Doctor or nurse practitioner starting point for getting a medical cannabis prescription

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Medical cannabis has been legal in Canada for almost two decades, but with recreational’s entrance into the regulated space last October, rules around accessing medical cannabis changed. So how does a patient go about getting a prescription?

There are two broad-stroke things to do to get the process started: meet with a healthcare practitioner and then register with a licensed producer. The exact guidelines for gaining authorization to medical cannabis can vary from province to province, per the standards of each provincial medical college. Depending on wait times, the process can take anywhere between a few weeks and a year (the time it takes to get an appointment with some clinics sometimes accounts for the bulk of the waiting time).

Kira London-Nadeau, chair of Canadian Students for Sensible Drug Policy, says the first step in securing access to medical cannabis is to see a physician (or a nurse practitioner in some provinces) to secure an authorization, which, in essence, is a prescription. A patient authorized by a healthcare provider can access cannabis for medical purposes by buying directly from a federally licensed seller(which operate on a mail-order system), registering with Health Canada to produce a limited amount of cannabis for his or her own medical purposes, or designating someone to produce it for him or her.

Unfortunately, not all doctors are willing to authorize their patients to use cannabis, says London-Nadeau, who is also co-founder of VoxCann and digital media associate at Santé Cannabis, which opened its first legal medical cannabis clinic in Quebec in 2014. Both London-Nadeau and Ashleigh Brown, community manager and patient liaison with Strainprint Technologies who is also founder of SheCann, say physicians who are uncomfortable with prescribing cannabis can refuse to do so and need not refer to a healthcare worker who will. That is not the view of all, however.

What if a physician is not open to prescribing cannabis?

If patients have difficulty finding a healthcare professional who is opening to writing an authorization for medical cannabis, there are services available that connect patients with a physician (and/or nurse practitioner in some provinces) via Skype or phone. Although these services are legal in most provinces (Quebec does not allow inter-provincial telemedicine, so most of those services are illegal there), London-Nadeau says she is wary of these.

It would be difficult to know if a doctor involved in a teleconference is a licensed physician, she says. “Those options are usually best avoided, compared with the more difficult, but also more secure, an option of consulting with your physician.”

Her view is that a lack of education and experience impedes patient access. “It’s important to mention that the existence of these kind of shady alternatives are a direct correlation with physicians not being open or educated enough on medicinal cannabis to be able to guide patients or authorize patients to use cannabis,” she argues.

However, verified telehealth options do exist, and can be helpful for patients with limited access to medical cannabis treatment because of geographic location, a lack of services or limited mobility. Some cannabis clinics, such as Apollo Cannabis Clinics, work in telemedicine via government-approved software such as the Ontario Telemedicine Network. Additionally, Shoppers Drug Mart recently announced a collaboration with the HelloMD telehealth platform to improve accessibility.

Another option is to seek out a medical cannabis clinic specifically, says Brown. “It’s good for patients to know that their doctor may refuse for a variety of reasons (lack of knowledge, bias against cannabis) but a patient can and should pursue an authorization via self-referral,” she advises. “There is nothing wrong with accessing medical cannabis from a specialized clinic—just as you’d see an optometrist for your eyesight or a dietitian for nutrition—a doctor who focuses on cannabinoids may be a good fit if your own physician isn’t comfortable authorizing medical cannabis.”

Choosing a licensed producer

Once a patient has received a physician’s authorization, the next step is to select a licensed producer (LP) to supply the cannabis. With dozens of LPs, the selection process can seem daunting, but Brown encourages patients to do their research to find a match that best suits their needs.

“Shop around, get a sense of what your options are for LPs by visiting their websites and even calling their customer service lines to get a sense of the company culture,” she recommends. “There are plenty of people on the front lines who want to help patients.”

And if patients are unhappy with their producer(s), they have options. “If you’re not getting access to the medicine you need from your LP, switch until you find what you need,” Brown says. “You’re a consumer, so put your health first and vote with your wallet.”

What conditions might be aided by using cannabis?

While there is no fixed list of diagnoses in Canada that qualify a patient for a medical cannabis authorization, there is evidence cannabis use has been an effective treatment for certain symptoms and illnesses, such as chronic painmultiple sclerosis-related spasticity and chemotherapy-induced nausea.

Physicians open to prescribing cannabis may cite documents such as the National Academies of Science and Engineering manuscript, which includes thousands of articles on medical use of cannabis and evaluations of the quality of the evidence for different ailments, or the guide released by the College of Family Physicians of Canada.

Unlike most medications in Canada, cannabis is not a zero-rated drug and is subject to excise taxes, as well as GST/PST/HST in some provinces. Medical cannabis is, however, now considered an eligible medical expense by the Canada Revenue Agency.

London-Nadeau also cites unlicensed compassion clubs and dispensaries as options to which patients sometimes turn. “These other channels are important to make sure that people who have symptoms that are alleviated by cannabis can still have access to support,” she says. “So a lot depends on which type of channel you decide to use. And part of that might just be driven by the severity of your symptoms and how desperate you are for relief,” she adds.

Brown encourages patients to seek out groups or communities like SheCann or the Strainprint Community for support throughout the process. Both are “peer-led environments where there are no stupid questions,” she says. “Joining a community of people navigating the system together is a very powerful and reassuring action to take, whether you’re considering a medical authorization or already have it in hand and feel overwhelmed.”

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