When the Cannabis Act comes into force in October 2018, it will for the first time in Canada make access to and use of recreational cannabis legal. Yet while the country’s pharmacy regulatory bodies have not yet received any indication that the framework for accessing cannabis for medical purposes will be re-evaluated, there remains a clear need to support pharmacy professionals who can and should play an important role in promoting quality and safe patient care among cannabis users.
How can pharmacy professionals support high quality patient care when there is no legal framework in place that permits distribution of cannabis for medical purposes in pharmacies? What role should pharmacy professionals play when evidence related to the impact of cannabis on patient health is at the moment limited? What should pharmacy professionals do to help prevent known harms associated with smoking, including cannabis?
ENHANCING KNOWLEDGE, PROTECTING PATIENTS: A CANNABIS STRATEGY FOR PHARMACY
On June 11, 2018, the College’s governing Council endorsed the publication of A Cannabis Strategy for Pharmacy. The Strategy, developed with the guidance of a multi-stakeholder task force, simultaneously focuses on relevant areas of practice and prepares the College and pharmacy professionals to address evolving cannabis-related issues, while considering how to best serve and protect patients and Ontarians. It also reflects the health and social factors that are related to the legalization of cannabis for recreational use and its continued access for medical purposes.
The College recognizes that there are opportunities for pharmacists, in their clinical roles as medication experts, to further promote quality and safety by taking into account cannabis use by patients such as through flagging drug interactions and providing relevant cannabis-related information.
Ultimately, patients and the public should expect pharmacy professionals to have sufficient knowledge about cannabis use to contribute to positive health outcomes and prevent harm. This expectation is set in the College’s view that cannabis should be treated no differently than any other drug or substance on which pharmacists already provide advice.
The Strategy consists of four priorities that together, through effective communication and collaboration, will support the College’s mandate to serve and protect the public interest:
PHARMACY AND CANNABIS DISTRIBUTION: MAINTAINING A FOCUS ON PUBLIC PROTECTION
Throughout the creation of the Cannabis Strategy, the Cannabis Task Force recommended that the College develop a position statement that builds on the existing National Association of Pharmacy Regulatory Authorities (NAPRA) position and further defines an appropriate regulatory opinion on pharmacists’ role in cannabis for medical purposes. Council approved the following position statement:
With the recognition that the dispensing of cannabis within pharmacy is currently not permitted within the existing legal framework, the Ontario College of Pharmacists would not oppose any federal or provincial legislation that would permit the dispensing of non-smoked forms of cannabis for medical use within pharmacies, would not oppose legal dispensing for medical use within pharmacies regardless of whether cannabis is approved as a drug by Health Canada or whether it receives an assigned Drug Identification Number provided that sufficient quality control measures are put in place by Health Canada, and opposes the distribution by pharmacies of any forms of cannabis for the exclusive use or purpose of smoking, and in accordance with any provincial legislation.
The College’s position statement on the distribution of cannabis in pharmacies refers to cannabis for medical purposes only. The College continues to support NAPRA’s position statement which opposes pharmacy practitioners being involved in the distribution of cannabis for non-medical purposes.
STRIKING THE RIGHT BALANCE: ADAPTING TO THE REALITIES OF INCREASED LEGAL ACCESS TO CANNABIS
The College recognizes that cannabis is an evolving matter and may update its position and Strategy as the legislative and regulatory framework in Canada and Ontario related to access and distribution of cannabis evolves and becomes more defined over time.
The College’s position and Strategy strike an appropriate balance to make sure that the public is protected as society adapts to increased legal access to recreational cannabis and the emerging matter of cannabis for medical use. The position and Strategy also support professionals in playing an active and appropriate role as medication and clinical experts to provide patient-centred care and education so they can promote positive patient outcomes.
In the meantime, as always, the College expects all pharmacy professionals and pharmacies, including pharmacy owners, operators and designated managers, to act in accordance with established laws and regulations, standards of practice and the Code of Ethics.
ENHANCING KNOWLEDGE: COLLEGE PREPARES FOR MANDATORY CANNABIS EDUCATION FOR PHARMACISTS
In recognition of the important role education would be playing within the Strategy, in March 2018 the Task Force recommended that Council require all pharmacists to complete cannabis education in preparation for the anticipated practice changes due to the legalization of cannabis for recreational use. This recommendation was approved, allowing for work on the development of competencies and suggested learning objectives for cannabis education to move forward.
To prepare for this requirement, an advisory group was formed consisting of educators, community and hospital pharmacists and a patient advocate to provide input on defining competencies related to cannabis. Competencies and suggested learning objectives will be provided to the Canadian Council on Continuing Education in Pharmacy (CCCEP) and education providers later this fall. Approved programs will be identified through the CCCEP using their competency-mapped accreditation process. The College will communicate further details around this new requirement and the approved education programs and resources over the coming months. The deadline for completing an approved education program will be the 2020 license renewal.