Recreational Marijuana

Clearing the haze: How the legalization of recreational marijuana may affect your doctors approach

The recreational use of marijuana is legal across Canada effective October 17, 2018. So, will the new law signal the end of marijuana for medical purposes?

Impact on marijuana for medical purposes

Although the federal Cannabis Act1 legalizes and regulates marijuana for personal use, it does not substantively change or affect the current regulations around marijuana for medical purposes.

The government purposely kept the legislation governing marijuana for personal use separate from the regime for marijuana for medical purposes. The reasons include ensuring individuals who need marijuana for medical purposes are not limited by the restrictions that apply to recreational use under the Cannabis Act.

For example, some patients may ask their insurer to reimburse them for the cost of marijuana for medical purposes, which presumably will not be possible for recreational cannabis. As well, while there is no age restriction on access to marijuana for medical purposes, the Cannabis Act restricts access to recreational marijuana to persons 18 years of age and older. The limits for possession are also different under the two regimes.

The new legislation for recreational marijuana does not change the role of the physician or nurse practitioners plays with respect to marijuana for medical purposes. It is expected patients will continue to ask for the medical documents needed to access marijuana for medical purposes. When determining whether it is appropriate to complete a medical document for a patient, we should follow the guidelines and policies of our medical regulatory authority (College) that are specific to marijuana for medical purposes.

Impact on other aspects of medical practice

Until many of the details concerning the legal use of recreational marijuana are fleshed out in legislation and by-laws at the provincial and municipal levels, it’s difficult to predict its full impact. Parts of our medical practice that may see changes include police requests for blood samples, and the duty to report patients unfit to operate a motor vehicle.

Police requests for blood samples

We may see an increase in police requests for blood samples from patients suspected of driving while impaired by marijuana, especially from the emergency room. The government has amended the Criminal Code, making it an offence to have a blood drug concentration (BDC) equal to or in excess of the prescribed level for tetrahydrocannabinol (THC) within two hours after driving a motor vehicle. These amendments will also make it somewhat easier for police to demand a blood sample from a suspect, which could result in more requests to physicians.

We may also find that the police have a greater sense of urgency in requesting blood samples from suspected marijuana-impaired drivers than suspected alcohol-impaired drivers. BDC levels, particularly for smoked cannabis, can decline more rapidly after consumption than alcohol so time can take on greater importance for the police.

Despite these amendments and any perceived sense of urgency, we are still not allowed to take blood samples from competent patients without their consent. It is not an offence to refuse to take a sample from an individual in these circumstances.

If we determine a patient is incapable, but the police have obtained a search warrant requiring the taking of blood from this patient, we must comply. The police can only obtain and execute such a warrant if a qualified medical practitioner forms the opinion that the individual is unable to consent to the taking of a blood sample, and taking the sample would not endanger the person’s life or health.

Clinical issues

Marijuana may interact with other medications being taken by our patients. It may also potentially affect a patient’s existing medical condition.

The legalization of recreational marijuana may prompt us to consider more routinely asking patients about the use of the substance. This will allow us to better assess the health risks and potential interactions with other medications.  You should expect discussions about the known risks of cannabis consumption on health. We will document these discussions in the your medical record, to be compliant with the recommendations of The CMPA.

Fitness to drive

Please consider marijuana consumption might render our patients unfit to operate a motor vehicle safely. Health Canada states, "...it is well known that exposure to [cannabis] impairs psychomotor performance and patients must be warned not to drive or operate complex machinery after smoking or eating cannabis or consuming psychoactive cannabinoid medications (e.g. dronabinol, nabilone, nabiximols)."

You may also wish to consult with your provincial or territorial motor vehicle licensing authority about any guidance on the use of cannabis and driving.