Improving the regulation of medical cannabis in Canada to better serve pediatric patients

Huntsman, Richard J.; Kelly, Lauren; Alcorn, Jane; Appendino, Juan Pablo; Bélanger, Richard E.; Crooks, Bruce; Finkelstein, Yaron; Gilpin, Andréa; Lewis, Evan; Litalien, Catherine; Jacobs, Julia; Hepburn, Charlotte Moore; Oberlander, Tim F.; Rassekh, Shahrad R.; Repetski, Alexander E.; Rieder, Michael J.; Shackelford, Alan; Siden, Harold; Szafron, Michael; Jong, Geert W. ‘t; Vaillancourt, Régis

doi:10.1503/cmaj.202169

Cited by 11 publications

(11 citation statements)

References 5 publications

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“…The Canadian Pharmacists Association (CPhA) recently issued a position statement on improving the regulation of medical cannabis and highlighted that pharmacists are best suited to advise patients and oversee the safe storage and dispensing of medical cannabis. 23 Furthermore, given that pharmacists are trained to assess drug-drug interactions and adverse effects and as prescribers often initiate cannabis as third- or fourth-line adjunctive therapy on top of other medications, 24 we support the CPhA position statement on medical cannabis and argue that this is a crucial element of governmental efforts to shape demand around the principle of responsible consumption.…”

Section: Discussionmentioning

confidence: 93%

An examination of cannabis-related information typically asked by consumers at retail cannabis locations: A Canadian survey of budtenders and managers

et al. 2023

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Background: Since cannabis has been legalized in Canada for medicinal and recreational use, there has been an increased demand on pharmacists for cannabis counselling. The aim of the study was to examine typical questions posed by consumers to managers and budtenders working at licensed recreational cannabis stores in Canada and to assess how often consumers seek unlicensed medical advice to treat various conditions using cannabis. Methods: An online survey was synthesized, consisting of 22 questions capturing demographics and Likert scale responses to survey questions, and was distributed online across Canada from January to June 2021. Results: There were 211 survey respondents: 91 budtenders and 120 managers. A total of 87.7% ( n = 185) of respondents indicated that they receive questions related to cannabis use for medical purposes and/or perceived medical benefit, with the same number indicating that they have been told by a customer that their physician sent them to obtain a cannabis-containing product for medical purposes. The most common cannabis component asked about in an average day was THC (42% of responses). Conclusion: An alarming proportion of budtenders and managers in Canada report that they are fielding medical cannabis questions. This situation has the potential to put individuals at risk for drug-drug interactions and drug-disease interactions and to increase unnecessary hospitalizations due to adverse effects.

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Section: Discussionmentioning

confidence: 93%

An examination of cannabis-related information typically asked by consumers at retail cannabis locations: A Canadian survey of budtenders and managers

et al. 2023

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“…We discuss these barriers and explore ways in which decision-makers, the medical community, and licensed cannabis producers (LCPs) can facilitate access. This commentary builds on our recent article in the Canadian Medical Association Journal with recommendations for addressing regulatory deficiencies that negatively impact paediatric patients ( 2 ).…”

Section: Problem Statementmentioning

confidence: 98%

“…MC products used by children are plant-based and subject to variations in the strain of cannabis and extraction techniques used resulting in considerable variation in concentrations of active ingredients. Many formulations are available reporting similar ratios of THC and CBD on their labels but having their own unique concentrations of minor cannabinoids and terpenes ( 2 ). This compounds product shortages that LCPs are not required to report to patients or HCPs as would be expected for other Health Canada approved drugs ( 13 ).…”

Section: Problem Statementmentioning

confidence: 99%

Removing barriers to accessing medical cannabis for paediatric patients

Huntsman

Elliott²,

Lewis

et al. 2023

Paediatrics &Amp; Child Health

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Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.

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“…Cannabis has long been proposed to negatively impact cognitive development among youths who frequently use it [ 5 , 7 ], leading to a recent call for improving the regulation of medical cannabis in Canada, specifically for the health of pediatric patients [ 15 ]. Similarly, excessive cannabis use may be a concern for older populations, where worries regarding the development of cannabis use disorder and other cannabis-related adverse effects led to the development of the Canadian Guidelines on Cannabis Use Disorder Among Older Adults [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Supporting Evidence of Medical Cannabis Claims Made on Clinic Websites: Cross-Sectional Study

O'Neill,

Ferguson,

Dalueg

et al. 2023

J Med Internet Res

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Background Since the legalization of medical cannabis in Canada in 2013, prescription of cannabis for medical purposes has become commonplace and a multibillion dollar industry has formed. Much of the media coverage surrounding medical cannabis has been positive in nature, leading to Canadians potentially underestimating the adverse effects of medical cannabis use. In recent years, there has been a large increase in clinic websites advertising the use of medical cannabis for health indications. However, little is known about the quality of the evidence used by these clinic websites to describe the effectiveness of cannabis used for medical purposes. Objective We aimed to identify the indications for medical cannabis reported by cannabis clinics in Ontario, Canada, and the evidence these clinics cited to support cannabis prescription. Methods We conducted a cross-sectional web search to identify all cannabis clinic websites within Ontario, Canada, that had physician involvement and identified their primary purpose as cannabis prescription. Two reviewers independently searched these websites to identify all medical indications for which cannabis was promoted and reviewed and critically appraised all studies cited using the Oxford Centre for Evidence-Based Medicine Levels of Evidence rubric. Results A total of 29 clinics were identified, promoting cannabis for 20 different medical indications including migraines, insomnia, and fibromyalgia. There were 235 unique studies cited on these websites to support the effectiveness of cannabis for these indications. A high proportion (36/235, 15.3%) of the studies were identified to be at the lowest level of evidence (level 5). Only 4 clinic websites included any mention of harms associated with cannabis. Conclusions Cannabis clinic websites generally promote cannabis use as medically effective but cite low-quality evidence to support these claims and rarely discuss harms. The recommendation of cannabis as a general therapeutic for many indications unsupported by high-quality evidence is potentially misleading for medical practitioners and patients. This disparity should be carefully evaluated in context of the specific medical indication and an individualized patient risk assessment. Our work illustrates the need to increase the quality of research performed on the medical effects of cannabis.

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Improving the regulation of medical cannabis in Canada to better serve pediatric patients

Abstract: Children with chronic debilitating illness and pain are increasingly using cannabis for medical purposes, particularly when conventional treatment options have limited benefit or substantial adverse effects.

Cited by 11 publications

References 5 publications

An examination of cannabis-related information typically asked by consumers at retail cannabis locations: A Canadian survey of budtenders and managers

An examination of cannabis-related information typically asked by consumers at retail cannabis locations: A Canadian survey of budtenders and managers

Removing barriers to accessing medical cannabis for paediatric patients

Evaluating the Supporting Evidence of Medical Cannabis Claims Made on Clinic Websites: Cross-Sectional Study

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