Publications

By Georg Reuter and RBS

Cannabis is legal and many physiotherapists are understandably wondering how this will affect their practice. The general answer is: not as much as you may think. The legalization of cannabis should not cause clinics to significantly alter any policies and procedures in place. Instead, legalization serves as a good reminder of the general issues that arise regarding patients and intoxicating substances.

The Effects of Cannabis and Treatment

Studies on the effects of cannabis are continually developing and it would be worthwhile to keep up to date on developments as further studies are conducted. As a starting point, the Occupational and Environmental Medical Association of Canada issued a recent position statement that recognizes the following:

• “Cannabis use is associated with short-term impairment of memory, motor coordination and judgement, driving and risk of injury”;
• “The extent and duration of impairment from cannabis is uncertain, and may differ between different people, but it can last for up to 24 hours after cannabis use”;
• “The presence of cannabis results in an increased risk of road traffic accidents, likely more than doubling the crash risk”; and
• “Aside from intoxication, cannabis is considered to be addictive and associated with the potential for the development of cannabis use disorder as well as cannabis withdrawal”.

It also remains clear that physiotherapists are not able to prescribe, and should not recommend, cannabis for pain management.

Patient Consent, Safety, and Intoxication

The Health Care (Consent) and Care Facility (Admission) Act prescribes that a patient must provide consent to treatment. Under s. 7 of this Act, consent is generally measured based on the adult’s ability to understand the information given to him or her.

To ensure that you comply with the Act, it is important to adequately document interactions any patient that seems intoxicated by cannabis or another substance, and to follow any relevant procedures in place at your place of work. Accurate documentation will be important if a patient later claims that they did not consent to a treatment due to certain levels of intoxication.

In making the decision to treat, you should put the question of consent at the forefront of your mind. Even if the patient seems capable of consenting, it is also worth considering the nature of the activities being undertaken in the course of a physiotherapy session. Under the Act, true consent can only be given if the patient is adequately notified of the risks associated with certain forms of treatment. Therefore, knowledge of the impacts of certain levels of intoxication on, for example, motor coordination and judgment, will ensure the patient is provided with all the necessary information to make an informed decision.

Tips to Address these Issues:

• Implement mandatory education and training on the risks of cannabis use and physiotherapy exercises.
• Implement mandatory education and training on recognition of cannabis impairment and develop policies and procedures for obtaining consent and responding to emergency situations.
• Include in your intake form whether or not the patient has consumed any impairing substances, including cannabis. This may provide a baseline from which one can further assess the patient’s ability to consent to treatment and to partake in treatment.
• Have good resources on hand and develop and maintain good relationships with physicians and nurse practitioners who can provide information on cannabis use, its effects, and its relationship to pain management.

References:

• Position Statement on the Implications of Cannabis Use for  Safety-Sensitive Work, September 24, 2018; found at: https://oemac.org/wp-content/uploads/2018/09/Position-Statement-on-the-Implications-of-cannabis-use.pdf
• Physical Therapist Regulations to the Health Professions Act, B.C.Reg. 288.2008, Section 6.
• Health Care (Consent) and Care Facility (Admission) Act , RSBC 1996 c 181, Section 5.