SECTION A: POTENTIAL ADVERSE EFFECTS

 

I acknowledge and understand that in some individuals, medicinal cannabis (predominantly the THC component) may:

 

  • Exacerbate certain mental health conditions – particularly those with a component of psychosis, such as bipolar disorder and
  • Distort perception (sights, sounds, time, touch), impair memory, learning, thinking and problem-solving.
  • Increase heart rate and affect blood
  • Trigger anxiety, fear, distrust, panic or mood
  • Impair coordination, cause nausea, vomiting and

 

I acknowledge and understand that:

 

  • As with other medications, cannabis can potentially cause an allergic reaction in some individuals.

 

SECTION B: GENERAL CANNABIS USE INFORMATION

 

I acknowledge and understand that:

 

  • Long term, regular use of cannabis particularly by those under 25 years of age, may impact brain development in some individuals.
  • Currently, there is limited research available, that can conclusively establish the therapeutic benefits of medicinal cannabis, the optimal therapeutic dosage and the health risks associated with smoking, vaporizing, applying or ingesting medicinal cannabis.
  • Currently, there is limited research available that can conclusively establish the impact of cannabis use on various mental health conditions.
  • Use of cannabis should be avoided by individuals with a personal history or family history of a mental health condition, unless they are assessed and authorized to utilize cannabis for medical purposes by a Physician or Nurse Practitioner.
  • Currently, there is limited research available that can conclusively establish the degree to which regular long-term inhalation of dried flower medicinal cannabis via combustion (i.e. smoking of medicinal cannabis using rolled paper material which is burned – without using a vaporizing device) may damage cells in the respiratory tract, contribute to lung infections (particularly in those with weakened immune systems) and respiratory tract malignances.
  • There is some evidence to suggest that using a reputable vaporizing device to inhale dried flower medicinal cannabis is potentially safer for the respiratory tract than smoking medicinal cannabis and delivers a more accurate, efficient and predictable dose. Vaporizing is recommended over smoking medicinal cannabis for patients that wish to ingest dried flower cannabis by
  • It is possible for batches of the same medicinal cannabis products to have some variations in cannabis (i.e. cannabinoid and terpene) content due to differences in the cannabis plants from which they originate, which could potentially impact the effect.

 

SECTION C: SAFETY

 

I acknowledge and agree that:

 

  • I must avoid performing safety sensitive tasks, operating machinery or driving for at least 4-6 hours after inhalation of medicinal cannabis and at least 8-10 hours after consumption of oral medicinal cannabis.
  • Because of product variations and differences in individual responses, the times listed above are highly variable and impairment may exist outside of these time ranges.
  • I will monitor my response to medicinal cannabis and I will NOT attempt to perform safety sensitive tasks, operate machinery, or drive until I fully understand how a stable dose of medicinal cannabis effects my cognition/motor control/reaction
  • Even a stable dose of medicinal cannabis could potentially interfere with my ability to perform safety sensitive tasks, operate machinery, or drive, particularly if there are changes to my health status and other medications/natural health products.
  • I will not perform safety sensitive tasks, operate machinery or drive if I am impaired at any time.
  • I will notify my Primary Care Provider (i.e. Family Physician or Family NP) and assessing Pharmacist (if applicable), that I intend to use medicinal cannabis, as it may interact with other medications/natural health products or may not be appropriate in certain disease states.
  • I will disclose my medical history, including any personal or family history of mental health illnesses to TCN staff, Physicians or Nurse Practitioners involved in my medicinal cannabis care, along with any assessing Pharmacist (if applicable) or other Healthcare Providers in the circle of care.
  • I will discuss or have discussed other non-cannabis/conventional treatment options for my condition(s) (for which I am seeking medicinal cannabis) with my Physician or NP, prior to seeking a medicinal cannabis assessment through
  • I will NOT use cannabis during pregnancy or while I will inform TCN staff, the authorizing Physician or NP, assessing Pharmacist or other Healthcare Provider (if applicable) that I am or intend to become pregnant or that I am actively breastfeeding or intend to do so.
  • I will not use cannabis if I have a history of any allergic reaction(s) to a cannabis-based product – unless authorized to do so by a Physician or Nurse Practitioner. I will inform TCN staff of the nature of any allergic reaction(s) to cannabis, severity and date(s) of occurrence. I will also provide this information to the Physician or Nurse Practitioner involved in my medicinal cannabis care, along with any assessing Pharmacist (if applicable) or other Healthcare Providers in the circle of care.
  • I will provide TCN staff and the assessing Physician, NP, Pharmacist or other Healthcare Provider involved in my medical cannabis care, a list of any medications and/or natural health products that I am taking, so that potential interactions with cannabis can be assessed.
  • I will safely store my medicinal cannabis and keep it away from children and pets.

 

SECTION D: REGULATIONS

 

I acknowledge and agree that:

  

  • A medicinal cannabis authorization does not override workplace cannabis use policies and I will check with my workplace directly, if I require my workplace to accommodate my medicinal cannabis use.
  • I will only purchase cannabis for medicinal purposes from a Health Canada approved Licensed Producer/Seller.
  • I will only receive medical document authorization for medicinal cannabis from one Physician or Nurse Practitioner,
  • I will not use more medicinal cannabis, than the amount I am directed to do so, by the authorizing Physician or Nurse Practitioner and TCN staff.
  • A TCN affiliated, medical cannabis assessing Physician or NP will not be obligated to serve as my Primary Care Provider (i.e. Family Physician or Family NP) and I will seek routine medical care from my Primary Care
  • I will not re-sell, share or give any of my medicinal cannabis to another
  • I will comply with provincial/territorial/municipal regulations related to medicinal cannabis use and travel regulations within Canada, pertaining to carry limits.
  • I cannot travel with cannabis to any country outside of Canada – this includes not being able to travel with cannabis to the
  • I verify that I am a Canadian Citizen or Permanent Resident of Canada and that I reside in Canada.

 

 

*Pathway Health owns the Medical Cannabis Management System (MCMS) and TCN.

*The term medicinal cannabis may be used interchangeably with medical cannabis.