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medical cannabis solutions
N A T U R A L C A R E G R O U P. C O M
1.888.671.8022
HEALTHCARE PROFESSIONALS GUIDE
insideWorking with Natural Care 2
How Natural Care works for patients 5
How Natural Care works in senior care 7
Prescribing and administering medical cannabis 9
Why medical cannabis? 16
What’s
N A T U R A L C A R E G R O U P. C O M 2
We offer ongoing, on-demand support.
Our nurses and educators are on call to answer
your questions. Your patients, residents and
their caregivers can also call us directly for
help with their personalized cannabis plans,
licensed producer registration, orders, refills
and more.
We create personalized cannabis plans.
Whether you prescribe medical cannabis
or refer to a Natural Care prescriber, we’ll
incorporate your recommendations into
a personalized patient plan that includes
a careful dosing and titration schedule.
We’ll follow up with regular calls to your
patient, resident or their caregiver to ensure
everything’s on track.
Working with Natural Care
It’s simple: we’re here to improve your patients’ or residents’ quality of life, and to lighten your workload.
N A T U R A L C A R E G R O U P. C O M 4
We provide up-to-date cannabis education.
The Natural Care advantage
starts with education:
we offer comprehensive
cannabis education
for doctors, nurses and
healthcare providers; we
also conduct sessions at
retirement and long-term
care homes, community
groups and more.
We are experts in senior care and cannabis.
Our team combines decades
of retirement and long-
term care management
experience with senior-
specific healthcare expertise
and medical cannabis savvy.
We work directly with retirement and long-term care homes.
We provide customized
education sessions, as well
as policy and administrative
support. We make managing
medical cannabis easy for
homes and staff.
We don’t charge for our services.
No matter how complex your
patients’ or residents’ needs,
our comprehensive services
are always free.
firstWe put patients
We recommend the most suitable products for individual patients.
We are completely licensed producer-agnostic.
N A T U R A L C A R E G R O U P. C O M 6
We guide patients through every step of the prescription, registration, ordering and refill process.
Meet with a nurse practitioner or doctor in person or online.
Based on the cannabis medication plan, Natural Care completes registration with the most suitable licensed producer(s).
If medical cannabis is suitable, the patient’s MD or a Natural Care MD or NP generates a prescription.
Natural Care’s patient care team offers guidance throughout the ordering and refill process.
Natural Care provides ongoing support for the life of every prescription.
Based on the prescription notes, a Natural Care nurse creates an individualized cannabis medication plan.
ASSESS REGISTERPRESCRIBE ORDERPERSONALIZE SUPPORT
How Natural Care works for patients
N A T U R A L C A R E G R O U P. C O M 8
Provide medical cannabis
prescriptions
Create
personalized
cannabis
medication
plans
Update home
and residence
policies and
procedures
as needed
Complete
patients’ LP
registration
Provide on-
demand
phone and
email support
to staff, residents,
families and
caregivers
Provide ongoing education with
staff, residents, families and
caregivers
How Natural Care works in senior care
NATURAL CARE’S COMPLIMENTARY
SERVICES
Every home is different, and we work quickly to implement a
customized medical cannabis program designed to improve
residents’ quality of life and lighten staff workload. From
training to policy implementation, medical administration,
documentation and more, we’ve got it covered.
Medical cannabis and its legal bureaucracy can be complicated.
WE MAKE IT SEAMLESS.
N A T U R A L C A R E G R O U P. C O M 10
fast facts
CBD CBD:THC
Cannabidiol only Cannabidiol and tetrahydrocannabinol blends
Potential medical benefits
• Analgesic
• Anti-inflammatory
• Antiemetic
• Antispasmodic
• Anti-epileptic
• Anxiolytic
• Reduces THC-induced psychoactivity/anxiety
• Analgesic
• Anti-inflammatory
• Antispasmodic
• Antiemetic
• Appetite stimulant
• Soporific
• Mood elevator
• Decreases intestinal motility
Likely beneficial for
• Anxiety
• Depression
• Chronic pain
• Spasticity associated with MS, ALS and spinal cord
injury
• Epilepsy
• Inflammation & inflammatory conditions, including
IBS, ulcerative colitis, Crohn’s, fibromyalgia, rheumatoid
arthritis
• PTSD
• Chronic pain
• Nausea & vomiting
• Anorexia
• Spasticity associated with MS, ALS and spinal cord injury
• Inflammation & inflammatory conditions, including IBS, ulcerative colitis,
Crohn’s, fibromyalgia, rheumatoid arthritis
• Limited evidence suggests that THC in particular may be beneficial for
insomnia, neuropathic pain, nausea/vomiting and PTSD. It is recommended to
start with CBD and introduce 1:1 in the evenings if needed for insomnia, PTSD,
etc.
Potential side effects
Cannabidiol exhibits biphasic properties – most therapeutic effects are found at lower doses; slow titration may mitigate potential side effects.
• Somnolence, changes in appetite/weight
• In rare cases, may cause diarrhea
Tetrahydrocannabinol exhibits biphasic properties – most therapeutic effects are found at lower doses; slow titration may mitigate potential side effects.
• Anxiety, disorientation, intoxication, somnolence
• May induce psychosis in susceptible individuals (personal or family history)
• In rare cases, may cause orthostatic hypotension, depression, ataxia/
dyscoordination, tachycardia, cannabis hyperemesis, diarrhea
Prescribing and administering medical cannabis
The rules and best practices around medical
cannabis are just like other prescribed drugs.
N A T U R A L C A R E G R O U P. C O M 12
CBD CBD:THC
Cannabidiol only Cannabidiol and tetrahydrocannabinol blends
Contra-indications
• Unsuitable for pregnant and breastfeeding patients • Acute psychosis, severe/unstable psychiatric conditions, actively suicidal
• History of THC-induced hyperemesis
• Under age 25
• Severe cardiovascular, immunological, liver or kidney disease (especially in
acute illness – can exacerbate arrhythmias)
• Caution should be exercised in patients with history of drug or alcohol
addiction (although recent evidence points to cannabis as potential harm
reduction substitution)
• Unsuitable for pregnant and breastfeeding patients
Drug interactions
Many interactions can be mitigated in complex patients with polypharmacy by slowly titrating.
• CYP450 enzyme inhibitor
• May interact with anti-epileptic drugs; close monitoring of
AED levels and LFTs advised
• Potent inhibitor of CYP3A4 and CYP2D6; may increase
serum concentrations of macrolides, calcium channel
blockers, benzodiazepines, cyclosporine, sildenafil (and
other PDE5 inhibitors), antihistamines, haloperidol,
antiretrovirals, and some statins (atorvastatin and
simvastatin, but not pravastatin or rosuvastatin);
may increase serum concentrations of SSRIs, tricyclic
antidepressants, antipsychotics, beta blockers and opioids
(including codeine and oxycodone)
Many interactions can be mitigated in complex patients with polypharmacy by slowly titrating.
• CYP450 enzyme inhibitor
• CYP1A2 inducer (theoretically can decrease serum concentrations of
clozapine, duloxetine, naproxen, cyclobenzaprine, olanzapine, haloperidol, and
chlorpromazine)
• Potential interaction with medications metabolized by P450 enzymes (2C9,
2C19, 3A4), including antidepressants, proton pump inhibitors, cimetidine,
macrolides, antimycotics, calcium antagonists, HIV protease inhibitors,
amiodarone, isoniazid
• The following drugs may decrease the availability of THC: carbamazepine,
rifampicin, phenobarbital, phenytoin, primidone, rifabutin, St. John’s wort
Safety No reports of abuse or dependence; no public health risk. Minimal risk of dependence, similar to anxyolitics at 9%.
(Versus 21% for opioids, 23% for alcohol and 68% for tobacco.)
Dosing Oils & capsules/softgels
• Daytime dosing, non-intoxicating
• Daily dosing
• Start at 8-10mg/day
• Titrate by 5 mg as tolerated
*Unless you wish otherwise, a Natural Care nurse will create a
personalized dosing and titration schedule for every patient, with
regular telephone check-ins and follow-up, at no charge.
Oils & capsules/softgels
• Nighttime dosing, mild psychoactive, sedating effects
• At hs only to start
• Start at 2.5 mg, titrate by 1mg q 2-3 days as tolerated and to desired effect
*Unless you wish otherwise, a Natural Care nurse will create a personalized dosing and
titration schedule for every patient, with regular telephone check-ins and follow-up, at no
charge.
N A T U R A L C A R E G R O U P. C O M 14
INHALATION ORAL INGESTION
Product Flower Oils, capsules, softgels
Onset Less than 5 min 30 min to 2 hrs
Peak effect Less than 15 min 2 to 4 hrs
Duration 2 to 4 hrs 4 to 8 hrs
Notes Ingestion methods are
generally preferred for
consistent dosing and
longer impact. Some
patients may desire
inhalation for acute and
breakout pain.
Vapourizing
recommended
(not smoking).
OilsAdministered
sublingually, swallowed or
mixed with food.
Capsules & softgelsIngested as usual.
Driving after cannabis use
Patients should be
counselled not to
drive for 4 hours after
inhalation, or for 8
hours if euphoria is
experienced.
Patients should be
counselled not to drive for
6 hours after ingestion, or
for 8 hours if euphoria is
experienced.
Onset and duration of effects
N A T U R A L C A R E G R O U P. C O M 16
Cannabis treats so many symptoms and conditions that a single cannabis prescription may reduce total prescription load.
whycannabis?medical
According to the Canadian Institute for Health Information,
nearly a quarter of Canadians 65 and up take 10 or more
prescription drugs: “Seniors who were prescribed 10+ drugs
were more likely to be hospitalized for an adverse drug
reaction – over five times more likely than seniors who were prescribed fewer drugs.”1
N A T U R A L C A R E G R O U P. C O M 18
it's
sF EaA cannabis prescription can significantly
reduce opioid reliance, sometimes replacing opioid drugs entirely.
18.1% of older adult patients stopped using
opioid analgesics or reduced their dose after
six months.3
Medical cannabis is safe. Fatal cannabis overdose is impossible.4
The results of the Israel nursing home study
were published in The European Journal of
Internal Medicine.5 “Conclusion: Our study finds that the therapeutic use of cannabis is safe and efficacious in the elderly population.”
Medical cannabis patients report significant pain relief.
In an observational study of over 2700
medical cannabis patients, conducted over
three years at a nursing home in Israel2, 93.7
% of respondents reported an improvement
in their condition after six months. On a scale
of one to 10, reported pain levels decreased
from a median of eight to a median of four,
representing a 50% REDUCTION IN PAIN.
Why medical cannabis?
N A T U R A L C A R E G R O U P. C O M 20
Cannabis use is associated with better quality of life in patients with chronic pain.6
In a 2016 retrospective study of chronic pain patients,
published in The Clinical Journal of Pain, researchers found a
clinically significant association between cannabis use and
better quality of life, as well as reduced opioid use and a better
side effect profile when compared with opioid drugs.7 A
National Academies review also found that cannabis has a
clinically meaningful effect on pain.8
Get your life back
Cannabis treatment in agitated patients may reduce caregiver burnout.
In a 14-week trial of Alzheimer’s patients treated with the
synthetic cannabinoid nabilone9, Sunnybrook Hospital
researchers found significantly reduced agitation compared
with a placebo group and significantly improved behavioural
symptoms overall. Researchers also found that this reduced
patient agitation and aggression was associated with a
“clinically meaningful” reduction in caregiver stress.
N A T U R A L C A R E G R O U P. C O M 22
usPlease visit naturalcaregroup.com/forms to download new forms, or call or email us and
we’ll send some your way.
DO
WN
LOA
D
REF
ERR
AL
FOR
MS
Contact usNo matter how complex your patients’ or residents’ needs, our comprehensive services are always free.
Email us at:[email protected]
Call us at:1.888.671.8022 to learn more
Ji No
Join the growing number of healthcare professionals referring to Natural Care. Your patients and residents will thank you!
N A T U R A L C A R E G R O U P. C O M
This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practioners for professional advice pertaining to your particular condition.
1. The Canadian Institute for Health Information. May 17, 2018. 1 in 4 Canadian seniors prescribed 10 or more drugs. Available online at: https://www.cihi.ca/en/1-in-4-canadian-seniors-is-prescribed-10-or-more-drugs
2. Abuhasira R et al. 2018. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly, European Journal of Internal Medicine. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/29398248
3. Ibid
4. To date, there has never been a recorded death from ingesting too much cannabis. It is estimated that “a fatal dose of marijuana would require the (physically impossible) ingestion of fifteen hundred pounds in fifteen minutes,” according to David Schmader, author of “Weed: The User’s Guide” and published at www.businessinsider.com/can-marijuana-kill-you-2016-11.
5. Abuhasira R et al. 2018. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. European Journal of Internal Medicine. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/29398248 FO
OTN
OTE
S6. Bellnier T et al. 2018.Preliminary evaluation of the efficacy, safety, and costs associated with
the treatment of chronic pain with medical cannabis. Mental Health Clinician. Available online at: http://mhc.cpnp.org/doi/10.9740/mhc.2018.05.110 Elliott DA, et al. 2016. Medical marijuana use in head and neck squamous cell carcinoma patients treated with radiotherapy. Supportive Care in Cancer. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/27005465 Fiz J et al. 2011. Cannabis use in patients with fibromyalgia: effect on symptoms relief and health-related quality of life. PLoS One. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/21533029 Haroutounian S et al. 2016. The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study. The Clinical Journal of Pain. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/26889611 National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. The National Academies Press. Available online at: http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx
7. Haroutounian S et al. 2016. The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study. The Clinical Journal of Pain. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/26889611
8. National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. The National Academies Press. Available online at: http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx
9. Funded by The Alzheimer’s Drug Discovery Foundation, the trial was conducted at Sunnybrook Hospital using the synthetic cannabinoid nabilone. Researchers noted that although it is too soon to extend the results to medical cannabis, the results are nevertheless promising. Learn more from the study’s authors here: http://alzheimersocietyblog.ca/clearing-the-air-about-cannabis-and-dementia/ and here http://health.sunnybrook.ca/alzheimers/alzheimers-patients-agitation-cannabinoids