Nurse Practitioners Authorizing Cannabis for Medical Purposes
On February 21, 2019, ARNNL Council approved that NPs in Newfoundland and Labrador (NL) who have the individual competence (necessary knowledge, skills, and judgment) could authorize the use of cannabis for medical purposes. This regulatory direction outlines the legislative and regulatory requirements for NPs who are contemplating offering this service. NPs are required to comply with legislation, regulation, applicable evidence-informed clinical practice guidelines and employer/agency policies related to authorizing the use of cannabis for medical purposes in their practice setting.
NPs must only provide a medical document for clients under their professional treatment. Under Section 272(1) of the Cannabis Regulations, “a health care practitioner is authorized, in respect of an individual who is under their professional treatment and if cannabis is required for the condition for which the individual is receiving treatment,
- to provide a medical document;
- while practicing in a hospital, to issue a written order;
- to administer to the individual a cannabis product, other than cannabis plants or plant seeds; or
- to transfer to the individual, or an adult who is responsible for them, a cannabis product, other than cannabis plants or plant seeds,
- that has been received from a holder of a license to sell or a license for processing, and
- in respect of which the quantity of cannabis does not exceed that individual or adult is authorized to possess under Section 266 or 267”.
It is prudent for an NP to ensure that their nursing assessment supports their decision that in their professional opinion cannabis is required for the condition and that clinical documentation adequately reflects the rationale for the plan of care. While a patient may request that an NP authorize cannabis as treatment, the ultimate decision rests with the individual NP who should be satisfied that the treatment is required for the patient’s condition. Some possible questions for consideration when making that determination:
- Does the client have a primary care provider? If so, consider the rationale for being involved in the authorization of cannabis for medical purposes when a primary care provider is involved in the client’s care.
- Do I have enough information about the client to provide a treatment recommendation?
- Do I know enough about the client’s treatment history to determine whether cannabis is required for their condition? Can I adequately assess the client?
- Does the client understand the risks and benefits of proceeding with cannabis for medical purposes to treat the condition?
- If nursing care is being provided remotely (e.g., through telenursing),
- is the client under my professional treatment when practicing telenursing?
- have I properly considered whether the patient’s complaints can be addressed remotely?
- have I managed the risks associated with providing an assessment via telehealth?
The NP must assess whether cannabis is the most appropriate treatment and consider available evidence in support of cannabis as well as the evidence regarding risks or contraindications. It is also important for the NP to educate clients on the risks; benefits of cannabis, including its therapeutic effects; side effects; contraindications with other drugs; safe transportation and storage of cannabis as well as the importance of obtaining cannabis from an authorized supplier.
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