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Patient Journey: Medical Cannabis

While medical cannabis has been used by doctors in the treatment of arthritis symptoms since 2001, many people still have questions.  This resource will help you understand the different steps involved in adding medical cannabis to your treatment plan, if appropriate.

First Steps

Considering medical cannabis for arthritis

While medical cannabis can’t cure arthritis or slow disease progression, it may help some people with arthritis pain and inflammation, as well as poor sleep and anxiety. However, medical cannabis is not right for everyone. Typically, it’s used only after trying other arthritis management strategies first, such as therapeutic exercise, weight management, and pain relief medication. If you’ve tried other methods and you’re still seeking relief, it’s important to get the facts and speak to a healthcare professional before trying cannabis. Medical cannabis should not be used to replace other medications, but rather used in conjunction with your current medications. There is a perception amongst some people that medical cannabis is the better or more effective choice for treatment because it is natural, but this is not necessarily the case.

You should not use medical cannabis if you are pregnant or breast-feeding; allergic to cannabinoid products; or, if you have a history of psychotic illness, substance abuse or suicidal thoughts. People under the age of 25 are also advised against using medical cannabis for arthritis symptoms.

Learning more about medical cannabis

Take the time to learn about medical cannabis and whether it might be an appropriate choice for you. Visit the Arthritis Society’s Medical Cannabis page and Online Guide to learn more about the difference between CBD & THC, different ways of consuming medical cannabis and their effects, as well as possible risks and side effects.

Knowing the law

It’s important to be aware of the legislation that exists around cannabis use. In Canada, to purchase medical cannabis products, you will need to obtain a medical document signed by a doctor or authorized nurse practitioner. While non-medicinal cannabis is now legal in Canada, the Arthritis Society recommends obtaining a medical document to help ensure appropriate dosing, monitoring of effects and symptoms, as well as access to rights that recreational cannabis users don’t have, such as an increased carrying limit.

Individuals can carry only up to 30 grams of dried cannabis (or equivalent) per person in public for non-medicinal use, whereas authorized patients are allowed to carry an additional 30-day supply of their prescription or 150g, whichever is less. Additionally, while smoking or vaping non-medicinal cannabis may be prohibited in some areas, an authorized user of medical cannabis can smoke or vaporize their medicine in public, as long as they do so in a space that is also designated for public tobacco use. Smoking medical cannabis is not recommended.

The federal government has established legal limits for blood THC content. Individuals should not drive after using cannabis. The amount of time that is needed before driving depends on the method of administration and the THC content of the cannabis used. The effects of edibles or oral formulations can persist for several hours and should be used with caution if planning to drive. For more information on prohibited drug concentrations, impaired driving laws and potential penalties, visit the Department of Justice’s website.

Talking with your doctor

Before trying cannabis to address your arthritis symptoms, it’s important to talk to your doctor. They can help you understand the potential risks and benefits, whether it may be appropriate for you, and if so, provide you with a medical document. By this point, most physicians are aware of medical cannabis, which makes this initial conversation easier than it would have been even a few years ago. Your physician may not be ready to authorize medical cannabis but they should be open to the conversation and ideally refer you to someone with the required expertise.

Approach the matter from the perspective of seeking out health information focusing on a specific issue you want to address such as pain or sleep. For example, “I’ve read about medical cannabis being used to manage chronic pain and I was wondering if this would be a good choice for me.” An assessment for medical cannabis should not be that different than being evaluated for any other treatment or medication. Before making a decision, a physician should be aware of your physical and mental health history, your diagnosis of arthritis, other physical or mental health conditions you might have, your reasons for considering medical cannabis, and any medications you are taking.

  • What if my physician is against the use of medical cannabis?

    It is important to first understand if your physician is against the use of medical cannabis in general, or for you in your particular circumstances. There are a number of factors that could make it unsafe for some individuals to use medical cannabis. If your doctor feels that medical cannabis would not be appropriate for you given your particular situation, you can ask for a further explanation to help you understand why it might not be a good choice.

    However, if your physician does not feel comfortable authorizing or monitoring the use of medical cannabis in general, it is reasonable to ask for a referral to a physician with more expertise in this area. Most physicians are willing to forward patients to physicians who are familiar with authorizing medical cannabis and can advise patients on products and dosing. In the unlikely situation where a physician will not make a referral, there are clinics that will accept self-referrals, though this route is generally advised against if it can be avoided. For more information on talking to your doctor about medical cannabis, visit the Arthritis Society’s Doctor Discussion Tool

For a list of questions you might want to ask your doctor, visit the Arthritis Society’s Medical Cannabis: A Guide to Access.

Self-referral to medical cannabis clinic (if necessary)

If possible, it is advised to explore medical cannabis as a treatment option with your family physician, rheumatologist, or a referral from your doctor. In the uncommon event that your doctor refuses to make a referral, you can self-refer to a medical cannabis clinic or online service. If there is a clinic you can visit in your community, this is preferable to an online service, as a clinic can provide a full health assessment. Follow up visits, particularly if your condition is stable, can be done virtually. Do your research beforehand to ensure that a clinic or service is reputable, has knowledgeable doctors on staff, and will deny authorization to individuals at higher risk of harm from medical cannabis.

A physician at a clinic or with an online service should perform a full assessment of your physical and mental health, health history, arthritis symptoms and current medications before authorizing medical cannabis. Self-referral to a medical cannabis clinic should not be used to seek a second opinion if your doctor has determined that medical cannabis would be unsafe for you given your particular circumstances. For example, if you are pregnant or breastfeeding, have a personal or family history of psychotic illness, or have a pre-existing condition that might put you at higher risk of adverse events, your doctor may determine that medical cannabis would be unsuitable for you.

 

"Your doctor is the best place to start if you are considering medical cannabis use for arthritis.  They can help determine if it might be appropriate for you or provide a referral to someone with greater expertise in the area."

 

Access

Authorization

Authorized:

If a doctor or authorized nurse practitioner determines that medical cannabis might be a suitable addition to your arthritis treatment plan, they will provide you with a medical document of authorization. This document will enable you to purchase cannabis through Health Canada-licensed sellers or apply to produce your own cannabis for medical purposes. The medical document will contain your authorized daily dosage as well as the period of use for which you are authorized, which cannot exceed 12 months at a time. When a patient is starting medical cannabis, most physicians will start with a low dose and increase as required to manage symptoms. Most physicians will also start with a pure CBD preparation as this is the non-intoxicating component of medical cannabis and will add THC in small amounts only in specific situations if needed.

Not authorized:

Medical cannabis is not a suitable treatment option for everyone. There are a number of factors that could increase an individual’s risk of adverse events, such as certain medical and psychiatric conditions, pregnancy or breastfeeding, as well as age. If a doctor will not authorize the use of medical cannabis based on your particular circumstances, it’s important that you understand their reasoning and why medical cannabis may be unsafe or inappropriate for you.

Medical cannabis is typically a third-line treatment option for arthritis. If you haven’t tried other standard arthritis treatments yet, a doctor may suggest you try first- and second-line treatments before trying medical cannabis. Additionally, if you are seeking to replace disease-modifying arthritis medications (such as methotrexate or biologics) with medical cannabis, your doctor should discuss with you that this is not a realistic expectation. As medical cannabis can only address symptoms of arthritis and not slow disease progression, replacing your regular arthritis medications with medical cannabis can result in further damage to your joints. Your doctor may also advise against the use of medical cannabis if you have just started on a number of other medications or if you have a new or evolving health issue.

Understanding the medical cannabis authorization document

Accessing medical cannabis in Canada requires obtaining a medical document from a doctor or authorized nurse practitioner. The Government of Canada’s Cannabis Regulations define a medical document as “a document provided by a health care practitioner to support the use of cannabis for medical purposes.” Your doctor can use a templated form from the government or a different form, though all medical documents must contain the following information, according to section 273 of the Cannabis Regulations:
 

  • the health care practitioner’s given name, surname, profession, business address and telephone number and, if applicable, their facsimile number and email address;
  • the province in which the health care practitioner is authorized to practice their profession and the number assigned by the province to that authorization;
  • the given name, surname and date of birth of the individual who is under the professional treatment of the health care practitioner;
  • the address of the location at which the individual consulted with the health care practitioner;
  • the daily quantity of dried cannabis (or equivalent), expressed in grams, that the health care practitioner authorizes for the individual; and
  • a period of use, specified as a number of days, weeks or months.

The period of use specified cannot be longer than one year. The medical document will enable you to register to buy or produce a limited amount of cannabis for your own medical purposes. To register to purchase medical cannabis, you will need to submit your medical document to a Health Canada-licensed seller. To register to produce cannabis for your own use or to designate someone else to produce it for you, you will need to submit your medical document and an application form directly to Health Canada. For more information, you can visit the webpage Medical document authorizing the use of cannabis for medical purposes on the Government of Canada’s website.

Purchasing medical cannabis

In Canada, there are three ways to access medical cannabis:
 

  • buying cannabis from a federally licensed seller authorized to sell medical cannabis
  • registering with Health Canada to produce a limited amount of cannabis for your own medical purposes
  • designating someone to produce medical cannabis for you

While cannabis for recreational use is now available through authorized retailers and online sales platforms, it is advised to use medical channels to purchase cannabis. This will ensure proper monitoring of your dosage and any potential negative effects, as well as ensure you are able to access the rights and tax benefits afforded to registered medical cannabis users.

  • Why Should I Register to Use Medical Cannabis Rather Than Buy Recreational Cannabis?

    Obtaining cannabis through medical channels can help keep you safer, in that your physician will be able monitor and adjust your dosage and frequency of use to identify optimal levels to help alleviate your arthritis symptoms while minimizing side effects. Initiating medical cannabis can be daunting as there are many producers and products available. A knowledgeable physician will help you in selecting the right producer, the correct products and outline a plan for introducing medical cannabis to your current medication regimen. There are a number of other benefits to registering as an authorized medical cannabis user, including:
     

    • Increased carrying limits
    • Greater rights with respect to public consumption
    • Greater rights in the workplace
    • Tax incentives
    • Reliable access, quality and consistency
  • Registering with a Federally-Licensed Seller

    After you have received a medical document from your doctor authorizing your use of cannabis for medical purposes, you will need to register with a licensed seller.  This involves: 

    • completing a registration form specific to that licensed seller; and 
    • providing your original medical document 

    You can find registration forms on the licensed seller’s website or by contacting them directly.  If you have any questions about application requirements, contact the licensed seller.   

    A complete list of licensed sellers can be found on the Government of Canada’s website Licensed cultivators, processors and sellers of cannabis under the Cannabis Act.  It’s important to ensure that a seller has a license for medical cannabis.  Under the column “License(s)”, this will appear as “Sale (Medical)” if they have the necessary license.  You can also enter the word “Medical” in the “Filter Items” search bar for a complete listing of all medical cannabis licensed sellers. 

    Once you have registered with a licensed seller, it is possible to switch to a different seller, though you will need to request that your original medical document be transferred directly to the new licensed seller, or that it be returned to you.  You will need to cancel your registration with your current licensed seller and register with the new provider, who will require the original copy of your medical document.   

    As a registered medical cannabis user, you are permitted to possess up to a 30-day supply of dried marijuana, or its equivalent, to a maximum of 150g.  The Government of Canada’s website Accessing Cannabis for Medical Purposes from a Licensed Producer provides additional information.  

    It is also possible to register with Health Canada to produce a limited amount of cannabis for your own medical purposes, or to designate someone to produce cannabis for you.  However, it is not recommended to produce your own, as dosage, quality and consistency can vary based on how it is grown.  For more information, visit the Government of Canada’s website on Registering to Produce or Possess Cannabis for Your Own Medical Purposes website. 

    For a list of questions you might want to ask a licensed seller, visit the Arthritis Society’s Medical Cannabis:  A Guide to Access.  

For more information, visit the Arthritis Society’s resource Medical Cannabis: A Guide to Access [3.2 MB].

 

“Accessing cannabis for your arthritis through medical channels rather than from recreational sellers will help ensure proper monitoring, dosage, and greater rights under the law.”

 

Usage

Dosing:

The medical document you receive from your doctor will indicate the daily quantity of medical cannabis you are authorized to access. Your doctor should provide you with an individualized plan for what products to purchase and how to start your trial of medical cannabis. Cannabis affects everyone differently, so there is no scientifically supported dosage for any particular medical condition. The primary approach to medical cannabis dosing is to “start low and go slow.” If it is your first time using medical cannabis, it’s recommended to start with a CBD-dominant product at a low dose and increase gradually until your symptoms are addressed. THC should be introduced only as needed.

Finding the right product and dosage for you may take some trial and error, which is why monitoring by a doctor is important. Oils and capsules generally make it easier to track dosage, though other cannabis delivery methods are available. Smoking medical cannabis is not recommended. There are alternatives to smoking such as using a vaporizer or sublingual spray which provide a safer alternative to this option. To learn more about the difference between CBD and THC, delivery methods, and dosing, visit the Arthritis Society’s Medical Cannabis resources.

Ordering medical cannabis

  • Once your registration form and medical document have been processed by your chosen licensed seller, they will contact you to by email or phone to let you know.
  • You can place orders to a licensed seller online or by phone. This generally requires a credit card or debit card. Orders cannot be paid for with cash. The seller will often have service representatives available to help you navigate the process or to answer any questions.
  • Once your ordered is processed, it is shipped by courier or post to the address your licensed seller has on file for you.
  • At the time of writing, medical cannabis can only be obtained by direct mail, there are no licensed medical cannabis storefronts at the moment. Stores you may see in your community are for recreational cannabis sales only.
  • If you are registered with a licensed seller, the cost of medical cannabis is considered a medical expense by the Government of Canada, so you can claim these expenses on your tax return. For more information, visit the Government of Canada’s website on Eligible Medical Expenses You Can Claim on Your Tax Return.

Using medical cannabis

  • CBD and THC

    Medical cannabis is available in many different forms and with varying levels of CBD and THC, the two main active ingredients in cannabis. CBD, or cannabidiol, is non-euphoric, meaning that it won’t make you feel “high.” It can also help counter-act some of the psychoactive effects of THC when they are used in combination. CBD can be helpful for managing inflammation, chronic pain, anxiety and insomnia.

    THC, or tetrahydrocannabinol, can produce an intoxicated or “high” feeling when taken in larger doses, but may help alleviate some symptoms when taken in smaller doses or combined with CBD. THC can help alleviate pain, anxiety and nausea.

    For people with arthritis, it is recommended to start out with a CBD-dominant product and add small amounts of THC if needed.

    Visit the CBD & THC section of the Arthritis Society’s Medical Cannabis and Arthritis module for more information.

  • Methods of Consumption

    Medical cannabis can be taken orally, inhaled or applied topically as a cream.  Different forms of cannabis will effect individuals at different rates.  For managing arthritis symptoms, it is advised to start with CBD-dominant oils or capsules to more easily track dosage.  However, be sure to follow directions from your doctor and/or licensed seller.

    Medical cannabis can be taken orally as an oil, capsule, spray, dissolvable strip, or in edible format.  “Edibles” is a term used to describe cannabis-infused foods, which can include baked goods, chocolates, or other foods prepared with cannabis-infused cooking fats.  Topical forms include creams, lotions and topical oils.  Methods of inhalation include vaporizers, e-cigarettes, or joints/cannabis cigarettes.  Smoking medical cannabis is not recommended. 

    Inhaled forms of cannabis are the quickest to take effect and can last up to three hours.  The effects of topicals and orally-consumed cannabis can last up to six hours or longer for extended pain relief.  Topicals can act at the site of pain with effects lasting several hours. With topicals, little to no active ingredients (CBD or THC) enter the bloodstream, making this a method of avoiding ingesting these compounds.

    If you are using medical cannabis edibles, it is important to start with a small quantity that has a lower amount of THC.  Cannabis-infused foods can take up to two hours for your body to process and may have a stronger and longer-lasting effect than other types of cannabis.

    For more information on ways to consume medical cannabis, visit the Forms of Medical Cannabis section of the Arthritis Society’s Medical Cannabis and Arthritis module.

    Our Understanding Medical Cannabis [806 Kb] infographic also provides an overview of methods of consumption. 

Monitoring effects

Finding the right medical cannabis product and dosage to maximize your arthritis symptom relief while minimizing side effects can take some trial and error. It’s important to monitor the effects of your treatment and discuss these with your doctor. Additionally, as your condition changes over time, you might need to make adjustments to the products or dosage you are taking. It can be helpful to keep track of your arthritis symptoms as well as your medical cannabis use and its effects, including both positive and negative. Starting a daily treatment diary can help you gain a better understanding of how well your treatment is working and whether you may need to adjust or reassess your use of medical cannabis.

  • What to track and monitor
    Some areas you might want to track in your treatment diary include:
     

    • Arthritis symptoms before taking cannabis
    • Severity of symptoms (rate on a scale of 1-10, with 1 being Very Mild and 10 being Very Severe)
    • Time cannabis taken
    • Product used
    • Dosage used
    • How long did it take to feel effects?
    • How long did the effects last?
    • Arthritis symptoms after taking cannabis
    • Severity of symptoms after taking cannabis (1 = Very Mild, 10 = Very Severe)
    • Any positive effects
    • Any negative effects
    • Severity/Unpleasantness of negative effects (1 = Very mild, 10 = Very Severe/Unpleasant)
    • How would you rate your overall experience with your treatment? (1 = Very Negative, 10 = Very positive)

If you are keeping track of your cannabis use, bring this information to your next doctor’s appointment so that your doctor can help determine if any adjustments need to be made. There are some digital apps you can download on your phone to help you track your experience with medical cannabis. However, before using a digital service, make sure it is from a reputable company that has involved doctors in the development process, and that you are familiar with and comfortable with their privacy policies. Some apps may use aggregated data for research purposes and/or sell data to third party companies.

Returning to doctor/follow up

Maintaining communication with your doctor about your use of medical cannabis will help ensure the right arthritis treatment approach for you. If you are experiencing any negative or unpleasant side effects from medical cannabis, it is important to let your doctor know. You should also notify your doctor if there are any changes to your other medications or if you have a new or worsening health condition. They may adjust your dosage or determine that medical cannabis is not appropriate for you.

Your doctor can also help re-assess your dosage and product if your current medical cannabis treatment doesn’t seem to be helping your arthritis symptoms. You will also need to speak to your doctor to renew your medical document annually. As with all medications, doctors can only authorize a certain amount at a time. Registration with a licensed seller is valid for 12 months. Before your registration expires, you will need to request a new medical document from your doctor and submit it to your licensed seller.

Reassessing use of medical cannabis

As with any medication, it’s important to evaluate the effectiveness and any potential negative impacts of your medical cannabis use to determine whether it should be a continued part of your arthritis treatment plan. If you have any questions or concerns, it’s important to speak to your doctor about them. If you are planning to become pregnant, it is advised to discontinue use of medical cannabis. Cannabis should not be used to manage pregnancy-associated symptoms such as nausea. The long-term effects of cannabis use on fetal development are unknown and caution should be used.

As medical cannabis cannot treat or slow the progression of arthritis, your symptoms may worsen over time or your current dosage may decrease in efficacy. If so, your doctor can help reassess your dosage and determine if an increase might be appropriate.

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Recognition

This resource was reviewed in November, 2020 with expert advice from: 

Carolina Landolt-Marticorena, MD, PhD, FRCPC 
Rheumatologist, Summertree Medical Clinic & Runnymede Healthcare Centre 
Scientific Advisor, MediPharm Labs 

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