Administration and Distribution of Cannabis for Medical Purposes

This document¹ outlines the legislative and regulatory requirements for registered nurses (RNs), licensed practical nurses (LPNs), registered psychiatric nurses (RPNs), and nurse practitioners (NPs) who are contemplating participating in the administration and distribution² of cannabis for medical purposes. This direction has also been provided to assist employers to develop their own policies and processes and for nurses to understand the regulatory implications when their practice involves the administration or distribution of cannabis for medical purposes. (This document does not address the NP’s role in authorizing the use of cannabis for medical purposes).

Nurses may engage in activities related to the care of clients receiving cannabis for medical purposes, which may include the administration or distribution of cannabis if the following conditions are met:

Nurses must:

• be knowledgeable of applicable federal legislation, e.g., Cannabis Act and Cannabis Regulations; and provincial legislation;
• have the individual competence (be educated and authorized) to administer or distribute cannabis for medical purposes:
  • have the necessary knowledge, skill, and judgement and individual competence to administer or distribute cannabis for medical purposes safely, evaluate its effectiveness, and identify and manage adverse effects following administration or distribution (e.g. including, but not limited to, proper understanding of cannabis in its various forms and how the form of cannabis (e.g. dried leaf or oil) may impact dosage, knowledge of possible drug interactions, risks of usage, side effects, contraindications, the risks to children and pets, etc.);
  • have employer authorization through policy, guidelines, etc. Administration and distribution can only be undertaken if the hospital³ permits it. Nurses should also refer to the College’s Medication Management document. It is important for nurses to know their organizational policy and, if no policy exists, to advocate with their employer for the development of a policy;
• verify that the client has a medical document or written order to authorize administration or distribution. Within a hospital setting, there is generally a requirement for a client specific order;
• review the written order authorizing cannabis for medical purposes for the client to ensure it meets all required elements, including the daily quantity of dried cannabis, expressed in grams, that the healthcare practitioner authorizes for the client;
• have a reliable means of authenticating the cannabis (i.e. it has been received from a licensed producer). Clients who receive cannabis for medical purposes from a licensed producer are expected to present to the nurse the cannabis in a container that will generally include a description of the content;
• ensure that informed consent has been obtained from the client. It is the responsibility of the healthcare practitioner (NP or medical practitioner) to both determine whether a client has the legal capacity to consent to the treatment and to obtain informed consent; and
• document assessment of the client, discussions regarding consent, procedures, collaboration and communication with the health care team, and any other pertinent information in accordance with legislative and regulatory requirements, documentation standards, and employer policy.

Nurses can conscientiously object to the administration or distribution of cannabis for medical purposes. They should reflect on their Professional Code of Conduct or applicable Code of Ethics and determine if they are willing to participate when faced with this ethical dilemma. If nursing care is requested that conflicts with the nurse’s moral beliefs and values, but is in keeping with professional practice, the nurse is expected to provide safe, compassionate, competent, and ethical care until alternate care arrangements are in place to meet the person’s needs or desires. If nurses can anticipate a conflict with their conscience, they have an obligation to notify their employer in advance so that alternate care arrangements can be made.

If nurses have specific questions related to cannabis for medical purposes, they can contact the College. Nurses may also wish to seek legal advice (e.g. Canadian Nurses Protective Society or their professional liability insurer) to better understand the relevant provisions of the Cannabis Act and the Cannabis Regulations.