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Can Fam Physician. 2018 Feb;64(2):111-120.

Simplified guideline for prescribing medical cannabinoids in primary care.

Author information

1
Professor of Evidence-Based Medicine in the Department of Family Medicine at the University of Alberta in Edmonton. michael.allan@ualberta.ca.
2
Knowledge Translation Expert in the Physician Learning Program with the Alberta Medical Association and in Lifelong Learning and the Department of Family Medicine at the University of Alberta.
3
Research Fellow in the EPICORE Centre at the University of Alberta.
4
Nurse practitioner in the Division of Hematology at the University of Alberta Hospital in Edmonton.
5
Retired registered nurse and patient representative from Edmonton.
6
Associate Professor at Queen's University and the Northern Ontario School of Medicine in Kingston, Ont.
7
Consultant for Alberta Health Services Chronic Pain Centre and Clinical Assistant Professor at the University of Calgary in Alberta.
8
Family physician at the Boyle McCauley Health Centre in Edmonton.
9
Director of Family Physician Programs in Continuing Professional Development in the Faculty of Medicine at Dalhousie University in Halifax, NS.
10
Director of the Adult Compulsive Disorder Clinic and Clinical Assistant Professor at the University of Alberta.
11
Medical oncologist at Cross Cancer Institute in Edmonton.
12
Associate Professor of Evidence-Based Medicine in the Department of Family Medicine at the University of Alberta.
13
Associate Professor of Evidence-Based Medicine in the Department of Family Medicine at the University of Alberta in Peace River.
14
Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver.
15
Coordinator of Evidence-Based Medicine in the Department of Family Medicine at the University of Alberta and the Alberta College of Family Physicians.
16
Health Innovation Studio Lead and Human-centred Knowledge Designer for Lifelong Learning in the Faculty of Medicine and Dentistry at the University of Alberta.
17
Knowledge Translation and Evidence Coordinator for the Alberta College of Family Physicians and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta.

Abstract

OBJECTIVE:

To develop a clinical practice guideline for a simplified approach to medical cannabinoid use in primary care; the focus was on primary care application, with a strong emphasis on best available evidence and a promotion of shared, informed decision making.

METHODS:

The Evidence Review Group performed a detailed systematic review of 4 clinical areas with the best evidence around cannabinoids: pain, nausea and vomiting, spasticity, and adverse events. Nine health professionals (2 generalist family physicians, 2 pain management-focused family physicians, 1 inner-city family physician, 1 neurologist, 1 oncologist, 1 nurse practitioner, and 1 pharmacist) and a patient representative comprised the Prescribing Guideline Committee (PGC), along with 2 nonvoting members (pharmacist project managers). Member selection was based on profession, practice setting, location, and lack of financial conflicts of interest. The guideline process was iterative through content distribution, evidence review, and telephone and online meetings. The PGC directed the Evidence Review Group to address and provide evidence for additional questions as needed. The key recommendations were derived through consensus of the PGC. The guideline was drafted, refined, and distributed to a group of clinicians and patients for feedback, then refined again and finalized by the PGC.

RECOMMENDATIONS:

Recommendations include limiting medical cannabinoid use in general, but also outline potential restricted use in a small subset of medical conditions for which there is some evidence (neuropathic pain, palliative and end-of-life pain, chemotherapy-induced nausea and vomiting, and spasticity due to multiple sclerosis or spinal cord injury). Other important considerations regarding prescribing are reviewed in detail, and content is offered to support shared, informed decision making.

CONCLUSION:

This simplified medical cannabinoid prescribing guideline provides practical recommendations for the use of medical cannabinoids in primary care. All recommendations are intended to assist with, not dictate, decision making in conjunction with patients.

PMID:
29449241
PMCID:
PMC5964385

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