MEDICAL CANNABIS

To recognize that there is limited evidence to support safe and effective use of medical cannabis; further,

To encourage research that quantifies the therapeutically active components and defines the effectiveness, safety, and clinical uses of medical cannabis; further,

To recognize that there is not a standardized product subject to the same regulations as a prescription drug product, and to advocate for the development of processes that would ensure standardized formulations that would ensure consistent potency and quality of medical cannabis; further,

To advocate for the alignment of federal and state laws to eliminate barriers to research on and therapeutic use of medical cannabis, including review of medical cannabis’s status as a Schedule I controlled substance, and its potential for reclassification; further,

To encourage healthcare organizations to develop policies and procedures regarding the handling of medical cannabis consistent with applicable laws, regulations, and accreditation standards; further,

To promote the documentation of medical cannabis use and indication in the electronic health record; further,

To encourage education that prepares pharmacists as part of an interprofessional team to educate patients, caregivers, healthcare providers, and healthcare administrators about therapeutic and legal aspects of medical cannabis use.

Rationale

To date, 33 states and the District of Columbia, Guam, and Puerto Rico have enacted workable medical cannabis laws that provide, or will provide, meaningful access to medical cannabis for qualifying patients. Healthcare providers in those jurisdictions, including pharmacists, are grappling with the challenges presented by medical use of medical cannabis (defined for purposes of this policy as whole or parts of the natural marijuana plant and therapeutic products derived therefrom). ASHP recognizes that there is some evidence supporting the effectiveness of medical cannabis to treat or ameliorate symptoms of disease. The extent and quality of this evidence is limited, however, and even less is known about the safety of medical cannabis, especially related to its long-term use. Well-designed research is necessary to further define the therapeutic uses of medical cannabis, including determination of its therapeutically active components; clinical indications and contraindications; precautions; dosing; routes of administration; adverse effects; drug-drug, drug-disease, and drug-laboratory interactions; and effectiveness compared to existing therapies.

Current inconsistencies in product formulation, potency, and quality are also a hindrance to developing a strong evidence base. Standardizing these factors, to the extent possible, will help ensure the quality and reliability of research results. ASHP encourages efforts by the United States Pharmacopeia to develop quality standards for medical cannabis. Federal legislation and regulation, including marijuana’s classification as a Schedule I substance under the Controlled Substances Act, remains a barrier to the necessary research, and ASHP advocates that federal and state laws and regulations be aligned to remove or minimize these barriers.

Conflicting federal and state laws also create confusion about research on and use of medical cannabis, as federal law precludes procurement, storage, preparation, or distribution of medical cannabis by pharmacies or healthcare facilities registered with the Drug Enforcement Administration. Given the complexity of the issues involved, ASHP encourages healthcare organizations to develop policies and procedures regarding medical cannabis to conduct research and provide patient care that is consistent with applicable laws, regulations, and accreditation standards. Recreational or medical use of cannabis should be documented in the patient medical record. ASHP recognizes the need for pharmacists and other healthcare providers to provide education about the unique therapeutic and legal issues created by research on and use of medical cannabis