Cannabis legalization: minor changes to College standard, and a reminder to physicians to practise without impairment

As of October 17, 2018, recreational use of cannabis will be legal in Canada. Accordingly, the College will make minor amendments to the current practice standard, Cannabis for Medical Purposes. Although federal laws have changed, few reliable published studies remain available on the medical benefits of cannabis and physicians must continue to take appropriate precautions when prescribing cannabis to patients for medical reasons. Proper assessment, documentation, and patient education remain imperative in ensuring that patients are using cannabis safely.
 
Just as prescribing cannabis to patients requires thoughtful consideration, physicians must also be cognizant of their own use of cannabis for recreational purposes. Evidence shows that residual effects of cannabis can influence psychomotor and cognitive functioning, causing conditions such as confusion, sleepiness, impaired memory, anxiety, and diminished reflexes.1  These effects can persist for hours, sometimes days, after consumption. 
 
The Canadian Armed Forces lay out strict rules regarding cannabis consumption, generally stating that cannabis consumption both at work, and during the eight hours before work, is prohibited.2  Those in the military who perform high risk duties such as operating loaded weapons are further prohibited from consuming cannabis during the 24 hours before such tasks. The Occupational and Environmental Medical Association of Canada recently announced that until definitive evidence is available, it is not advisable to operate motor vehicles or equipment, or engage in other safety-sensitive tasks for 24 hours following cannabis consumption, or for longer if impairment persists.3
 
As the practice of medicine also has a direct influence on public safety, the College reminds registrants that they are required to show up fit for work and capable of performing their duties in a safe and effective manner. As outlined in the CMA Code of Ethics, physicians must:
  1. Practise the art and science of medicine competently, with integrity and without impairment.
Registrants are not permitted to consume cannabis if the immediate or lasting effects will impact their work. The nature and severity of the consequences for failure to comply with the CMA Code of Ethics are determined on a case-by-case basis, following investigation by the Inquiry Committee. 
 
Registrants may seek further advice by contacting the College and asking to speak with a member of the registrar staff, or by seeking medical legal advice from the CMPA. 
 
References:
  1. Health Canada [Internet]. Health effects of cannabis. Ottawa: Health Canada; 2018 Mar 6. [cited 2018 Oct 10]; [about 5 screens]. Available from: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects/effects.html
  2. National Defense and Canadian Armed Forces [Internet]. DAOD 9004-1, Use of cannabis by CAF members. Ottawa: Government of Canada; 2018 Sep 7. [updated 2018 Sep 24; cited 2018 Oct 10]; [about 27 screens]. Available from: http://forces.gc.ca/en/about-policies-standards-defence-admin-orders-directives-9000/9004-1.page
  3. Occupational and Environmental Medical Association of Canada [Internet]. Position statement on the implications of cannabis use for safety-sensitive work. Winnipeg: Occupational and Environmental Medical Association of Canada; 2018 Sep 24. [cited 2018 Oct 10]; 3p. Available from: https://oemac.org/wp-content/uploads/2018/09/Position-Statement-on-the-Implications-of-cannabis-use.pdf