Cannabis Strategy FAQs
What is the Cannabis Strategy?
Pharmacy professionals, including pharmacists and pharmacy technicians, are trusted members of a patient’s health care team and play an invaluable role in providing quality and safe patient care as more people legally access cannabis. The Cannabis Strategy for Pharmacy simultaneously addresses relevant areas of practice and prepares the College and pharmacy professionals to address evolving cannabis-related issues, while considering how to best serve and protect patients and Ontarians in line with the College’s mandate and within the current legal framework for accessing cannabis.
The development of the Strategy was guided by the College’s public-protection mandate and is consistent with the position of the National Association of Pharmacy Regulatory Authorities (NAPRA) related to cannabis and pharmacy, which was endorsed by Council in June 2017. The Strategy is focused on promoting knowledge among pharmacy professionals as clinical and medication experts to ultimately help patients better understand and avoid risks associated with cannabis and its potential interactions with other medications.
Why is the Strategy coming out now?
The legalization of recreational cannabis, once the Cannabis Act comes into force in October 2018, is expected to result in more open use of cannabis among the public including patients. It is therefore important that pharmacy professionals are prepared to engage in discussions with patients who use cannabis.
What should patients expect?
Patients should expect their pharmacy professional to have the knowledge to assist patients who may be using cannabis to help them make the best decisions about their care to meet their needs or health goals. Pharmacy professionals are often the most accessible healthcare providers for patients and therefore have an opportunity to provide additional support and education related to the use of cannabis as it relates to a patient’s overall pharmacy care, experience and outcomes, such as helping to educate patients on known interactions of cannabis with other medications.
What are the expectations of pharmacy professionals?
The College believes that the profession of pharmacy has a role to play in supporting quality and safe pharmacy care for patients who use cannabis. As medication experts, pharmacists are in a unique role to support quality and effective patient care for those who are using cannabis and to collaborate with other health care professionals to enhance patient safety, even on emerging matters.
Pharmacy professionals are also often the most accessible healthcare providers for patients and therefore have an opportunity to provide additional support and education related to use of cannabis as it relates to their overall pharmacy care and experience. The College supports opportunities for pharmacy professionals to be involved in contributing to greater knowledge and understanding of the impact of cannabis on patient health outcomes.
Does the Strategy address sale of recreational cannabis in pharmacies?
No. Cannabis for recreational purposes can only be dispensed online through the Ontario Cannabis Store or through privately run retail stores that have received a license from the Ontario government.
This Strategy focuses on promoting pharmacy professional knowledge, understanding and competency related to cannabis use and to use their knowledge and skills to educate patients, provide optimal patient care for those who use cannabis along with other medications and encourage professionals to contribute to a broader understanding of the use of cannabis among pharmacy patients and its impact on health outcomes.
The strategy makes no mention of dispensing of cannabis within pharmacies. Why is that?
The College’s regulatory approach focuses on patient safety. It is not the College’s role to advocate for dispensing within pharmacies. We believe that our position and our Strategy strike the right balance for Ontario so that safe access to cannabis is not impeded while recognizing that Ontario pharmacy professionals should play a role in how people use cannabis in the context of their health care experience, regardless of where it is sold.
What is the College’s position of dispensing of cannabis for medical use in pharmacies?
With the recognition that the dispensing of cannabis for medical use within pharmacy is currently not permitted within the existing legal framework, the Ontario College of Pharmacists would not oppose any federal or provincial legislation that would permit the dispensing of non-smoked forms of cannabis for medical use within pharmacies, would not oppose legal dispensing for medical use within pharmacies regardless of whether cannabis is approved as a drug by Health Canada or whether it receives an assigned Drug Identification Number provided that sufficient quality control measures are put in place by Health Canada, and opposes the distribution by pharmacies of any forms of cannabis for the exclusive use or purpose of smoking, and in accordance with any provincial legislation.
Why does the College have this position on the dispensing of cannabis for medical use in pharmacies?
The College’s position and Strategy strike a responsible balance to make sure that the public is protected as society adapts to increased legal access to recreational cannabis and the emerging matter of cannabis for medical use while supporting the profession of pharmacy to play an active and appropriate role as medication and clinical experts to promote positive patient outcomes.
The College also recognizes that cannabis is an evolving matter. As a responsive and responsible regulator, the College may update its position and Strategy as the legislative and regulatory framework in Canada and Ontario related to access of cannabis evolves and becomes more defined over time and as more information about the benefits and risks of cannabis use becomes available.
Can pharmacies dispense or distribute medical cannabis?
Pharmacies must abide by the methodologies of distribution of medical cannabis outlined in the federal cannabis regulations, which state that medical cannabis must be delivered by mail by holders of a license for sale for Medical Purposes.
No. Under the current Access to Cannabis for Medical Purposes Regulations it is illegal for pharmacies (or any retail outlet) to distribute medical cannabis.
Will the College review its Strategy as more information about cannabis becomes available or as governments make decisions that impact where it can be dispensed?
Yes. The College may update its position and Strategy as the legislative and regulatory framework in Canada and Ontario related to access and distribution of cannabis evolves and becomes more defined over time.
How is vaping addressed in the College’s position on cannabis for medical purposes?
The College is aware that there may be potential health distinctions between vapourizing (vaping) cannabis and smoking cannabis. Vaping is when raw cannabis (dried buds) or tetrahydrocannabinol (THC) oil is placed in a vapourizing machine. The product is then heated, but below the level of combustion, allowing fatty resins and oils to melt without burning plant materials. This is different than combustible methods of smoking cannabis, where the plant material is burned (joints, pipes, bongs etc.).
NAPRA’s position is that smoked cannabis products should be subject to the same provincial or territorial legislation as smoked tobacco products as cannabis smoke contains many of the same carcinogenic chemicals found in tobacco smoke. However, some studies have shown that vaping may be seen as a safer alternative for administering cannabis for medical purposes, making vaping an emerging issue that needs to be researched further. There may be long-term health impacts associated with vaping cannabis; however, the current evidence remains inconclusive. Therefore, the College will remain engaged with the literature and findings associated with vaping cannabis and may update its position and Strategy accordingly.
1Matthew N. Newmeyer, Madeleine J. Swortwood, Megan E. Taylor, Osama A. Abulseoud, Thomas H. Woodward and Marilyn A. Huestis, Evaluation of divided attention psychophysical task performance and effects on pupil sizes following smoked, vaporized and oral cannabis administration, Journal of Applied Toxicology, 37, 8, (922-932), (2017).
Is the College advocating for more/easier access to cannabis in pharmacies?
No. The College’s regulatory approach focuses, first and foremost, on patient safety. It is not the College’s role to advocate for distribution of cannabis within pharmacies.
Can I compound/manipulate cannabis into edibles? Can a patient bring their own recreational cannabis to a pharmacist to have it altered or compounded into a capsule or cream?
No. The Cannabis Act states that activities with cannabis are prohibited unless authorized. Under the Act, it is prohibited to obtain, or offer to obtain cannabis by any method or process, including altering its chemical or physical properties. As such, any compounding activity by a pharmacy professional involving cannabis would require enabling regulations, in addition to complying with applicable provincial requirements.
Will the sale of cannabis edibles for recreational use be permitted?
The government has indicated that it intends to add cannabis edible products and cannabis concentrates to the list of products permitted for legal sale authorized no later than 12 months following the coming into force of the Cannabis Act, once appropriate regulatory controls are developed.
Do I need to ask all my patients about their cannabis use?
Pharmacists are expected to gather relevant information through dialogue with the patient to assess the appropriateness of a prescribed medication and to identify potential drug interactions. This may include asking about allergies, medical conditions, and also lifestyle factors, such as the patient’s diet, alcohol, exercise, tobacco, and cannabis use.
How should I respond to questions from the public or other health professionals on cannabis use?
As with any medication or substance, pharmacists are considered to be the experts and should be able to effectively respond to drug-related inquiries. Ultimately, pharmacists are in a position to help patients better understand cannabis use and avoid the associated risks through harm prevention strategies. In addition to the opportunity to provide advice on safe and appropriate cannabis use, there is also an opportunity to identify and assist persons who are at risk of cannabis use disorder. Also, as a patient could acquire recreational cannabis - without the intervention of a health professional – and intend to use it for medical purposes, pharmacists are in an ideal position to provide patient education in such circumstances.
Why is the College requiring pharmacists to be educated on cannabis and not other substances, such as opioids, naloxone and biologics?
The legalization of cannabis is an extraordinary public policy shift that has a significant impact on the health and safety of Canadians. The College has a duty to respond and pharmacy professionals must adapt to this important change to ensure patients receive safe and quality care.
Education on opioids, naloxone and biologics is part of undergraduate education on pharmacotherapy as initial training for pharmacists, and practicing pharmacists are expected to identify their own knowledge gaps about emerging drugs and therapies and seek out education before dispensing them. However, cannabis education has been limited. There was no education about cannabis in undergraduate programs until it was legalized in 2018, and education programs available to practicing pharmacists until now have focused on the benefits of medical cannabis. These programs rarely addressed patient care for those who use cannabis recreationally, which is covered in the mandatory education courses approved by the College, along with the ethical and professional responsibilities of the healthcare provider.
The decision to make cannabis education mandatory for Part A pharmacists was firmly grounded in patient safety and a commitment to protect and serve the public interest on a rapidly evolving health matter for Ontarians. It was recommended by the College’s Cannabis Task Force, which included members of the public as well as the profession. Please go here for more information regarding the Task Force’s recommendation in the context of a broader Cannabis Strategy for Pharmacy.
Why is cannabis education mandatory when pharmacists are not even allowed to dispense it?
As medication experts who are often the most accessible healthcare provider for patients, pharmacy professionals play an important role in educating their patients if equipped with the necessary knowledge. As the availability of recreational cannabis expands, pharmacists will have to consider that any patient, not only those prescribed medical cannabis, may need to be informed on the interaction of cannabis with other medications, much like they do for alcohol use. While alcohol and tobacco are not dispensed in pharmacies, pharmacy professionals do have the knowledge to educate their patients on their health impacts and interactions with other medications. The consumption of alcohol and use of tobacco also have a longstanding history and knowledge about their impact on health is readily available and commonly considered, while the use of cannabis is less understood and information about its impact on health outcomes is far more limited.