With the decriminalization of cannabis for recreational use set to occur on July 1, 2018, questions continue to arise regarding access to cannabis for medical use. In particular, there is uncertainty whether cannabis for medical use should be available in pharmacies.
The issue was brought to the forefront again this week when a major pharmacy chain announced its intention to dispense cannabis, subject to approval from Health Canada.
ACP Council has released the following policy statement addressing access to cannabis for medical use from pharmacy teams through policies and processes that ensure patient safety, accommodate informed decision making, and emphasize public health, thus reinforcing the trust and respect that pharmacy professionals have earned. ACP’s approach supports the health of individuals and populations.
ACP’s policy statement on cannabis for medical use
Cannabis is a Schedule II drug under the Controlled Drugs and Substances Act, and, unless otherwise regulated for production and distribution for medical purposes, is subject to offences under that Act. The Access to Cannabis for Medical Purposes Regulation, accommodates access to cannabis by individuals through the authorization of a physician or nurse practitioner. It does not authorize pharmacists or pharmacy technicians to be in possession of cannabis; however, it permits pharmacists practicing in hospitals to order cannabis (S149 of Regulation). Pharmacists practicing in hospitals should only order, store, dispense, or facilitate the administration of dried cannabis or cannabis oil in accordance with hospital policy.
Pharmacists and pharmacy technicians not practicing in a hospital have no legal authority to possess cannabis and, therefore, cannot order, store, sell, distribute, compound, dispense, or administer cannabis.
Pharmacists should include discussion about cannabis use, as they would any other substance, when assessing individuals about their health and medication use. Pharmacists should educate the public about the risks of cannabis including, but not limited to, its impact on brain development in individuals younger than 25 years of age and about its potential for impairment, particularly when used in conjunction with other drugs and substances that affect the central nervous system.
Should cannabis for medical use be allowed to be ordered, stored, compounded, dispensed, administered, or sold from a licensed pharmacy?
Any product, including cannabis, that is ordered, stored, compounded, dispensed, administered, or sold from a licensed pharmacy must be sourced from a facility that is licensed and inspected by Health Canada based on standards and processes that apply to pharmaceutical grade products. Any product, including cannabis that is authorized for medical use pursuant to a prescription, should be licensed through Canada’s Drug Licensing process to address safety and efficacy, and be assigned a Drug Identification Number (DIN). Once being assigned a DIN, the primary source of distribution of cannabis should be through pharmacies, like most other prescription drugs.
Until such time that federal legislation, policies, and procedures are amended to recognize and accommodate cannabis products as licensed drug products (i.e.: assigned a DIN), they must not be ordered, stored, compounded, dispensed, administered, or sold from a licensed pharmacy.
Despite this, ACP supports pharmacists and pharmacy technicians compounding and dispensing cannabis, as part of ethically approved, peer-reviewed medical research designed to further our understanding about its potential therapeutic benefit, safety, and efficacy.
Smokable cannabis has potential to negatively impact health status, particularly respiratory health. Therefore, dried cannabis to be administered or used in a smokable form should not be ordered, stored, compounded, dispensed, or sold from a licensed pharmacy.
If cannabis becomes licensed as a drug product, depending on its regulatory and scheduling status, pharmacists should ensure that it is stored, secured, and dispensed like any other drug, in accordance with ACP Standards and its Code of Ethics. Akin, the regulation and licensing of cannabis products will determine whether pharmacists have a role in prescribing cannabis.