country to legalize recreational cannabis. It was also the first of the G7 (Group of Seven) countries to do so.
Now, almost three years later, recreational cannabis is available through…
- Government-operated online stores such as the Ontario Cannabis Store website.
- Authorized retailers.
Rules for recreational cannabis, for example, use in public places, change by province.
The following list presents more information on how each province governs cannabis use.
Important Note: Medical marijuana has a different set of rules than recreational cannabis.
How do the rules differ for medical and recreational cannabis?
The production and selling of recreational cannabis is all done by way of the federal government.
Medical cannabis still requires a prescription by an authorized healthcare professional.
To find out more, you can visit the following link:
https://www.canada.ca/en/health-canada/topics/cannabis-for-medical-purposes.html
Though pharmacists are not yet able to dispense medical cannabis products, it is important that they keep updated and educated on the use, rules, and risks surrounding the drug. Staying informed will allow pharmacists to better administer quality patient care and protect their patients.
It should be noted that the Canadian Pharmacists Association has created a variety of resources for pharmacists on medical cannabis.
