Currently, Canada has among the highest rates of cannabis use in the world. It remains unclear how the upcoming legalization of cannabis will impact the current rates of use, but clinicians will likely experience an increased incidence of cannabis use disclosures and questions about safe use from individuals. In light of this, the Canadian Research Initiative in Substance Misuse (CRISM) has issued lower-risk cannabis use guidelines (LRCUG) to provide evidence-based support to clinicians to help counsel their patients with respect to safer cannabis use. A brochure for the general public can be found here.
Some main points from the lower-risk cannabis use guidelines follow, annotated for further specificity:
• Cannabis associated health risks are best avoided by abstaining
• Delay taking up cannabis until later in life, specifically after the age of 25
• Choose lower-risk cannabis products and smoking practices (e.g. opt to use vaporizers over pipes or rolled joints)
• Avoid synthetic cannabinoids
• Limit and reduce cannabis use (e.g. no more than once or twice per week, using a maximum of 400 mg of 9% THC)
• Avoid cannabis use altogether if there is a risk of mental health problems or if pregnant
• Do not use and drive, or operate machinery
Additionally, clinicians should clearly emphasize to patients to avoid combining cannabis with alcohol and other substances.
These guidelines have been endorsed by the Canadian Medical Association (CMA), the Canadian Public Health Association (CPHA), the Canadian Society of Addiction Medicine (CSAM), the Centre for Addiction and Mental Health (CAMH), the Council of Chief Medical Officers of Health (in principle), and the Canadian Centre on Substance Use and Addiction.
RAAM clinicians will likely have to include screeners for cannabis use into their initial client assessments and also determine how to incorporate lower-risk cannabis use or other harm reduction strategies into treatment plans. If a patient reports using daily or almost daily, and/or spending a lot of time using or being preoccupied with use, these may be signs of problematic cannabis use and these patients will require assistance. It is also advisable for clinicians in RAAM settings to redirect patients to primary care if patients endorse using cannabis for sleep, pain, or anxiety and to provide education as to why primary care clinicians are more appropriate in addressing these issues than RAAM clinicians or cannabis clinics.
A lack of evidence with respect to the specific effects and potential harms of cannabis use, and especially its potential physiological interaction with other substances or pharmaceuticals, continues to be problematic and may challenge clinicians in their attempts to determine appropriate treatment. However, it is important to reiterate that therapeutic rapport and negotiating with patients around treatment planning continues to be a crucial aspect of care, especially while navigating this new and evolving cannabis use landscape in Ontario.