B.C. hospitals lack policies, struggle to accommodate medical cannabis patients
Patients
prescribed medical cannabis face a patchwork of policies and ad hoc
accommodations for their treatment that’s compounded by conflicting
legislation and lack of proper administration for medical marijuana, a
StarMetro investigation has found.
/https://www.thestar.com/content/dam/thestar/vancouver/2018/05/07/bc-hospitals-lack-policies-struggle-to-accommodate-medical-cannabis-patients/_2_van_cannabis_policies.jpg)
VANCOUVER—Fed
up with her experience at Alberta hospitals, Calgary resident Lisa
Kirkman came to B.C. in 2013 on the recommendation of a doctor,
believing hospitals here would be more tolerant of her prescribed
cannabis treatment.
But, she found hospitals in this province are no better than in Alberta in how they deal with her treatment, which she is unable to take in oral forms following surgery.
Sometimes, hospitals will give her a private room where she can use her vaporizer. Others try to force her to use the vaporizer outdoors. But eventually, they always kick her out.
Patients prescribed medical marijuana face a patchwork of policies and ad hoc accommodations for their treatment that’s compounded by conflicting legislation and lack of proper administration for medical cannabis, a StarMetro investigation has found.
Health authorities across British Columbia are now scrambling to make policies allowing hospitalized patients to consume medical cannabis, despite it being available in some form for almost two decades. The current state of affairs means patients legally permitted to consume cannabis are often turned away from hospitals and refused treatment.
But, she found hospitals in this province are no better than in Alberta in how they deal with her treatment, which she is unable to take in oral forms following surgery.
Sometimes, hospitals will give her a private room where she can use her vaporizer. Others try to force her to use the vaporizer outdoors. But eventually, they always kick her out.
Patients prescribed medical marijuana face a patchwork of policies and ad hoc accommodations for their treatment that’s compounded by conflicting legislation and lack of proper administration for medical cannabis, a StarMetro investigation has found.
Health authorities across British Columbia are now scrambling to make policies allowing hospitalized patients to consume medical cannabis, despite it being available in some form for almost two decades. The current state of affairs means patients legally permitted to consume cannabis are often turned away from hospitals and refused treatment.
Hospital
staff struggle to answer questions such as how to permit a stigmatized
drug that varies by strain, has few guidelines on dosage and
administration, but is still prescribed for patients.
To date, there are no policy-based answers for many of these questions. Northern Health, Island Health, Fraser Health, Vancouver Coastal Health, Providence Health Care all said they are developing policies, but none are likely to permit smoking or inhaled forms of marijuana in hospital settings. Several of the health authorities expect to have policies in place sometime this spring.
Administering marijuana for in-patient settings is a virtually impossible task without changes in regulations and legislation, according to Dr. Pippa Hawley of the BC Cancer Agency. She was the only direct policy-maker permitted to speak on this topic by the provincial government.
To date, there are no policy-based answers for many of these questions. Northern Health, Island Health, Fraser Health, Vancouver Coastal Health, Providence Health Care all said they are developing policies, but none are likely to permit smoking or inhaled forms of marijuana in hospital settings. Several of the health authorities expect to have policies in place sometime this spring.
Administering marijuana for in-patient settings is a virtually impossible task without changes in regulations and legislation, according to Dr. Pippa Hawley of the BC Cancer Agency. She was the only direct policy-maker permitted to speak on this topic by the provincial government.
/https://www.thestar.com/content/dam/thestar/vancouver/2018/05/07/bc-hospitals-lack-policies-struggle-to-accommodate-medical-cannabis-patients/_4_cannabis_hospital_policy.jpg)
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She
said the BC Cancer Agency’s policy would encourage patients to use oils
instead of inhaled cannabis, and permit non-licensed products from
black-market shops in medical care.
“But we can’t actually implement it,” Hawley said. “The problem is that the laws are unenforceable and conflicting. By not allowing access, they would then be breaking the other law, which is that people must be allowed reasonable access.”
In lieu of defined policies, she said physicians generally push to provide access whenever possible.
The only health authority in B.C. with an existing, limited policy is Interior Health. All patients have to prove that they can access legal marijuana, but it’s up to themselves to supply their own marijuana, be it an edible, oil or suppository. Smoked or inhaled forms of cannabis are generally not allowed. A special permission is required even if the patient is willing and physically able to smoke outside.
Under the policy, patients are required to notify nursing staff whenever they use cannabis, and document themselves the date, time, amount, dosage and frequency of their use. There are no procedures in the policy for checking the quality of the medication — or whether the medication is even cannabis at all.
“But we can’t actually implement it,” Hawley said. “The problem is that the laws are unenforceable and conflicting. By not allowing access, they would then be breaking the other law, which is that people must be allowed reasonable access.”
In lieu of defined policies, she said physicians generally push to provide access whenever possible.
The only health authority in B.C. with an existing, limited policy is Interior Health. All patients have to prove that they can access legal marijuana, but it’s up to themselves to supply their own marijuana, be it an edible, oil or suppository. Smoked or inhaled forms of cannabis are generally not allowed. A special permission is required even if the patient is willing and physically able to smoke outside.
Under the policy, patients are required to notify nursing staff whenever they use cannabis, and document themselves the date, time, amount, dosage and frequency of their use. There are no procedures in the policy for checking the quality of the medication — or whether the medication is even cannabis at all.
/https://www.thestar.com/content/dam/thestar/vancouver/2018/05/07/bc-hospitals-lack-policies-struggle-to-accommodate-medical-cannabis-patients/_3_cannabis_hospital.jpg)
And
even if there was someone checking the medication, they likely wouldn’t
know where to begin. There are no regulations to allow pharmacists to
dispense the medication, and the College of Pharmacists of BC, which
regulates every pharmacist in the province, stated pharmacists are not
permitted to identify, dispense, relabel or store medical cannabis.
That’s in spite of federal laws permitting, and in some cases requiring, pharmacists to play a role in supplying medical cannabis in hospital.
These requirements are in the federal Narcotic Control Regulation, and cover pharmacists’ responsibilities to handle, order and gate-keep access to the medication if authorized by the head administrator of their hospital, and to log details such as the quantity and name of medical marijuana received from a licensed dealer.
There are also special exemptions under section 56 of the Controlled Drugs and Substances Act that allow hospital employees to provide marijuana “to a person under treatment as an in-patient or outpatient of the hospital.”
The issue for pharmacists is that there’s no legislation implicitly permitting pharmacists to order medical marijuana from licensed producers, said David Pavan, deputy registrar with the College of Pharmacists. And until that is resolved, pharmacists cannot act.
“We need some guidance here,” he said. “Everybody would like to see provincial legislation be enacted to help guide through the dispensing of medical marijuana to patients in British Columbia.”
That’s in spite of federal laws permitting, and in some cases requiring, pharmacists to play a role in supplying medical cannabis in hospital.
These requirements are in the federal Narcotic Control Regulation, and cover pharmacists’ responsibilities to handle, order and gate-keep access to the medication if authorized by the head administrator of their hospital, and to log details such as the quantity and name of medical marijuana received from a licensed dealer.
There are also special exemptions under section 56 of the Controlled Drugs and Substances Act that allow hospital employees to provide marijuana “to a person under treatment as an in-patient or outpatient of the hospital.”
The issue for pharmacists is that there’s no legislation implicitly permitting pharmacists to order medical marijuana from licensed producers, said David Pavan, deputy registrar with the College of Pharmacists. And until that is resolved, pharmacists cannot act.
“We need some guidance here,” he said. “Everybody would like to see provincial legislation be enacted to help guide through the dispensing of medical marijuana to patients in British Columbia.”
/https://www.thestar.com/content/dam/thestar/vancouver/2018/05/07/bc-hospitals-lack-policies-struggle-to-accommodate-medical-cannabis-patients/_5_lisa_kirkman.jpg)
Kirkman
has been refused treatment by several hospitals due to her cannabis
treatment. One time, when she had to take an ambulance to hospital, the
paramedics called police for help so the officers could wheel her in and
out of the hospital every 20 minutes to use her medication.
“The police did it twice and said ‘screw this.’ They had their police van parked in the emergency, right by the door, they had me smoking the pipe, smoking marijuana, in the back of the police van,” she recalled.
Kirkman approached two hospitals in B.C., including Burnaby General Hospital’s emergency department seeking access to long-term psychiatric care and was rejected. But she was admitted for nine hours when she tried again.
To accommodate her vaporizer, she was placed in a negative pressure room — isolated rooms used primarily to prevent the spread of infectious diseases — in the emergency room.
But the negative pressure room is often needed in emergencies and she wasn’t allowed to stay there.
“The solution the psychiatrist there had was that I’d be off all my pain medication and they were going to give me ECT, shock therapy, because they thought that would make more sense,” said Kirkman, who declined the doctor’s suggestion.
Burnaby General Hospital is administrated by Fraser Health, which said in a statement that patients are not permitted to smoke cannabis on site, and that Kirkman was connected to services in the community after being released from hospital.
“The police did it twice and said ‘screw this.’ They had their police van parked in the emergency, right by the door, they had me smoking the pipe, smoking marijuana, in the back of the police van,” she recalled.
Kirkman approached two hospitals in B.C., including Burnaby General Hospital’s emergency department seeking access to long-term psychiatric care and was rejected. But she was admitted for nine hours when she tried again.
To accommodate her vaporizer, she was placed in a negative pressure room — isolated rooms used primarily to prevent the spread of infectious diseases — in the emergency room.
But the negative pressure room is often needed in emergencies and she wasn’t allowed to stay there.
“The solution the psychiatrist there had was that I’d be off all my pain medication and they were going to give me ECT, shock therapy, because they thought that would make more sense,” said Kirkman, who declined the doctor’s suggestion.
Burnaby General Hospital is administrated by Fraser Health, which said in a statement that patients are not permitted to smoke cannabis on site, and that Kirkman was connected to services in the community after being released from hospital.
/https://www.thestar.com/content/dam/thestar/vancouver/2018/05/07/bc-hospitals-lack-policies-struggle-to-accommodate-medical-cannabis-patients/_7_cannabis_hospital_3.jpg)
When
questioned about the development of cannabis-in-hospital policies,
Health Minister Adrian Dix said hospitals already have policies in
place.
“The medical use of marijuana has been in its own legal category for some time, and so the health authorities all have policies to deal with that, and I’m sure we can forward those to you,” Dix said on April 23.
But those policies were never shared and attempts to obtain copies of still-in-development policies were stymied by the five individual health authorities in British Columbia.
“I don’t think there will be legislation,” said Dix, the provincial health minister. “I mean, the legislation is changing at a national level. You know, it’s obviously an evolving area but I think, I think in a way, we have that now.”
B.C. is not alone in its struggle to come up with in-patient policies for medical cannabis.
“The medical use of marijuana has been in its own legal category for some time, and so the health authorities all have policies to deal with that, and I’m sure we can forward those to you,” Dix said on April 23.
But those policies were never shared and attempts to obtain copies of still-in-development policies were stymied by the five individual health authorities in British Columbia.
“I don’t think there will be legislation,” said Dix, the provincial health minister. “I mean, the legislation is changing at a national level. You know, it’s obviously an evolving area but I think, I think in a way, we have that now.”
B.C. is not alone in its struggle to come up with in-patient policies for medical cannabis.
/https://www.thestar.com/content/dam/thestar/vancouver/2018/05/07/bc-hospitals-lack-policies-struggle-to-accommodate-medical-cannabis-patients/_6_cannabis_hospital_2.jpg)
Jack
Lloyd, a Toronto cannabis lawyer who represented Canadian pot royalty
Marc and Jody Emery in court last year, said the lack of policies across
the country means patients often get turned down or turned away.
In those cases, he writes the hospital a letter warning that they must provide reasonable access to the medication as required by law. But not everyone has access to a lawyer, and even lawyers like Lloyd are worried of upsetting the status quo should they challenge the hospitals in court.
Moreover, not every hospital makes exemptions simply because they receive a letter, and there are no indications health authorities in B.C. will permit exemptions to anti-smoking laws.
In Montreal, one hospital has managed to permit patients to vaporize and inhale their medical marijuana within its facility.
To deal with the second-hand vapour issue, Dr. Michael Dworkind, who works in palliative care at the city’s Jewish General Hospital, said administration simply purchased smoke filters for patients to exhale into.
“The policy is in place, but implementation is slow,” he said. “It’s the physicians who lack the knowledge. We need to work collaboratively with pharmacies, and nurses have to reduce their fears of exposure.”
But Dworkind’s policy only applies to his hospital. The issue is that every hospital needs to develop its own policies for medical cannabis to be properly introduced to in-patient settings, said Dr. Danial Schecter, who works at the Royal Victoria Regional Health Centre in Barrie, Ont.
He agreed it’s not unusual for patients who have been prescribed medical marijuana to be refused the medication while in hospital, particularly when it comes to children in palliative care settings.
“There’s no easy way around it,” Schecter said. “Usually, these things are easier to ignore than actually be proactive about.”
With files from Cherise SeucharanMichael Mui is a Vancouver-based investigative reporter. Follow him on Twitter: @mui24hours
In those cases, he writes the hospital a letter warning that they must provide reasonable access to the medication as required by law. But not everyone has access to a lawyer, and even lawyers like Lloyd are worried of upsetting the status quo should they challenge the hospitals in court.
Moreover, not every hospital makes exemptions simply because they receive a letter, and there are no indications health authorities in B.C. will permit exemptions to anti-smoking laws.
In Montreal, one hospital has managed to permit patients to vaporize and inhale their medical marijuana within its facility.
To deal with the second-hand vapour issue, Dr. Michael Dworkind, who works in palliative care at the city’s Jewish General Hospital, said administration simply purchased smoke filters for patients to exhale into.
“The policy is in place, but implementation is slow,” he said. “It’s the physicians who lack the knowledge. We need to work collaboratively with pharmacies, and nurses have to reduce their fears of exposure.”
But Dworkind’s policy only applies to his hospital. The issue is that every hospital needs to develop its own policies for medical cannabis to be properly introduced to in-patient settings, said Dr. Danial Schecter, who works at the Royal Victoria Regional Health Centre in Barrie, Ont.
He agreed it’s not unusual for patients who have been prescribed medical marijuana to be refused the medication while in hospital, particularly when it comes to children in palliative care settings.
“There’s no easy way around it,” Schecter said. “Usually, these things are easier to ignore than actually be proactive about.”
With files from Cherise SeucharanMichael Mui is a Vancouver-based investigative reporter. Follow him on Twitter: @mui24hours
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