Can Canadian nurse practitioners prescribe medical marijuana?

Can Canadian nurse practitioners prescribe medical marijuana?

While it’s been suggested that Canada’s new rules for access to medicinal marijuana – the Marihuana for Medical Purposes Regulations (MMPR) – make medicine more expensive for those who had previously grown their own supply, there seemed to be one unqualified benefit to the new system: the ability of nurse practitioners to grant access to cannabis produced by Health Canada-licensed providers.For those who couldn’t access an MD (or, at least, one willing to discuss cannabis as a treatment option), or who lived in rural regions where medical care is offered mostly by NPs, the new rules appeared to offer welcome relief. “The MMPR will simplify the process of obtaining medical marijuana permits, by allowing nurse practitioners to prescribe the drug, in addition to doctors,” reported the National Post on February 28, one month before the legislation would take effect.Strange, then, that nursing organizations didn’t want to talk about the new powers their members were reportedly granted. After the Ontario Nurses’ Association and the Registered Nurses’ Association of Ontario both declined comment on how nurse practitioners had prepared for the changes, and what benefits (if any) they were seeing for nurses and patients, it seemed there had been a miscommunication somewhere along the line.The Canadian Federation of Nurses Unions confirmed that none of their member organizations had had any contact with federal or provincial health bodies – which is strange, given how active nursing unions tend to be around new developments that affect, for better or worse, the working environment.Soon after, a CP story had been filed during Ontario’s recent election: Kathleen Wynne, now recently re-elected as Premier, had then promised to “expand the powers of nurses and nurse practitioners to include more tasks currently carried out only by doctors[, including] prescribing a wide range of medications.” But, the report noted in a brief aside, “prescriptions for narcotic drugs would still be handled only by physicians.”Not only were nurse practitioners in at least one province not able to authorize marijuana use, but at least one province’s Premier is dead set against the idea.In fact, according to the College of Nurses of Ontario (CNO), the body that regulates Ontario nurses, NPs’ ability to grant access to any controlled substance authorized by Health Canada is still in flux. Marijuana is actually the one clear exception: it’s a definite no-go.“While the College is working to recommend changes to the provincial regulations to permit NPs to prescribe controlled substances, marijuana is not an approved prescription drug in Canada,” said the CNO’s Bill Clarke by email. “As a regulator, our role is to put standards in place to protect the public. The availability of evidence to support guidelines for safe prescribing will influence any future discussions and decisions regarding NP prescribing.”Anyway, he added, it’s currently illegal for Ontario NPs to grant access to marijuana in the first place.The situation appears to be the same across Canada: today, there is no province or territory where patients can ask nurse practitioners for access to medicinal marijuana. (The health ministries in the three territories – Nunavut, the Northwest Territories, and the Yukon – did not respond to inquiries, but there’s no indication things are any different.)The country is mired in this confusion despite news reports to the contrary – reports which Health Canada didn’t initiate, it’s true, but which they also didn’t refute or seek to correct.“We permit [authorizing marijuana use] – so we open the door, where provincial legislation allows it,” says Sean Upton of Health Canada. “Nurses and doctors are regulated by their own colleges; if their colleges don’t permit, they can’t prescribe it. Provincial legislation is dominant, in that sense.”Given that preparations for and consultations around the MMPR had been ongoing for months beforehand, weren’t there attempts to inform provincial ministries of the changes and encourage them to prepare their own regulations? “No, and that’s not the kind of thing we would do,” says Upton. “Health Canada is not encouraging or discouraging use of [marijuana], except we say it’s not an approved drug in Canada, or anywhere in the world. The genesis of [medicinal access] is the courts, in 2001.”But by simply creating the legal possibility for expanded access, isn’t that in a sense encouraging it as a treatment option? Not so, says Upton. It just happens that there was a change in other legislation that allowed NPs to prescribe controlled substances, and the MMPR reflects this. “A lot of rural communities are served by NPs, not doctors. So if you want the playing field to be even, you need to make sure the people who give their medical care have the same advantages as in cities. It’s about being fair, not encouraging.”In fact, while it has decriminalized access for medical purposes, Health Canada is sending some decidedly mixed smoke signals. An earlier statement, sent by email, says “the determination as to whether the use of dried marihuana for medical purposes is appropriate … is best made through a discussion with their authorized health care practitioner.”That’s MDs, in other words, whose professional organizations still discourage medical marijuana use. The Canadian Medical Association has repeatedly expressed opposition to marijuana, due to lack of safety evidence. The Ontario Medical Association issued a report on the MMPR in March, just before it came into effect, noting concerns over “increased liability” and citing “limited clinical evidence as to safety and efficacy” and the fact that “cannabis is not an approved therapeutic product” by the same Health Canada that now nonetheless allows its use.Many nursing regulatory bodies take a similar attitude. The College of Registered Nurses of Manitoba says there is little interest in allowing use of marijuana until there are regulations to guarantee “public safety.” There are some signs of movement, however. The College of Registered Nurses of British Columbia is working with the provincial government on legislation to allow NPs to prescribe controlled substances, and it is expected at this time – though not guaranteed – that marijuana will be phased in. And the PEI Department of Health and Wellness reports that they are involved in discussions with Health Canada about how to alter provincial legislation to a similar end.These discussions are almost certainly not driven at the federal level, though. A spokesperson with New Brunswick Health and Safety said in an interview that NPs can’t grant access to marijuana, because Health Canada would first have to allow it. The spokesperson was told that they already have.If anything, the federal government continues to take the vaguely passive-aggressive line it has taken on medical marijuana use since 2001: while the courts said it had to allow access, no one said it had to make it easy.Source:

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