Prescribing Medical Cannabis

When our physicians prescribe Medical Cannabis, they are doing so with a focus on functional outcomes for the patient to ensure the medicine is working as intended. Below is a guideline of functional outcomes we focus on, general guidelines for both prescribing* and dosing* medical cannabis, as well as follow-up care.

*NOTE: these are the guidelines our experienced practitioners follow in our clinic. This list is by no means exhaustive and not recommended as a substitute for proper Medical Cannabis prescribing education.

PHYSICAL: Reduced spasticity, increased body mass, decreased nausea, increase in appetite, increase in energy, decrease in pain, increase in quality sleep, decrease inflammation, etc.
FUNCTIONAL: Hours in bed, days off work or school, etc.
MENTAL: External evidence of decreased stress, anxiety, and/or depression, or increased focus. Enquire through patient’s personal and professional relationships. (This element requires collateral information/testimony from husband/wife/kids/boss, etc.)
PHARMACOLOGICAL: Reduction in benzodiazepines, opioids, etc.

This section gives an overview of how medical cannabis is prescribed. It is important to note that physicians do not prescribe medical cannabis, but rather “recommend” or “authorize” its use as an alternative therapy. It is also important to note that there are no set guidelines for dosing. Therefore, we follow the intention to START LOW, GO SLOW. Below is a general guideline.

• Encourage active participation and experimentation, journaling and reflection on use and outcomes. Having your patient keep a daily journal is both recommended and very helpful when exploring the efficacy of medical cannabis as an alternative treatment.
• Medical Cannabis is essentially a process of “trial and error” and it may take several visits before patients find the strain(s) most effective for their condition.
• We teach patients to self-titrate to find their lowest, most effective dose. Our Registered Nurses follow-up with our patients regularly to ensure they are responding favorably to the medicine.
• Health Canada does NOT require physicians to indicate the maximum percentage of THC or CBD for their patients.

• Standard authorization is for 1g/day for 3 months. (90% of patients use between 0.5g and 1.5g/day). If patient asks for more than 3g/day, screen for CUD (Cannabis Use Disorder).
• It is good practice to initially limit the TCH % (9, 12, 15, 18% depending on patient and MD experience/comfort)
• Recommend starting with CBD only or 1:1 TCH:CBD
• Recommend “Sativa” for daytime and “Indica” for nighttime. Avoid “Sativa” in patients with underlying anxiety.
• For daytime and episodic symptoms, consider vaporized cannabis.
• For chromic symptoms or evening/nighttime dominant symptoms, consider cannabis oils.
• Regardless of whether your patient is new or experienced with cannabis usage, it is recommended to start them on a lower percentage of THC. START LOW, GO SLOW.

• Regular monitoring of patient response to treatment with cannabis due to the potential for abuse, tolerance and dependency.
• Consider patients QOL, function, as well as the pain relief.
• Physician should discontinue authorization if the therapy is not clearly effective or is causing the patient harm (i.e. treatment not improving sleep, mood function and/or QOL; patient experiences side effects such as memory impairment, sedation, fatigue, and worsening function; patient shows clinical features of Cannabis Use Disorder.
• Patient journaling is HIGHLY recommended (daily or weekly).
• Utilize validated screening tools, as required.
• Patient use over time does not usually escalate.
• When cannabis is used with moderation, patients tend to become tolerant to the psychoactivity but not to the analgesic, anti-spasmodic or anxiolytic effects.

Tends to be sedating and relaxing with full-body effects. Often used for anxiety, insomnia, pain, and muscle spasms.

Tends to be uplifting and creative with cerebrally- focused effects. Often used for depression, ADD, fatigue, and mood disorders.