A Clinical Approach to Prescribing Cannabis
All Access Medical Clinic (AAMC) is committed to supporting physicians who wish to acquire a “working knowledge” of the science behind cannabinoids and how to effectively apply this knowledge within a clinical setting. Given this branch of medicine does not have an established clinical history (evidence-based research), the 5 years of experience our physicians and support staff have acquired is vitally important.
Patients tired or unresponsive to prescription drugs are turning to natural types of medicine, and cannabis requests to physicians are increasing exponentially. The following document is intended to clarify and answer some of the questions that physicians may have.
AAMC support staff and physicians have in place standard policies and procedures to deal with patient screening, intake, assessment and documentation. This includes identifying patients with risk factors due to cannabis use. It is important to convey that the use of cannabis is simply a part of an overall strategy to assist the patient in achieving an improved quality of life.
To initiate the process, AAMC has created an “Intake form” which patients can fill out online or can phone in and a support member will walk them through the process. The form includes information concerning the patients past medical history, previous cannabis use (including frequency, timing and method of consumption) as well as a list of previous medications. The purpose of acquiring this information is to ensure the patients safety and prevent abuse. Certain risk factors are considered including any
To aid referring physicians, AAMC has developed an online “referral form”. Our support staff will review the document for completeness and accuracy; and communicate with the patient and/or their physician to acquire additional medical information, if necessary.
Once the patient completes the screening process, an appointment will be made with one of our trained educators and subsequently with an AAMC physician. The purpose of the consultation with our educator is to review the information from the screening process, identify the main purpose (ailment) for the patient’s visit and provide cannabis education. Following the educators review the patient will consult with a physician. When appropriate to recommend medicinal cannabis, a daily dosage regimen will be stipulated, a strain type may be suggested, the “medical document” (prescription) signed and an interval care schedule is established. Following the physician consultation, a second educator discussion will ensue regarding Licensed Producer and ingestion options. Finally, AAMC support staff are available throughout the term of the medical document to answer patient questions regarding product delivery, quality concerns, alternative stain types, pricing options, new strain development and longitudinal care.
There are two sub-species of cannabis: Indica and Sativa. Indices are as a rule more sedative and Sativa’s more stimulatory. Since they are not individual species, they are cross breed to create hundreds of hybrid strains, each strain holding a different pharmacology.
There is no “established” dosing schedule for medicinal cannabis, however according to Health Canada, the average patient use is between 1-3 grams daily. The average percentage of tetrahydrocannabinol (THC) and cannabinoids (CBD) is 17% and 5% respectively. However it should be noted that there is an increased demand for high CBD/low THC flower and oil products. CBD Promotes calmness, and a positive sense of well being, an upbeat mood and relaxation. Patients describe the experience as that of being clear-headed and focused, with no change in cognitive function.
Dosage regimes vary depending on the patients aliment, and preferred method of intake (i.e vaporizing, oral ingestion or smoking). Of all the methods of intake, smoking is the least effective and most physically damaging. The average ingestion of THC when smoking indicates that only 20-25%% of the available THC/CBD is ingested. By example, if the THC in the strain in question was 15%, the patient would ingest approximately 3.5% per gram of smoked, however, since most cannabis cigarettes are normally .75 of a gram, this would equate to a rate of 2.6% THC per dose.
Vaporization, with occurs at between 180 and 200 degrees C (just short of combustion with occurs at 230 degrees C) offers a much more efficient and less harmful method of ingestion. According to University of California researchers, smokeless and odourless cannabis-vaporizing devices deliver the same or a higher level of active therapeutic ingredients and produces the same biological effect as smoking cannabis, but without the harmful toxins.
AAMC support staff will advise patients on usage parameters as well as the risks of cannabis treatment. In particular, patients will be cautioned with regard to driving or the of use of heavy equipment while using cannabis. Also, possible side effects are discussed such as anxiety or mood changes.
Patients will receive from our support staff a thorough understanding of the relevance of Licensed Producers, cannabis types (Indica and Sativa), THC and CBD ratios, pricing, product delivery, packaging, labelling and maintenance of documentation to ensure legality.
To date, medicinal cannabis is not covered as a medication through any provincial health care plan. Occasionally private insurers have covered the cost of cannabis and equipment such as vaporizers, however for the most part patients are must pay for
AAMC and Licensed Producers offer compassionate pricing based on disability and/or the
AAMC operates as private “resource centres” in Vancouver, Nanaimo, Calgary, Edmonton, Toronto and Montreal. Nationally we also offer Telehealth consultations.
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