Cannabis for medical purposes

RNs and NPs involved at any level of client care may be in possession of and/or distributing cannabis for the purposes of providing treatment to a client. The Cannabis Regulations provide the nurse with the legal authority to possess and distribute cannabis for medical purposes despite the limitations or restrictions in the Cannabis Act. For example, a nurse who possesses cannabis for the purposes of administering it can be found to be in possession of the cannabis. For the purposes of the Cannabis Act, the definition of possession in the Criminal Code is adopted.

A person is deemed to be "in possession" when the person has the substance in their personal possession, knowingly has it in the actual possession or custody of another person or has it in any place, whether or not that place belongs to or is occupied by them, for the use or benefit of themselves or of another person. "Distribute" is defined as "administering, giving, transferring, transporting, sending, delivering, providing or otherwise making available in any manner, whether directly or indirectly, and offering to distribute."

All clients require a medical document in order to receive cannabis for medical purposes. A client treated in a hospital setting usually requires a written order by a health-care practitioner in addition to the medical document. The written order supports the dispensing and/or administration of the cannabis for medical purposes to the client.

A medical document is “a document provided by a health care practitioner to support the use of cannabis for medical purposes.” The period of use of a medical document cannot exceed one year. A medical document must be signed and dated by the health-care practitioner who is providing it and must include a statement confirming that the information in the document is correct and complete. A written order is defined as "a written authorization given by a health care practitioner that a stated amount of cannabis be dispensed for the individual named in the authorization."

The components of a medical document must include the following:

1. the health-care practitioner’s given name, surname, profession, business address and telephone number and, if applicable, their fax number and email address;
2. the province in which the health-care practitioner is authorized to practise their profession and the number assigned by the province to that authorization;
3. the given name, surname and date of birth of the individual who is under the professional treatment of the health-care practitioner;
4. the address of the location at which the individual consulted with the health-care practitioner;
5. the daily quantity of dried cannabis, expressed in grams, that the health-care practitioner authorizes for the individual; and
6. a period of use, specified as a number of days, weeks or months.

The components of a written order must include the following:

1. the health-care practitioner’s given name, surname, and profession;
2. the given name and surname of the individual who is under the professional treatment of the health-care practitioner; and
3. the daily quantity of dried cannabis, expressed in grams, that the health-care practitioner authorizes for the individual

No. RNs are not considered "health care practitioners" under the Cannabis Regulations and do not have the authority to issue medical documents for cannabis for medical purposes.

Not currently. The Prescribing Standards for Nurse Practitioners (2018) currently restricts NPs from issuing a medical document for fresh or dried marijuana or cannabis oil or providing a written order.

Yes. An RN or NP can administer cannabis for medical purposes to a person under 18 years of age.

Generally, yes. RNs and NPs are authorized to possess and administer cannabis for medical purposes in settings other than those defined as a hospital through employer policy.

In these settings, the nurse has access to the client’s private residence by way of invitation to provide nursing services. The invitation may be "express" through direct communication orally or in writing e.g. inviting the nurse into the home or "implied" through actions or conduct e.g. nodding or gesturing for the nurse to enter the home (CNPS, 2018).

A hospital is defined as "a facility that is licensed, approved or designated by a province under the laws of the province to provide care or treatment to individuals suffering from any form of disease or illness; or that is owned or operated by the Government of Canada or the government of a province and that provides health services." The definition of "hospital" may encompass facilities other than those identified as hospitals in provincial legislation such as a hospice or a long-term care facility.

Generally, yes. RNs and NPs are authorized to possess and administer cannabis. Subsection 348 of the Cannabis Regulations sets out the requirements for cannabis products and gives permission to an individual in charge of a hospital to allow cannabis products (other than cannabis plants and cannabis plant seeds) to be administered or distributed to an inpatient or outpatient. Each individual hospital setting will make its own policy regarding cannabis for medical purposes (including administration) in its facility.

The new federal Cannabis Act and Cannabis Regulations are the primary law governing cannabis in Canada. Cannabis is no longer listed as a controlled substance under Schedule II of the Controlled Drugs and Substances Act. Legislative requirements for cannabis for medical purposes are outlined in Part 14 of the Cannabis Regulations.

Yes, the federal Cannabis Act and Cannabis Regulations make certain forms of possession, distribution, selling, and importing and exporting of cannabis illegal. Provincial and municipal bylaws may set restrictions about consumption –for example, the Alberta Tobacco and Smoking Reduction Act (Section 3). RNs and NPs must follow the legislation regarding possession, distribution etc. Failure to do so could result in, for example, disciplinary action, civil lawsuit, or charges under the Criminal Code.

• Follow legislation, bylaws and organization/agency policies.
• Follow the CARNA Medication Guidelines.
• Ensure there is a client-specific medical document or order from a person authorized to provide access to cannabis for medical purposes.
• The cannabis product must be packaged, labelled (dried cannabis, cannabis oil, or fresh cannabis) and received from a licensed retailer or producer.
• Ensure the client-specific medical document authorizing cannabis for medical purposes for a client meets all of the required components, including the daily quantity of dried cannabis that the health-care practitioner authorizes for the individual.
• Ensure that the written order that supports the dispensing and/or administration of the cannabis for medical purposes for the client meets all of the required components, including the daily quantity of dried cannabis that the health-care practitioner authorizes for the individual.
• Be able to authenticate the substance and determine the required dosage (a licensed producer will be able to present the substance in a container that will generally include a description of the content).
• Ensure that informed consent is obtained and documented within the client’s medical record.
• Have the knowledge, skill, judgement and individual competence to administer cannabis for medical purposes safely, as well as be able to:
  • identify and manage any adverse effects following administration;
  • evaluate the effectiveness of cannabis following administration; and
  • document the care provided including education about the administration of cannabis.
• Take educational courses and training as necessary to maintain competence for evidence-informed practice as related to the use of cannabis for medical purposes.
• Seek legal advice to better understand the relevant provisions of the Cannabis Act and theCannabis Regulations.