What does medical cannabis treat?

Because cannabis has been illegal or heavily restricted until only recently, there has been a lack of strong clinical evidence supporting its use. However, most clinicians concede that cannabis can be a safe and effective option for pain, anxiety, and sleep problems if used appropriately. There are currently many ongoing clinical studies exploring cannabis’ use in these areas as well as many others. The evidence is starting to catch up to what many healthcare providers have known for quite some time. High-dose CBD is already being incorporated into guidelines for use in epilepsy and seizure conditions. Both CBD and THC can be used in cancer patients for chemotherapy-induced nausea and vomiting (CINV), as well as to help limit spasticity in multiple sclerosis (MS) patients.

How do you use medical cannabis oil?

Many people also use CBD oils for joint pain, arthritis and inflammation. Low-dose THC from Indica strains of cannabis can be quite effective for sleep, on its own or in combination with CBD. Cannabis is a sort of “pleiotropic” substance, meaning that it has a variety of potentially useful therapeutic effects.

Will I be “stoned” if I use medical cannabis? Do I have to smoke it?

Absolutely not! There are two major pharmacological components in cannabis: CBD and THC. CBD is the non-psychoactive part of cannabis. It is a good anti-inflammatory and anxiolytic, but does not produce a “high” or euphoria. THC is the psychoactive component of cannabis that can produce a “high,” but can also be useful in a variety of medical conditions. Getting “stoned” is considered a side effect of medical cannabis and something that we work hard to avoid for our patients. If your goal is to get “high,” there is a recreational stream that can accommodate, but if your goal is to improve your medical condition with minimal side effects, then medical cannabis could be a good option for you. The vast majority of our patients do not smoke their cannabis, but instead use cannabis oils and sprays, which offer more therapeutic benefits with fewer health risks than smoking or vaporizing.

Are there risks when using medical cannabis?

Yes, especially when using the THC component of cannabis. A lot of the risks and side effects from cannabis are related to high-dose THC use. The majority of our patients use primarily medical CBD oils. Only if needed, do we combine these with low-dose THC oils, typically for sleep or complex chronic pain.

Medical Cannabis

Medical cannabis in Canada: who is eligible and how authorization works

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Medical Cannabis

In Canada, medical cannabis is authorized by a physician or nurse practitioner, who signs a medical document stating how much cannabis you may use each day and for how long. You then register with a seller licensed by Health Canada, and the seller ships the product to you. NutriChem does not sell or dispense cannabis. What NutriChem offers is a medical cannabis consultation with Adam Livingston, PharmD, RPh, for people who want to understand whether cannabis is a reasonable option for them, how authorization works, and how to use cannabis alongside the medications they already take.

Medical cannabis at a glance

Who can authorize it: a physician or nurse practitioner licensed in your province. Naturopathic doctors and pharmacists cannot.
What they sign: a medical document, not a pharmacy prescription. It states a daily amount in grams of dried cannabis and a period of use of up to one year.
Where the cannabis comes from: a seller licensed by Health Canada, which ships it to you, or your own production registered with Health Canada. Pharmacies in Ontario cannot dispense cannabis.
How much you may carry: the lesser of your authorized 30 day amount or 150 grams of dried cannabis, or its equivalent in other forms.
What NutriChem does: a consultation with a clinical pharmacist before and after authorization, covering suitability, interactions with your other medications, product forms, and dosing.
What NutriChem does not do: sell, dispense, or supply cannabis, or promise that cannabis will work for you.

Who is eligible for medical cannabis in Canada

A physician or nurse practitioner decides whether cannabis is appropriate for you. The federal rules do not list qualifying conditions. The practitioner weighs your condition, what you have already tried, every medication you take, and the risks cannabis carries for you in particular. Health Canada has not approved cannabis products to treat any specific disease or symptom, and it describes the research as limited, with more support for some uses than others. A practitioner who authorizes cannabis is making a judgment about one person.

People who book a medical cannabis consultation at NutriChem have usually already seen a physician for the problem they want to address, and many have tried more than one medication. That history is the starting point of the conversation. We take what you are experiencing seriously, and we also say plainly when cannabis is unlikely to help or when the risks outweigh what it might offer.

A medical document is not a prescription

A medical document authorizes you to possess and use cannabis for medical purposes; it does not send you to a pharmacy. Under the federal Cannabis Regulations the document records the practitioner’s name, profession, and license, your name and date of birth, the daily quantity of dried cannabis in grams, and a period of use stated in days, weeks, or months, which cannot exceed one year. The practitioner signs and dates it. When it expires, you need a new one.

The Ontario College of Pharmacists states that pharmacies in Ontario cannot dispense cannabis for medical purposes. The licensed seller you register with ships directly to you. This is why NutriChem’s pharmacy, which fills and compounds prescriptions every day, does not fill a medical cannabis document. The consultation is a clinical service; the supply comes from the licensed seller.

How to get medical cannabis in Ontario, step by step

Talk it through first. Book a medical cannabis consultation at NutriChem or raise the question with your own physician or nurse practitioner. Bring a complete list of your medications and supplements with doses.
Get a medical document. A physician or nurse practitioner reviews your history and, if cannabis is appropriate, signs a medical document with a daily amount and a period of use.
Register with a licensed seller. You complete the seller’s registration form and send the original medical document. The seller confirms the document with the practitioner’s office and then issues you a registration document with your daily amount and an expiry date.
Order and receive. You order from that seller, and the product ships to you. You are registered with one seller at a time; to switch, the original document is transferred.
Follow up. Dosing is adjusted over the first weeks, your other medications are reviewed as you go, and the medical document is renewed before it expires if cannabis is still the right choice.

What the NutriChem medical cannabis consultation covers

Adam Livingston, PharmD, RPh, leads the medical cannabis consultation at NutriChem. He is NutriChem’s Director of Science and the Designated Manager of the pharmacy, and he has run the pharmacy’s deprescribing program since 2017, so the consultation looks at cannabis in the context of everything else you take. NutriChem sits in the middle: a pharmacist who reads your full medication list, and a clinic that works with your physician rather than around them.

A first consultation covers your health history and what you want cannabis to do for you; every prescription, over the counter medicine, and supplement you take, and how cannabis could interact with each; the difference between CBD and THC and why most people start with little or no THC; the forms available, which are usually oils, capsules, and sprays rather than smoking; how to start at a low dose and adjust it; and what to track so the follow up is useful. If one of your goals is to take fewer medications, the consultation looks at whether that is realistic for you and how it would be coordinated with your prescriber through NutriChem’s deprescribing program. No medication is stopped or reduced without the prescriber who manages it.

After authorization, follow up visits review your response, side effects, and dose, and adjust the plan. The personalization does not stop at the recommendation.

Risks and side effects to weigh first

Cannabis carries health risks, and Health Canada notes that not all of them are fully understood. The short term effects of THC include drowsiness, confusion, slower reactions, and trouble with memory and attention; some people experience anxiety, fear, or panic, and cannabis use can bring on a psychotic episode in some people. THC can raise heart rate, which is a concern for anyone with a heart condition, and can lower blood pressure enough to cause fainting. Edible forms take 30 minutes to 2 hours to take effect, which makes accidental overuse easier.

Regular use raises the risk of dependence. Smoking cannabis carries lung risks similar to tobacco, which is one reason the consultation steers people toward oils, capsules, and sprays. Health Canada advises that people who are pregnant or breastfeeding should not use cannabis, and that people under 25 should not use it unless a health care provider judges that the benefits outweigh the risks. Cannabis can also interact with other medications; the consultation reviews every medication and supplement you take before anything is started. Do not drive or operate machinery while impaired.

What NutriChem does not do

NutriChem does not sell, dispense, or supply cannabis, including CBD products, and does not recommend a brand or a seller. NutriChem does not promise that cannabis will relieve a condition; Health Canada has not approved it to treat any specific disease or symptom, and the consultation says what the evidence supports and what it does not. The consultation does not replace your physician. It is designed so that the patient does not have to piece their healthcare together: the pharmacist, the authorizing practitioner, and your own physician each know what the others are doing.

Frequently asked questions

Can a naturopathic doctor prescribe medical cannabis in Ontario?

No. Under the federal Cannabis Regulations only a physician or nurse practitioner can sign a medical document. Naturopathic doctors in Ontario may prescribe only the substances listed in the table attached to their regulation, and cannabis is not among them. NutriChem’s naturopathic doctors can discuss cannabis with you as part of your care, and the medical document comes from a physician or nurse practitioner.

Can a pharmacist authorize or sell medical cannabis?

No. A pharmacist cannot sign a medical document, and pharmacies in Ontario cannot dispense cannabis. What a pharmacist can do is review your medications for interactions, help you choose a form and a starting dose, and follow your response. That is the role Adam Livingston, PharmD, RPh, plays at NutriChem.

How long does a medical document last?

Up to one year. The practitioner sets the period of use in days, weeks, or months, and the federal rules cap it at one year. Before it expires, you see the practitioner again for a new document if cannabis is still part of your plan.

Can I use recreational cannabis for medical reasons instead?

Adults in Ontario can buy cannabis from licensed recreational retailers, and some people do use it for a medical reason. Without a medical document you have no authorized daily amount, the lower recreational possession limit applies, and no practitioner is following your use. A pharmacist can still review interactions with your other medications if you are already using cannabis this way, and the consultation is open to you.

Does NutriChem sell CBD oil?

No. CBD is cannabis under the federal Cannabis Act, and NutriChem does not sell or dispense cannabis in any form. Medical cannabis, including CBD, comes from the licensed seller you register with.

Book a medical cannabis consultation

Book online through the clinic’s booking page or call the clinic at 613-721-3669. Bring a list of every medication and supplement you take, with doses, and any notes from your physician about the condition you want to address.

Keep reading

Naturopathic doctors in Ottawa: the NutriChem Clinic and its services.
Conditions naturopathic doctors commonly help with: where naturopathic care usually turns up.
Deprescribing with a NutriChem pharmacist: reducing or stopping medications safely, with your prescriber.

Sources

Cannabis Act, S.C. 2018, c. 16, sections 17 and 18 (promotion). Justice Laws Website.
Cannabis Regulations, SOR/2018-144, Part 14, Access to Cannabis for Medical Purposes (definitions; section 273, medical document; sections 279 to 282, registration). Justice Laws Website.
Accessing cannabis for medical purposes from a licensed producer. Health Canada.
Cannabis for medical purposes: general information. Health Canada.
Health effects of cannabis. Health Canada.
Cannabis and patient care. Ontario College of Pharmacists.
What NDs can prescribe. College of Naturopaths of Ontario.