Cannabis Information for Health Professionals

Some people who use cannabis may begin to develop a dependency, also known as cannabis use disorder (CUD), which can range in intensity from mild to moderate to severe. CUD is defined by the Diagnostic and Statistical Manual of Mental Disorders: V5 (DSM-5) as a problematic pattern of cannabis use leading to clinical significant impairment or distress, as manifested by at least two diagnostic symptoms outlined in the DSM-5, occurring within a 12-month period.

Tolerance, psychological and physical dependence can occur with prolonged use of cannabis. Dependence develops slowly and appears more likely with higher, more frequent dosing.

Two cannabis-based pharmaceuticals with a drug identification number (DIN) are available in Canada: SATIVEX® and Nabilone. EPIDOLEX® is another cannabis-based medical product, but is not available in Canada.

SATIVEX® (Nabiximols)

A combination medication that can relieve pain in people with advanced cancer and relieve muscle stiffness and spasticity in people with multiple sclerosis. This drug has naturally occurring THC and CBD.

Nabilone (Cesamet)

A medication used to treat severe nausea and vomiting caused by chemotherapy. Nabilone is a human-made drug similar to the natural compounds found in cannabis. Nabilone is a synthetically produced THC product.

EPIDIOLEX®

EPIDIOLEX is a purified and pharmaceutical-grade CBD extract derived from the cannabis plant, and is FDA approved for the treatment of childhood epilepsy (2+ years of age). There is a significant difference between this medication and other CBD products, where other CBD products and medical cannabis may contain small amounts of THC. Clinical trials in children with drug resistant epilepsy (DRE) exploring the use of purified CBD have consistently demonstrated efficacy, with reductions in seizure occurrences as well as improved quality of life. Despite global authorizations for the management of DRE, EPIDIOLEX is not yet marketed in Canada. However, EPIDIOLEX was submitted to Health Canada for DIN review and approval in late 2022.

Indigenous people use cannabis and other substances for many reasons. Understanding why people use substances can help provide health-care providers with the tools to better support people along their healing journey.

Supporting individuals requires time, patience and reflection. The First Nations Health Authority (FNHA) offers a number of resources to assist health-care providers to better understand the needs of Indigenous peoples.

There are also a number of peer support networks available to FNHA clients that offer non-judgmental support, understanding, and help with navigating the system and finding services and resources. 

Resources:

Get Support (FNHA)

Cannabis Use across the Lifespan (FNHA)

Non-medical Cannabis Information (FNHA)

First Nations Community Guidebook to Cannabis Legalization (FNHA)

Cannabis Toolkit (Thunderbird Partnership Foundation)

Cannabis-Related Resources for First Nations, Inuit and Métis (Government of Canada)

In some people, cannabis use may increase the risk of , especially those who:

• Start using cannabis at a young age
• Use cannabis frequently (daily or almost every day)
• have a personal or family history of psychosis and/or schizophrenia

Persistent cannabis use has also been shown to be associated with neuropsychological decline broadly across domains of functioning. This includes increased cognitive problems among persistent cannabis users. Further, cessation of cannabis use does not fully restore neuropsychological functioning, particularly among adolescent-onset cannabis users. Frequent cannabis use has also been associated with an increased risk of:

• Suicide
• Depression
• Anxiety disorders

There is some emerging evidence that CBD may help dampen some of the psychoactive effects of THC such as mood disturbances and other psychotic symptoms.

Resources:

Cannabis Use, Psychosis and Schizophrenia (Government of Canada)Cannabis and Mental Health (Government of Canada)

Clearing the Smoke on Cannabis: Regular Use and Cognitive Functioning (CCSA)

Cannabis Impairment and Safety Risk (Government of Canada)

Lower-Risk Cannabis Use Guidelines for Psychosis, Clinical Toolkit (Laboratoire de recherche Didier Jutras-Aswad)

People who identify as lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual (LGBTQ+) or two-spirit (2S) in Indigenous cultures, often face social stigma, discrimination and other challenges not encountered by people who identify as heterosexual. They also face a greater risk of harassment and violence.

As a result of these and other stressors, sexual minorities are at increased risk for various behavioral health issues and cannabis may be used as a way of regulating emotions in the short-term—but exacerbating depression symptom severity in the long-term. Recent data suggests that substance use patterns reported by sexual minority adults differ from those reported by heterosexual adults.

The proportion of people reporting cannabis use in the past 12 months was higher among people who identified as bisexual (61 per cent), another sexuality (55 per cent), or lesbian/gay (39 per cent), than among people who identified as heterosexual (25 per cent).

Resources:

Canadian Cannabis Survey (Government of Canada)

Cannabis Use among Sexual Minorities (Cannabis and Cannabinoid Research | Mary Ann Liebert Inc. Publishers)

Cannabis Use and Mental Health among Young Sexual and Gender Minority Men (International Journal on Drug Policy)

Cannabis use in this age group is strongly linked to:

• Cannabis dependence and other substance use disorders;
• The initiation and maintenance of tobacco smoking;
• An increased presence of mental illness, including depression, anxiety and psychosis;
• Impaired neurological development and cognitive decline
• Diminished school performance and lifetime achievement

Rates of acute medical care and hospitalization for younger children who have ingested cannabis unintentionally are increasing. Health-care clinicians and primary care professionals can make a difference by asking children and youth about their and their parents’ cannabis use, offering prevention information or advice about how to quit and other psychological interventions, as appropriate. Find more information on the health impacts on youth.

Cannabis and Canada’s Children and Youth (Canadian Paediatric Society)

Lower-Risk Cannabis Use Guidelines for Youth (CAMH)

Talking Pot with Youth: A Cannabis Communication Guide for Youth Allies (CCSA)

Talking with teenagers about drugs and alcohol (Government of Canada)

Pediatric Cannabis Poisoning: Stakeholder Toolkit (CCSA)

Preventing Cannabis Poisoning in Children (Government of Canada)

Get Help with Substance Use (Government of Canada)

Older adults report using cannabis primarily for medical reasons, whereas non-medical use is more prominent at younger ages. There are many reasons why older adults might be interested to use cannabis products, which might include:

• Coping with side effects from chronic diseases
• For pain
• For anxiety and depression
• For sleep problems
• As an alternative to a prescription drug
• To achieve a better quality of life

It's important to review the benefits and risks associated with cannabis use for older adults, as well as educate on how to use cannabis products safely. The Canadian Coalition for Seniors Mental Health offers a available for guidance and recommendations when talking with older adult patients about cannabis use, and whether or not it might be right for them. The Canadian Guidelines on Cannabis Use Disorder among Older Adults also offers support with patient education, screening, assessment and treatment of Cannabis Use Disorder.

View the Canadian Guidelines on Cannabis Use Disorder among older adults

National Cannabis Survey (Statistics Canada)

A Guide to Cannabis for Older Adults (CCSA)

Canada's Lower Risk Cannabis Use Guidelines (CAMH)

Cannabis and Older Adults (Active Aging Canada)

Health Effects of Cannabis on Adults Over 55 (Government of Canada)

What Older Adults Need to Know about Cannabis (CCSMH)

Canada's Lower Risk Cannabis Use Guidelines - Ways to reduce your risk when using cannabis (CAMH)

Canadian Guidelines on Cannabis Use Disorder Among Older Adults (CCSMH)

Cannabasics - Fact sheet for health & social service providers (CPHA)

Addiction to Cannabis (Government of Canada)

Get Help with Substance Use (Government of Canada)

Cannabis and cannabinoids - Information for health-care professionals (Government of Canada)

About Cannabis (Government of Canada)

Cannabis Resources for Family Physicians (CFPC)

Cannabis Resources - Resources for health professionals, individuals and communities (FNHA)

About cannabis (CAMH)

Medical Cannabis (HealthLink BC)

Medical Cannabis for Children: Evidence and Recommendations (Canadian Paediatric Society)

Medical Marijuana (Epilepsy Foundation)

Information on Sativex

Information on Nabilone (HealthLink BC)

Information on EPIDIOLEX® (cannabidiol)