Cannabis Q&A

Cannabis edibles became legal for sale on October 17, 2019. Cannabis edibles are available for purchase from retailers that possess the appropriate license. The use of cannabis in edible products can bring cannabis into the spotlight for dietitians. Given potential work opportunities and expectations, you are encouraged to understand your role limitations in this new area.

It is important for you to recognize that there is limited published literature on the health benefits of cannabis, but that the volume of research is changing rapidly. Performing a literature search that considers the quality of the study design and the evidence is also an important aspect that Dietitians need to consider when planning their nutrition recommendations.

New evidence is expected to improve robustness of evidence as legal edible cannabis becomes more popular and mainstream. CDBC has developed a Cannabis Resource Toolkit (see the question above), which may be helpful in directing clients to reputable resources online and addressing health risks associated with cannabis consumption.

The first step to take is to consider whether the client’s request falls within a BC dietitian’s scope of practice. It is within the scope of dietitians in BC to discuss nutritional aspects of cannabis edibles, given that the definition of dietetics in the Dietitians Regulation is:

“the assessment of nutritional needs, design, implementation and evaluation of nutritional care plans and therapeutic diets, the science of food and human nutrition, and dissemination of information about food and human nutrition to attain, maintain and promote the health of individuals, groups and the community.”

Once you have determined that the question from the client is within the dietetic scope of practice, the CDBC encourages you to reflect on your own personal limitations on scope of practice. Do you have the knowledge, skills and judgement to take on a new aspect of practice safely, ethically and competently?

Included in the Standards of Practice , “a Dietitian uses critical thinking to obtain assessment date, determine practice problems, plan, implement and evaluate professional services.” You may consult the CDBC Decision Tool for New Aspects of Dietetic Practice  to help you determine whether counselling on cannabis is right for you. If you determine that you are outside of your personal scope, you may choose to refer to another health professional for independent or collaborative practice, as appropriate.

Cannabis is a scheduled drug and prescribing drugs is a restricted activity. For any questions you receive from a client considering medical/therapeutic cannabis use, you must refer to the client’s physician. For example, a dietitian working in an interdisciplinary setting in cancer care, is approached by a client who is experiencing poor appetite as a side effect of the disease or medication and feels that medical cannabis may help. Your first step is to refer to the physician for an assessment, who may prescribe medical cannabis as an appetite stimulant, at which point, you would collaborate as a member of the healthcare team and include a comprehensive nutrition care plan that takes this into consideration.

Adapted from College of Dietitians of Ontario: Cannabis Edibles & the RD Scope of Practice.

 It is within dietetic scope to discuss a client’s current cannabis use as an appetite stimulant for a client whose goal is weight loss, for example. You are not prescribing, nor are you recommending cannabis, but you are rather commenting on the potential nutritional side effects cannabis may have.

Adapted from College of Dietitians of Ontario: Cannabis Edibles & the RD Scope of Practice.

Commenting on dosing, recipe recommendations/development to achieve a specific dosing, nutrition labeling of amounts of cannabis in a given product, is outside of scope. Phytocannabinoids are scheduled drugs and dietitians are not authorized prescribers in BC. You can speak to health risks associated with consumption of food containing cannabis and refer patients to consult with their physician regarding dosages. For example, you can comment on the carbohydrate amount of the edible for a client with diabetes or on the salt content for a client with hypertension. You could, in these cases, propose changes to the recipe of the edible but not in relation to the amount of cannabis in the edible.

Adapted from College of Dietitians of Ontario: Cannabis Edibles & the RD Scope of Practice.

First, you should define the purpose and scope of what they will write about. As mentioned previously, cannabis is scheduled drug and dietitians have a limited role when it comes to both therapeutic and recreational use. The next step is to consider the relevant legislation, standards and guidelines applicable to dietitians.

The Cannabis Act sets out rules and exception for the promotion of Cannabis in Canada. For

example, the Cannabis Act prohibits Canadians from advertising, promoting or selling cannabis to minors (under the age of 19 in BC). Any writing you develop may be seen by a wide audience and there is no way in which to prevent minors from accessing it. Any questions, comments or complaints about the Cannabis Act should be directed to Health Canada at: cannabis@canada.ca.

You may also choose to seek legal advice on the interpretation of this Act for your practice. The

College’s policy on QA-09 Marketing, Sales and Conflict of Interest provides direction on the type of information Dietitians may not include in advertisement such as misleading information, endorsement of products not related to dietetic scope of practice or recommendation of exclusive use of a product. Additionally, identification and management of conflict of interest should be documented.

If a client is under the influence of cannabis, similar to if they were under the influence of alcohol or any other substance that impairs judgement, you must determine if you can proceed with the appointment. The first step is to use your professional judgement to determine if a client has the capacity to consent and if the appointment can proceed.

If you are unable to provide services, you can discuss how the appointment may be rescheduled. You can also have a discussion with the client about your inability to provide services if the client repeatedly arrives under the influence.

It is also important to address any safety risks to the client or others. If the client drove to the appointment under the influence of cannabis and is visibly impaired, you should take steps to address the safety concern. This could involve calling emergency services, notifying other professionals, or contacting the client’s emergency contacts. You should follow established organizational policies and processes. If no such procedures exist, you should consider developing such a policy for your practice setting. Be sure to document your interaction in the medical record, per the CDBC Standards for Record Keeping .

Adapted from College of Occupational Therapists. November 2018 Q&A: Clients under the influence of Cannabis.