Non-Medical Cannabis

Preventing and reducing cannabis use-related harms and risks are top-of-mind when it comes to the legalization of cannabis. Through screening, assessment and discussion with patients, primary care providers play an important role in harm reduction.

The Non-Medical Cannabis Resource is designed to equip primary care providers with evidence-based, balanced information to discuss cannabis use, its associated risks and benefits with their patients, and to screen for cannabis use disorder and related problems.

Non-Medical Cannabis Resource
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The Non-Medical Cannabis Resource outlines an approach for detecting, discussing and managing potential harms through the following three sections:

  • Section A: Screening for cannabis use
  • Section B: Harm reduction and patient counselling
  • Section C: Benefits/harms for patients using cannabis

The Non-Medical Cannabis Resource aims to assist primary care providers in discussing non-medical cannabis use with their patients in a safe and non-judgmental environment. Screening questions have been provided to help ascertain the cannabis use of their patients. Primary care providers will also find helpful talking points regarding cannabis-related harms and benefits, harm reduction techniques and risk factors for special populations.

Through evidence-based and balanced information about non-medical cannabis use, primary care providers can assist their patients in making informed decisions about initiating or continuing cannabis use.

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Project Overview

The Non-Medical Cannabis Resource has been developed to assist primary care providers in preventing and reducing harm from cannabis use through education and screening of their patients. This resource incorporates talking points and links to relevant resources for providers.

Development Process

The Non-Medical Cannabis Resource was developed by the CEP under the clinical leadership of Dr. Jonathan Bertram. The CEP engaged a clinical working group, experts, stakeholders and policy makers to ensure that the resource included all relevant information for primary care providers.

The Non-Medical Cannabis Resource is one of several resources developed as part of the Knowledge Translation in Primary Care Initiative. This multi-year initiative was a collaboration between the Centre for Effective Practice (CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supported primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.

Meet the Team

The Centre for Effective Practice enlisted the collaboration of the following clinical leadership throughout the development of the Non-Medical Cannabis Resource:

Clinical Lead

JonathanJonathan Bertram, MD, CCFP

Dr. Jonathan Bertram is a a Focused Practice Addictions & Pain Medicine Physician. He has special interests in working with Older Adults, Aboriginal Affairs, and Mental Health/Addictions in Primary Care. A Clinical Lecturer at the University of Toronto and a member of the Board of Directors at the Ontario College of Family Physicians, he is currently practicing Addictions Medicine at the Centre for Addiction & Mental Health (CAMH) in Toronto and running a Community Practice in Pain/Addictions Consultation & Shared Care co-located with the Bowmanville Family Health Organization. He is a consultant physician in Older Adult Addictions for COPA (Community Outreach Programs in Addiction) through Reconnect Mental Health Services and has been a part of the Substance Use/Geriatric Addictions Collaborative since its inception. He is also a part of CAMH’s Aboriginal Engagement & Outreach Initiative. His work in Older Adults includes a Health Canada Grant for the generation of Substance Use Disorder Guidelines for Older Adults.

Acknowledgements

A clinical working group oversaw the development of this resource. Members include:

  • Sharon Cirone, MD, FCFPC
  • Arun Radhakrishnan, MSc, MD, CM CCFP

Thank you to all of our members for their valuable input in the development of this resource.

Expert Opinion

In addition to our clinical working group, the Centre for Effective Practice sought expert input to inform the content of the Non-Medical Cannabis Resource. The CEP is grateful to these individuals and organizations for their time and expertise.

Supporting Material

Below are some additional resources and sources of information. These supporting materials are hosted by external organizations and the CEP cannot guarantee the accuracy and accessibility of their links. The CEP will make every effort to keep these links up to date.

Supporting Material

  1. Drug Free Kids Canada – Cannabis Talk Kit
    https://www.drugfreekidscanada.org/wp-content/uploads/2017/06/34-17-1850-Cannabis-Talk-Kit-EN-10.pdf
  2. Clearing the Air About Marijuana Use
    http://www.ontariosdoctors.com/wp-content/uploads/2018/09/cannabis-myth-fact.pdf
  3. What You Should Know About Recreational Cannabis
    http://www.ontariosdoctors.com/wp-content/uploads/2018/09/OMA_Cannabis-Infographic.pdf
  4. Cannabis in Canada resources
    https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/resources.html
  5. CAMH Cannabis Health Information & Resources
    https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/cannabis
  6. e-Couch
    https://ecouch.anu.edu.au/welcome
  7. Big White Wall
    https://www.bigwhitewall.com/V2/LandingV2.aspx

References

  1. Adamson SJ, Kay-Lambkin FJ, Baker AL, Lewin TJ, Thornton L, Kelly BJ, et al. An improved brief measure of cannabis misuse: the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug Alcohol Depend. 2010 Jul 1;110(1–2):137–43.
  2. Legleye S, Guignard R, Richard J-B, Ludwig K, Pabst A, Beck F. Properties of the Cannabis Abuse Screening Test (CAST) in the general population. Int J Methods Psychiatr Res. 2015 Jun;24(2):170–83.
  3. Brown RL, Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995;94(3):135–40.
  4. Knight, J.R., Sherritt, L., Shrier, L.A., Harris, S.K. & Chang, G. (2002). Validity of the CRAFFT Substance Abuse Screening Test Among Adolescent Clinic Patients. Archives of Pediatrics & Adolescent Medicine, 156, 607–614.
  5. Fischer B, Russell C, Sabioni P, van den Brink W, Le Foll B, Hall W, et. al. Lower-risk cannabis use guidelines: A comprehensive update of evidence and recommendations. AJPH Policy 2017;107(8):e1-12. Available from: https://crism.ca/wp-content/uploads/2018/03/LRCUG-2017.pdf
  6. Allan GM, Ramji J, Perry D, Ton J, Beahm NP, Crisp N, et. al. Simplified guideline for prescribing medical cannabinoids in primary care. CFP 2018;64:111-120. Available from: http://www.cfp.ca/content/cfp/64/2/111.full.pdf
  7. Canadian Nurses Association [Internet]. Harm reduction for non-medical cannabis use [cited 2018 Sept 1]. Available from:
    https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/harm-reduction-for-non-medical-cannabis-use.pdf?la=en
  8. Hall W, Fischer B. “Chapter 8: Harm reduction policies for cannabis” in Harm reduction: evidence, impacts and challenges, European Monitoring Centre for Drugs and Drug Addition. (2010). Available from: http://www.emcdda.europa.eu/publications/monographs/harm-reduction_en
  9. Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review. J Med Toxicol. 2017 Mar;13(1):71–87.
  10. Health Canada [Internet]. About cannabis [cited 2018 Sept 1]. Available from: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about.html?utm_source=google&utm_medium=cpc_en&utm_content=marijuana_3&utm_campaign=cannabis-18
  11. UpToDate [Internet]. Cannabis (marijuana): Acute intoxication [cited 2018 Sept 10]. Available from: https://www.uptodate.com/contents/cannabis-marijuana-acute-intoxication
  12. Government of South Australia SA Health [Internet]. Cannabis Withdrawal Management [cited 2018 Sept 10]. Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/substance+misuse+and+dependence/substance+withdrawal+management/cannabis+withdrawal+management

Copyright & Disclaimer

The CEP fully supports the use of the Non-Medical Cannabis Resource by providers, educators, decision-makers and others. Please read the following information prior to use of the resource to ensure appropriate permission is sought and appropriate citation is used.

Creative Commons License

Creative CommonsThe Non-Medical Cannabis Resource is a product of the Centre for Effective Practice. Permission to use, copy and distribute this material for all non-commercial and research purposes is granted, provided that all copies, modifications, and distributions contain full reproductions of this Creative Commons License and the following Disclaimer along with appropriate citation. Use of the Non-Medical Cannabis Resource for commercial purposes or any modifications of the resource are subject to charge and use must be negotiated with Centre for Effective Practice (Email: [email protected])

For statistical and bibliographic purposes, please notify the Centre for Effective Practice ([email protected]) of any use or reprinting of the resource.

Please use this citation when referencing the resource: Reprinted with Permission from Centre for Effective Practice (October 2018). Non-Medical Cannabis Resource. Toronto: Centre for Effective Practice.

Disclaimer

The Non-Medical Cannabis Resource (the “resource”) contains links to websites and other external resources (“Third Party Resources”) that are operated by and/or created by third party organizations. These third party organizations are solely responsible for the information contained in, and the operation of (as applicable), their respective Third Party Resource(s).

This resource was developed for licensed health care professionals in Ontario as a guide only and does not constitute medical or other professional advice. Primary care providers and other health care professionals are required to exercise their own clinical judgment in using this resource.

Neither the Centre for Effective Practice (“CEP”), Ontario College of Family Physicians, Nurse Practitioners’ Association of Ontario, Government of Ontario, the contributors to this resource, nor any of their respective agents, appointees, directors, officers, employees, contractors, members or volunteers: (i) are providing medical, diagnostic or treatment services through this resource; (ii) to the extent permitted by applicable law, accept any responsibility for the use or misuse of this resource by any individual including, but not limited to, primary care providers, or entity, including for any loss, damage or injury (including death) arising from or in connection with the use of this resource, in whole or in part; or (iii) give or make any representation, warranty or endorsement of any of the Third Party Resources, that are owned or operated by third parties, including any information or advice contained therein.