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Cannabis Standard FAQ

Here are some frequently asked questions about Cannabis Standard, medical cannabis and medical cannabis use, getting your prescription, Licensed Producers (LPs), and more.

About Medical Cannabis

What is medical cannabis?

Medical cannabis is a term used to describe products derived from the whole cannabis plant or its extracts that patients take for medical reasons.

What is the difference between medical and recreational cannabis?

Legal medical and recreational cannabis products are both produced by Licensed Producers (LPs) under the same quality and regulatory framework established by Health Canada pursuant to the Cannabis Act and Cannabis Regulations. The cannabis products sold in both markets are virtually the same.

One important distinction between medical and recreational cannabis is that medical cannabis products are treated like a medicine and recreational cannabis is treated as an adult-use recreational substance. which may have implications for workplace policies, insurance coverage, tax deductions, among other things.

In some cases, LPs cultivate different strains for medical use which may have different effects. For example, cannabis can be cultivated with varying amounts of THC (which is generally understood to be the cannabinoid responsible for the intoxicating or psychoactive effects of cannabis) and CBD (which is generally understood to not have any intoxicating or psychoactive effects).

Why do people take medical cannabis?

People take medical cannabis because a licensed healthcare professional has determined that it may assist him/her in managing a specific symptom, ailment or condition.

What scientific evidence is there for the use of medical cannabis?

There is good quality clinical evidence for the use of medical cannabis to treat the symptoms of certain medical conditions. However, as is the case with many other medical conditions, there is no or limited evidence suggesting that medical cannabis can treat the medical conditions themselves. All Cannabis Standard recommendations are backed by hundreds of hours of research and a comprehensive, expert review of best available evidence globally.

Is medical cannabis legal in Canada?

Medical cannabis is regulated by the federal government through the Cannabis Act and Cannabis Regulations. A patient must have a valid authorization for medical cannabis (in the form of an executed Medical Document, as discussed below) and have purchased medical cannabis through a LP. More information is available on Health Canada's website.

Since recreational cannabis is now legal, why don’t I just buy recreational cannabis instead of obtaining a medical authorization?

Some patients may not like accessing their cannabis through the recreational retail system. In addition, medical cannabis may be covered by certain insurance plans, while recreational cannabis is not. Medical cannabis is also a CRA-eligible medical expense and can usually be claimed on the patient’s tax return.

Who can authorize medical cannabis in Canada?

In Canada, a patient can receive authorization to use medical cannabis from a physician or a nurse practitioner. Patients can obtain this authorization (in the form of an executed Medical Document) in several ways, including from their family doctor or nurse practitioner, from a specialist physician (such as a pain specialist), online using telemedicine, or from a cannabis clinic (specializing in cannabis as a medicine).

How long does a medical cannabis authorization last?

The maximum duration of an authorization for medical cannabis is 12 months. Typically, a healthcare practitioner will start with a shorter authorization (1 to 3 months) to assess the effectiveness of cannabis as a medicine for their patient. If cannabis is shown to be an effective treatment, typically the healthcare practitioner will provide a longer authorization period (6-12 months).

What is a Licensed Producer (LP)?

An LP is a company that has been authorized by Health Canada to produce medical cannabis while adhering to a stringent set of regulatory guidelines.

Does medical cannabis have a DIN?

A Drug Identification Number (DIN) is an eight-digit number assigned by Health Canada to a drug product following Health Canada’s drug review process. The process involves Health Canada scientists assessing the drug’s safety, efficacy and quality to ensure it complies with the requirements of the Food and Drugs Act and its regulations. A DIN is required before a drug can be advertised or sold in Canada. DINs uniquely identify all drug products sold in a dosage form in Canada and are located on the label of prescription and over-the-counter drug products that have been evaluated and authorized for sale in Canada. At present, Sativex® and Cesamet® are the only Health Canada-approved pharmacological cannabinoids, and the only ones with DINs.

Are the costs of medical cannabis covered under benefits plans?

An increasing number of benefit plan providers are facilitating coverage of medical cannabis for employers and their employees, however to-date only very few employers provide coverage for medical cannabis.

If an employee currently has health benefits, Cannabis Standard encourages them to review their benefit guide for confirmation of their plan and coverage of benefits. Employees could also formerly request medical cannabis coverage through their benefit provider.

Employees with a Health Spending Account (HSA) / Health Care Spending Account (HCSA) may be able to expense medical cannabis under the Canada Tax Act. If they have health benefits, they should refer to their plan booklet or plan administrator to confirm whether medical cannabis is covered as part of a Health Spending Account.

Additionally, LPs may have compassionate pricing programs for individuals who may require financial assistance. If available, this information should be on a LP’s website. Furthermore, if the patient is a veteran of the Canadian Military their medical cannabis may be covered by Veterans Affairs Canada.

If the patient does not have private insurance, they may need to cover the costs personally. Fortunately, medical cannabis is a Canada Revenue Agency eligible medical expense.

How much does medical cannabis cost?

In Canada, medical cannabis product pricing varies significantly and patients should refer to individual LPs websites for pricing.

How does the Cannabis Standard make money?

Cannabis Standard charges a low monthly fee to users to access its research platform and preferred pricing from partner LPs. Reformulary Group does not make money from the sale of medical cannabis to patients, nor does receive any commissions from LPs or otherwise.

About Usage and Ingredients

How do patients take medical cannabis?

Cannabis is currently available for medical use in the form of sublingual oils, oral capsules or tablets, and by vaporizing or smoking dried cannabis. Pre-mixed topical creams and edibles are not currently legal in Canada but may be prepared by patients themselves and used to administer their medical cannabis. Other medical cannabis product forms include suppositories, patches, nasal pumps and film strips however these are not currently legally available in Canada.

The most appropriate route of administration will depend on symptoms, conditions and what a patient’s health care practitioner recommends.

What are the main active ingredients?

The chemical ingredients of cannabis are called cannabinoids. The cannabis plant contains at least 113 cannabinoids with varying effects. Cannabinoids are a class of chemical compound that occur naturally in the human body (endocannabinoids) and in the cannabis plant (phytocannabinoids).

Tetrahydrocannabinol (THC) and Cannabidiol (CBD) being the most common and best-understood cannabinoids.

While THC and CBD are the best-known cannabinoids, there are number of other known phytocannabinoids including cannabigerols (CBG), cannabichromenes (CBC), cannabinol (CBN) and cannabinodiol (CBL).

What is Tetrahydrocannabinol (THC)?

Tetrahydrocannabinol (THC) is the cannabinoid that is considered to give cannabis its psychoactive and/or intoxicating properties and generates the euphoric effect commonly associated with cannabis—that is, the feeling of being “high”. THC interacts with the body’s endocannabinoid system (ECS).

What is cannabidiol (CBD)?

Cannabidiol (CBD) is the cannabinoid that is best understood for its potential therapeutic uses and lack of intoxicating or psychoactive effect.

What are terpenes?

Terpenes are fragrant oils found in many types of plants, including the cannabis plant. The chemical compounds they secrete are the reason why fruits, vegetables, flowers and herbs smell the way they do. The cannabis plant has over 100 identified terpenes.

About Safety

Is medical cannabis safe?

According to Health Canada, medical cannabis has both risks and benefits as is the case with any medication. Patients should always consult their health care practitioner before using cannabis to see if it is right for them.

Are there any risks related to the use of medical cannabis?

Yes, there are risks related to the use of both medical and recreational cannabis. Some of the more notable risks are: addiction, impairment-related accidents or injuries, increased heart rate, lung damage (if cannabis is smoked) and more.

Patients should not drive, operate machinery, or perform other hazardous activities while using medical cannabis as it may cause dizziness, drowsiness, and impaired judgment. Please refer to the Health Canada website for more information on health effects and risks.

What action should be taken in the event of an adverse reaction?

In the event of a serious adverse reaction to medication, patients should seek medical assistance immediately, as well as notify their LP and report it to the Canada Vigilance Program, as soon as possible. This can be done in one of the following ways:

  1. Report online via the Health Canada website.
  2. Call toll-free at 1-866-234-2345.
  3. Complete a Canada Vigilance Reporting Form and: Fax toll-free to 1-866-678-6789, or Mail to: Canada Vigilance Program Health Canada Postal Locator 0701D Ottawa, Ontario K1A 0K9.

About Cannabis Standard

What is Cannabis Standard?

Cannabis Standard is an innovative new offering developed by the Reformulary Group. One-part formulary, one-part research platform, it helps medical cannabis patients make informed decisions and contribute to emerging evidence on the safe and effective uses of medical cannabis.

Is Cannabis Standard a dispensary?

Cannabis Standard does not sell cannabis. Cannabis Standard partners with LPs and medical cannabis experts to provide patients with a complete end-to-end experience, while building patient-driven evidence to better understand the effectiveness of different medical cannabis strains and establish health care value.

How does it work?

Powered by clinical evidence, the Cannabis Standard platform asks a series of medical questions to determine whether a patient could be a good candidate for medical cannabis. If a patient is a candidate, it then produces a template medical document containing medical cannabis recommendations tailored for the patient to review with his or her healthcare professional. In order to register with a LP, the patient must obtain a Medical Document, executed by his/her healthcare professional. The Cannabis Standard does not diagnose or identify a disorder for which the patient could or should receive medical cannabis. Prescribing medical cannabis is the responsibility of the patient’s healthcare practitioner as evidenced by the execution of a Medical Document. Once a patient is actively using medical cannabis, Cannabis Standard enables them to track and share their outcomes to help build patient-powered research.

Who is the Cannabis Formulary Committee and what do they do?

The committee comprises clinical experts that specialize in medical cannabis and evidence-based reviews. It builds scientific evidence for the use of medical cannabis by reviewing best available evidence, emerging research and real-time data to better understand the effectiveness of different medical cannabis strains.

Cannabis Standard is transforming the medical cannabis space by combining real-time data with the power of patient engagement. The service is backed by hundreds of hours of research and a comprehensive review of best available evidence globally. Additional expertise comes from the Cannabis Formulary Committee -- an expert, independent panel of clinicians experienced in prescribing medical cannabis, along with evidence-based reviews of the research and practical application. Cannabis Standard builds scientific evidence for the use of medical cannabis through three main processes: First, the Committee reviews available and emerging evidence to identify which indications are supported by good quality evidence. Second, the Cannabis Standard formulary continuously evolves as new evidence emerges – both through physician experience and patient evidence pulled through the platform. And finally, the Committee assesses real-time data and other evidence to better understand the effectiveness of different medical cannabis strains, delivering proven value to medical cannabis patients who are looking to make smart prescription choices

They guide Cannabis Standard’s review of best available clinical evidence and provide their expert advice related to the use of medical cannabis, recommending specific uses, lines of therapy, specific strains, form, grams per indication, mode of consumption, and quantity limits of medical cannabis. The Committee also provides advice on clinically relevant outcomes tools to be incorporated in the research platform.

What is a formulary?

A formulary is a list of drugs covered by a plan. Cannabis Standard is a formulary that focuses exclusively on medical cannabis. It helps medical cannabis users find the recommended product for their condition and symptoms.

How is patient data protected?

Cannabis Standard’s patients own their data, and all data is protected through the platform’s secure portal tracking system. Cannabis Standard ensures patient information remains secure and private using the latest state-of-the-art technology and best-in-class privacy protocols. More can be read about the privacy safeguards in the Privacy Policy section of the website at reformulary.com.

How do patients sign up for Cannabis Standard?

Patients must log into www.cannabisstandard.com, where they will be asked a series of questions regarding their condition and symptoms. Based on the answers and where there is good quality clinical evidence for medical cannabis, Cannabis Standard will provide a recommendation as to whether the patient may be a good candidate for medical cannabis. If so, Cannabis Standard will then generate a template medical document for the patient to take to his/her registered health care practitioner for discussion and if the healthcare practitioner determines that medical cannabis is appropriate for the patient, execution of the Document which then acts as the basis for the patient to register with the LP(s) that he/she chooses.

Do patients have to be a resident of Canada to subscribe to Cannabis Standard?

Currently, Cannabis Standard is only available to residents of Canada; however, Cannabis Standard has plans in the future to expand services to international residents.

How will Cannabis Standard determine what strain and dosage is needed?

Cannabis Standard will ask a series of questions to determine whether the patient would be a good candidate for medical cannabis, based on their condition and symptoms.

The answers – and Cannabis Standard’s review of clinical evidence and expert advice – help to identify the medical cannabis products that can help achieve the desired response for the patient. Cannabis Standard maintains a list of medical cannabis options that include products from different Licensed Producers (LPs) and provides the patient has with the choice to select a product from any of the listed LPs. The platform will then recommend specific products based on the patient’s symptoms and provide guidelines that a patient can use to discuss possible treatment options with their healthcare practitioner. These guidelines include dosing information that follows a “start low and go slow” approach.

What is the Cannabis Standard Quality of Life (QoL) survey and why is Cannabis Standard using it?

Cannabis Standard will offer several clinically-validated survey tools, starting with the World Health Organization Quality of Life (QoL) survey (WHOQOL-100). Designed for use in large research studies or clinical trials, this short-form QoL assessment measures the areas of physical health, psychological health, social relationships and environment. The survey has been adapted by the University of Cambridge and leverages data-gathering tools that are industry-accredited.

Cannabis Standard drives QoL research in the medical cannabis space by continuously gathering data and evidence provided by patients in real time. This data further informs and enhances the medical cannabis formulary, with the ultimate goal of tracking and aggregating patient outcomes. It also empowers patients to track their own outcomes. Through the QoL survey, Cannabis Standard evaluates and reports their subscribers’ responses to medical cannabis treatments to further advise them on treatment efficacy.

How is the Cannabis Standard’s Quality-of-Life (QoL) survey filled out?

Patients will be sent a QoL survey that will ask a series of questions relating to the patient’s health and well-being. All questions must be carefully answered by ticking the appropriate box. Some questions may appear to be the same as others but each one is different. Patients must try to answer each question as it is important to know whether or not a patient experiences those conditions or symptoms.

About Patient Relationships with Doctors and LPs

How does a patient get authorized via Cannabis Standard?

After a patient answer a series of questions, the Cannabis Standard system determines if medical cannabis may be safe and effective for use by the patient. If so, the system uses their information to pre-populate a template medical document for the patient to take to their healthcare practitioner for further discussion about the possible use of medical cannabis. To be eligible to sign the medical document, the healthcare practitioner must have the patient under their professional care.

Why do patients need a Medical Document?

It is a regulatory requirement. The Cannabis Regulations require that individuals have an authorization from their healthcare practitioner to access cannabis for medical purposes. This authorization is evidenced by the practitioner issuing a Medical Document to the patient. Cannabis Standard uses a template medical document, which contains information similar to a prescription as well as some mandatory information in order to facilitate the obtaining of a Medical Document by the patient from his/her healthcare practitioner.

How should the Medical Document be used?

A template medical document, provided on the Cannabis Standard website must be reviewed and signed by the patient’s healthcare practitioner, such as a family doctor, specialist, or in some provinces and territories, a nurse practitioner. To be eligible to sign a Medical Document, the healthcare practitioner must have the patient under their professional care. The healthcare practitioner will use his/her professional judgment and may use the Cannabis Standard template medical document to authorize the patient to use cannabis for medical purposes. A practitioner may also refuse to use the Cannabis Standard template medical document.

What should patients tell their health care practitioner when asking for an authorization for medical cannabis?

Patients must consult their healthcare practitioner if they’re interested in using medical cannabis. They should make sure their healthcare practitioner is aware of their medical history, including medications that are currently being taken, etc. And they should ask their healthcare practitioner as many informative questions as possible, such as, whether medical cannabis may interact with any of their other medications.

How do patients register with an LP?

Once a patient has obtained a Medical Document from his/her healthcare practitioner s/he will choose their desired LP(s) and product(s), they can register with the LP(s) to obtain cannabis for their own medical use. To register, the patient will need to complete a registration form specific to their chosen LP(s) and provide their original Medical Document, signed by their healthcare practitioner. Registration forms are available on the website of the LP, or by contacting them directly.

Can patients switch LPs?

Should a patient choose to access cannabis from a LP, the Medical Document must be sent directly to the LP of their choice. The patient may select any LP that is authorized to sell medical cannabis to registered clients. Please visit the Health Canada website for a list of licensed producers. Should a patient wish to switch from one Health Canada LP to another, they can request that their LP transfer the Medical Document to a new LP of their choice.

About Coverage under your benefits plan

What types of insurance coverage exist for medical cannabis?

There are several ways that medical cannabis is being covered for patients across Canada, including:

  1. Employer-sponsored benefits plans
    1. Some Canadian employers have added medical cannabis coverage to their employee benefit plans, either as part of the Extended Health Care (EHC) benefit, or through a Healthcare Spending Account (HAS) that allows medical cannabis reimbursement.
  2. Veterans Affairs Canada (VAC)
    1. Canadian Military Veterans receive medical cannabis coverage from VAC.
  3. CRA-approved medical expense
    1. Medical cannabis is an approved expense under the CRA guidelines and can be claimed on your income tax form.
  4. Provincial Workers’ Compensation Boards
    1. Certain provincial worker’s compensation boards will provide reimbursement for medical cannabis to injured workers as part of an approved medical cost of a worker’s compensation claim.
  5. Insurance coverage following a Motor Vehicle Accident
    1. Certain insurance companies have begun providing reimbursement for medical cannabis to people injured in a motor vehicle accident as part of the medical costs associated with their insurance claim.
How can I find out if I have coverage?

If you have insurance coverage under an employee benefits plan, call your insurer or plan administrator directly to find out if you have coverage for medical cannabis.

Getting Started on Cannabis Standard

The step-by-step guide to Cannabis Standard registration:
  1. Create an Account: Fill in the required details and read over Cannabis Standard’s Terms & Conditions and Privacy Policy and click 'next'.

  2. Medical Conditions: Patient must provide information about their main medical condition--even if they have multiple conditions.

  3. Symptoms: Provide additional information on the symptoms being experienced in order to help further refine the recommendations.

  4. Payment: The patient will now be able to sign up to get preferred pricing on medical cannabis products. They must select their payment method (Mastercard, Visa or Apple Pay), enter their credit card details, and click 'done'.

  5. Medical Document: Patients can download and print out the Cannabis Standard template medical document to fill out. They must then take the template medical document to their healthcare practitioner to discuss why they are interested in being prescribed cannabis for medical purposes. The patient will need to get their healthcare practitioner to provide them with a signed Medical Document.

  6. Report Outcomes/Track Quality of Life (QoL): The patient will be sent a QoL survey that will ask a series of questions relating to their health and well-being. Cannabis Standard actively encourages patients to participate in these surveys as the data and evidence provided will help to further advise the patient relating to their use of medical cannabis , as well as enhance the medical cannabis formulary to improve patient outcomes. The QoL survey lists several symptoms that could be experienced as a result of the patient’s medical condition. Patients must make sure to read the list carefully and select all the symptoms that they are currently experiencing. It is important that patients are as accurate as possible. Every time the patient provides their outcomes data, the platform will measure the impact the treatment has had on the patient’s physical, social, environment and psychological components and assign a percentage score. They can then monitor their progress through either a comparison chart or a graph.

Resource List

Health Canada

https://www.canada.ca/en/services/health/campaigns/cannabis.html

Canadian Pharmacists Association's Cannabis For Medical Purposes Evidence Guide

https://www.pharmacists.ca/cpha-ca/assets/File/education-practice-resources/Cannabis_EvidenceGuide_2018.pdf


Canadian Consortium for the Investigation of Cannabinoids (CCIC)
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http://www.ccic.net


Arthritis Society

https://www.arthritis.ca/treatment/medication/medical-cannabis

College of Physicians & Surgeons of Alberta

http://www.cpsa.ca/standardspractice/cannabis-for-medical-purposes/