FALL 2017

medical cannabis, the system that dispenses it, and Health Canada’s recommendations for healthcare professionals around managing this recent addition to approved medical therapies. [Appendix A, Information for Health Care Professionals on Medical Cannabis from Health Canada] First, an important cautionary note – combining use of cannabis with other prescribed medications or recreational drugs can lead to unpredictable and potentially dangerous effects. The risks of cannabis use to both immediate and long-term health are described in the Lower-Risk Cannabis Use Guidelines (LRCUG) released in June 2017 by several Canadian medical groups. [Appendix B, Information on Lower-Risk Cannabis Use from Centre for Mental Health and Addiction (CAMH)] At the local level, Quinte Counselling Services and Quinte Assessment and Treatment Group provide Employee Assistance Program services, psychological assessment and psychotherapy services including assistance with abuse and addiction.

The endocanninoid system

The body’s endocannabinoid system naturally produces chemicals like those found in the cannabis plant, which transmit signals between the brain and nerve cells throughout the body. In fact, cannabinoid receptors develop in humans before birth and naturally produced endocannabinoid compounds are even found in a mother’s breast milk. Research suggests that the endocannabinoid system is involved in a wide range of human bodily functions and dysfunctions, including development of the nervous system, immune function, inflammation, digestion, psychiatric disease, memory, sleep, pain, and regulation of stress and emotions.

Forms of cannabis

Cannabis is available in a variety of forms – it may be smoked, vapourized (“vaped”), or inhaled using an e-cigarette device, consumed as oil under the tongue or in food, juiced, or brewed as tea, or applied topically on the skin. The original prescribed, pharmaceutically-developed cannabinoids are taken orally: Nabilone (Cesamet) is synthetically produced and taken in capsule form, and THC/CBD (Sativex) is a spray derived from cloned cannabis, also taken by mouth. Another synthetic oral product, dronabinol (Marinol), is no longer available due to adverse effects. [Appendix H, Information from the nonprofit Canadian Consortium for the Investigation of Cannabinoids (CCIC)] Another untested, non-pharmaceutical form of synthetic cannabinoids (e.g., K2 and Spice) are offered as “legal” forms of cannabis. These have more severe psychoactive effects and carry significant health risks, including cases of death.10 [Appendix I, March 2014 Bulletin on Synthetic Cannabinoids from the Canadian Community Epidemiology Network on Drug Use]Method of administration The way a person takes cannabis will depend on their treatment requirements – such as how quickly they require it to take effect and how long they want the effect to last. The effects of smoked/vaped cannabis begin within minutes, and last a shorter time compared to taking cannabis in foods. In contrast, the effects of ingested cannabis occur more slowly over several hours, and last longer. Although there is conflicting evidence regarding the carcinogenic potential of cannabis smoke, Health Canada notes that this route of administration can have negative effects on respiratory health and is best avoided. While not entirely risk-free, vapourization or “vaping” and use of e-cigarette devices offer a lower-temperature alternative with less of the toxic by-products of smoking, and more efficient uptake of THC from the cannabis. Dabs are inhaled in very small quantities using a specially developed vaporizer called a dab rig. Edible cannabis oils can be added to foods or taken under the tongue, which is the most efficient means of maximizing the bioavailability of the cannabinoids, and obtaining the effects as rapidly as would be provided by inhalation.

What can cannabis be used to treat?

Those with a medical condition who are seeking access to medical cannabis should ideally broach the subject with their physician, since legal use requires a prescription. [Appendix J, Basic regulatory information on medical marijuana for Canadian doctors from the Canadian Medical Protective Association] Individuals who may not have a physician, are reluctant to make that request, or have had their physician refuse to prescribe medical cannabis may choose to pursue other avenues through medical cannabis clinics or an online medical provider such as Medical Marijuana Services, which lists potential indications.[Appendix K, A patient navigation service to help people access medical cannabis]

If it’s legal, it must be okay, right? Not necessarily. Alcoholics Anonymous, Mothers Against Drunk Driving and Health Canada would argue that alcohol is legal but using it can risk life altering consequences. Cannabis use is the same. It is about consequences. Regardless of whether something is legal or illegal, the consequences need to be considered. If using the substance brings negative consequences for the person using the substance or the people who care about that person, that may be an issue. If negative consequences outweigh the positive effects, then therapy may help to change that. Therapeutic approaches are as varied as individuals seeking counselling. However, what we do know is that how we “think” about cannabis use will impact how we “feel” towards the substance and this will decide our “behaviour” about using cannabis. In therapy, this approach is called Cognitive Behaviour Therapy (CBT). The goal in CBT is to examine the thoughts that are attached to the use, such as: “using helps me forget past or current trauma” (numbing out) or “using helps me cope with stress and/or anxiety” (coping mechanism) or “using helps me sleep” (sleep disorder), to name a few. Using cannabis may provide a temporary reprieve but it does not address the issue. For example: if you have had past or current trauma then therapy to heal from trauma may be needed; if stress and anxiety negatively impact your life then learning healthier coping strategies may be needed; if sleep is an issue then addressing the reasons for not sleeping and/or healthy strategies to assist with sleep, may be needed. In conclusion, legal or not, using Cannabis can result in negative consequences. If cannabis causes more problems for you or for people who care about you, possibly it is time to change your thoughts, feelings and actions because the reprieve from cannabis you sought has now become another issue.

Paula Buskard, M.A. RSSW, is an Employee Assistance Program therapist who provides services to adults, couples and families for addictions, PTSD, depression, anxiety, relationship issues and stress management.