The federal
Cannabis Act and
Cannabis Regulations are the primary law governing cannabis in Canada.
In B.C., the provincial
Cannabis Control and Licensing Act and its associated regulations support the province's implementation of legalized cannabis.
For details about cannabis for medical purposes, visit
Health Canada's website. For details about cannabis for non-medical purposes, visit the
BC Government's website.
What to consider
Nurses need to know that some activities with cannabis are still illegal. Before carrying out any activities with cannabis, whether for medical or non-medical purposes, nurses should familiarize themselves with federal and provincial cannabis legislation.
Nurses also consider:
- Their competence to carry out the activity.
- Their organization's policies and procedures related to cannabis.
- Their ability to authenticate the substance and determine the dosage.
The requirements set out in the BCCNM standards of practice specific to their nursing designation. These include
- their responsibility and accountability for their nursing actions,
- documentation requirements,
- collaboration and communication with the health care team, and
- identification and avoidance of actual, potential or perceived
conflicts of interest when interacting with licensed producers of cannabis or cannabis retailers.
Authorizing Medical Cannabis
Under section 272 of the
Cannabis Regulations, a nurse practitioner may authorize medical cannabis for a client if it is required for the condition for which the client is receiving treatment.
Nurse practitioners in B.C. may provide a medical document or, if practising in a hospital, issue a written order for medical cannabis, in accordance with the requirements of Part 14 of the Cannabis Regulations.
The
BCCNM Prescribing Drugs standards will apply to the authorization of medical cannabis.
Nurse practitioners who plan to authorize medical cannabis first familiarize themselves with the
BCCNM prescribing drugs standards, the
Cannabis Act and
Cannabis Regulations (in particular,
Part 14), review the
information about cannabis that is available from the Canadian Nurses Protective Society (CNPS), and review and comply with their organization's policies about medical cannabis.
Medical cannabis refers to cannabis that is authorized by a medical document or written order issued under Part 14 of the
Cannabis Regulations. It does not include prescription drugs containing cannabis, which are listed in in Schedule I of the
Drug Schedules Regulation and are regulated under Part 8 of the
Cannabis Regulations, such as Sativex. Nurse practitioners who prescribe drugs containing cannabis comply with the same standards, limits and conditions that apply to the prescribing of any other drugs.
Conflict of Interest & Authorizing Medical Cannabis
NPs identify and seek to avoid actual, potential or perceived conflicts of interest when authorizing medical cannabis. For example, a conflict of interest could occur if the commercial or financial interests of a medical cannabis clinic or licensed producer interfere with the NP's professional responsibilities or the client's best interests. NPs with questions about conflict of interest should contact BCCNM or CNPS.
FAQs
- Can nurses administer medical cannabis to adult clients in hospital settings?
-
Generally, yes, if there is a client-specific medical document or order from a physician or nurse practitioner, the employer permits nurses to do so, and the packaged and labelled cannabis product has been received from a licensed retailer or producer. Subsection 348 of theCannabis Regulations sets out the requirements for cannabis products in hospital settings.
Nurses also need to consider:
- Their competence to carry out the activity.
- Their organization's policies and procedures related to cannabis.
- Their ability to authenticate the substance and determine the dosage.
- The requirements set out in the BCCNM standards of practice specific to their nursing designation. These include
- responsibility and accountability for your nursing actions,
- documentation requirements, and
- collaboration and communication with the health care team.
- Applicable federal and provincial legislation.
- Can nurses administer medical cannabis to their adult clients in non-hospital settings?
-
Generally, yes, if there is a client-specific medical document or order from a physician or nurse practitioner, the employer permits nurses to do so, and the client has legally obtained the medical cannabis. Subsections 266(1)(f) and 269(2) of theCannabis Regulations give adults (including nurses) this authority.
Nurses also need to consider:
- Their competence to carry out the activity.
- Their organization's policies and procedures related to cannabis.
- Their ability to authenticate the substance and determine the dosage.
- The requirements set out in the BCCNM standards of practice specific to their nursing designation. These include
- responsibility and accountability for your nursing actions,
- documentation requirements, and
- collaboration and communication with the health care team.
- Applicable federal and provincial legislation.
- Can nurses administer medical cannabis to clients under 19 years of age?
-
There are specific provisions in BC'sCannabis Control and Licensing Act and BC'sCannabis Control Regulation that regulate the administration of cannabis to minors. In particular, there are specific consent requirements for minors. See section 26 of theCannabis Control Regulation for more details.
Nurses also need to consider:
- Their competence to carry out the activity.
- Their organization's policies and procedures related to cannabis.
- Their ability to authenticate the substance and determine the dosage.
- The requirements set out in the BCCNM standards of practice specific to their nursing designation. These include
- responsibility and accountability for your nursing actions,
- documentation requirements, and
- collaboration and communication with the health care team.
< /ul>
- Applicable federal and provincial legislation.
- Does BCCNM have any restriction on nurses' personal use of cannabis for recreational purposes?
-
Nursing is demanding work, in which impairment could result in direct and significant risk of injury to clients. Nurses must adhere to the BCCNM Standards of Practice, and in particular, the requirement that they maintain their physical, psychological, and emotional fitness to practice.
- Can NPs provide a medical document for or order medical cannabis?
-
Yes, as of July 22, 2019. Under section 272 of the Cannabis Regulations, a nurse practitioner may authorize medical cannabis for a client if it is required for the condition for which the client is receiving treatment.
Nurse practitioners do not authorize or order medical cannabis for themselves, a family members, or anyone else who is not a client the NP is treating in a professional capacity.
Nurse practitioners who plan to authorize medical cannabis:
- If an NP is approached to work for a licensed producer/retailer of cannabis or a medical cannabis clinic, what should they consider?
-
An NP needs to assess the situation to identify and seek to avoid actual, potential or perceived conflicts of interest. For example, a conflict of interest could occur if the clinic or producer’s commercial or financial interests interfere with the nurse’s professional responsibilities or the client’s best interests.
An NP also needs to consider whether they can meet the Prescribing Drugs standards in that particular setting. The Prescribing Drugs standards require that NPs:
- only authorize cannabis for a client the NP is treating in a professional capacity
- review the client’s health history and other relevant factors (e.g. age, gender, lifestyle, the client’s perspective on their health)
- undertake an appropriate clinical evaluation
- obtain the best possible medication history for the client, including accessing PharmaNet prior to authorizing medical cannabis
- establish or confirm a diagnosis for the client
- document the indication and duration for which medical cannabis is being authorized, the goals of treatment, and the rationale for its use over alternatives
- advise clients about the side effects and risks of medical cannabis
- complete medical documents or written orders for cannabis in accordance with the requirements set out in the Cannabis Regulations
- retain any copy of the medical document for cannabis in the client health record
- monitor and manage the client’s response to medical cannabis as appropriate
- communicate and collaborate appropriately with client’s health care team
NPs who are considering working in this type of setting are encouraged to contact BCCNM practice support and Canadian Nurses Protective Society for more information.
- Why do NPs have to access PharmaNet before ordering medical cannabis?
-
Access to a client's PharmaNet profile is an important part of obtaining the best possible medication history for the client and will allow NPs to assess whether there are any potential contraindications to medical cannabis.
-
- What does the College mean when you say the NP can only authorize cannabis for clients they have a professional relationship with?
-
This means that NPs do not casually authorize cannabis for persons. It also means that, when authorizing cannabis, NPs ensure that they have a professional relationship with the client and provide this care within an established treatment plan, including the appropriate level of assessment, follow up, and adherence to the standards of practice.