Patient’s Use of Medical Marijuana

1. Patient’s Use of Medical Marijuana New Corporate Policy March 20, 2013

2. Patient's Use of Medical Marijuana *NEW* Corporate Policy • The goal of this policy is to assist all members of the health care team to safely manage the use of medical marijuana • This policy applies ONLY to inpatients that have a valid authorization to possess medical marijuana from Health Canada

3. Patient's Use of Medical Marijuana On Admission (or in Preadmission Clinic) • Document the use of medical marijuana on the BPMH • The patient will be assessed whether it is appropriate for a patient to continue to use medical marijuana during hospitalization. The assessment must be confirmed with the MRP or Consulting Physician prior to an order being placed. • It will not be appropriate for most patients to continue marijuana in hospital because of their acute condition(s) and/or impaired mobility. • MRP’sarenot obligated to order medical marijuana for use during admission. • Sativex® is available for use at LHSC as an alternative product for patients authorized to use medical marijuana.

4. Patient's Use of Medical Marijuana Ordering Medical Marijuana • If the patient insists on continuing to use medical marijuana & the MRP is agreeable • MRP’s are encouraged to have a conversation with their Residents and Clinical Fellows regarding their thoughts about in hospital use of medical marijuana • The MRP must order medical marijuana if it is to continue. This order can be delegated via telephone or verbal order to Resident or Clinical Fellow but must be co-signed within 24 hours • Write an order that the patient may use own marijuana during hospitalization specifying route and frequency.

5. Patient's Use of Medical Marijuana For Patients Using Medical Marijuana • Patients must be provided a brochure for marijuana use • Patients must sign a contract for use of medical marijuana that outlines the use of medical marijuana under LHSC policy. • The contract is to be completed by the patient with someone from the health care team signing as a witness and placed in the health care record. • A copy of the patient’s authorization to possess marijuana is placed on the chart.

6. Patient's Use of Medical Marijuana Handling Marijuana • Patients must use their own supply of medical marijuana. • Patients must keep their authorization card and marijuana product on their person at all times. • It is federal law that only the person that holds an authorization card to possess marijuana may handle the product. • Staff and affiliates may not assist patients in storing or handling their medical marijuana • Exception: if a patient is suddenly incapacitated, the policy allows for witnessed, temporary storage of marijuana in the narcotic cupboard.

7. Patient's Use of Medical Marijuana Patients Using Marijuana • Notify Security if a patient has been ordered medical marijuana to be continued during hospitalization to advise and escort to a designated smoking area • Marijuana may be used in a patient’s room or hospital building if being ingested (as a tea or in food) • Marijuana MUST be used outside of hospital buildings if being inhaled (smoked, vaporizer) • Use of marijuana (or presumed use, if patient goes outside) is documented on the MAR

8. Patient's Use of Medical Marijuana Patients that go outside to use Marijuana • A schedule will be arranged through discussion between the patient and RN • Security will escort patients to a secure location to use their marijuana away from other patients and staff to limit exposure to second hand marijuana smoke. • Document in the health care record as per the policy

9. Patient's Use of Medical Marijuana • Discharge • Discharge prescriptions should NOT be written for medical marijuana as they are not valid. • Marijuana can be crossed off the printed discharge prescription

10. Patient's Use of Medical Marijuana Questions? • Contacts • Nursing Professional Practice OR • Pharmacy