While hospital pharmacies are not licensed to dispense medical cannabis, pharmacists and other hospital staff should have a policy for admitted patients who are prescribed medical marijuana, said Christine Roussel, PharmD, BCOP, Assistant Director of Pharmacy at Doylestown Hospital in Doylestown, PA, at the recent ASHP Midyear 2017 conference.
“I hear about various cases of medical cannabis patients presenting to health systems—and a variety of ways that the patients are being managed,” Roussel told Drug Topics.
Some hospitals allow patients to continue taking medical cannabis products such as capsules, cannabidiol oil, and other non-smokable forms, which have been recommended by their physicians through state-sanctioned programs.
Despite medical cannabis laws that are now in place in 29 states and additional states allowing cannabidiol products, cannabis is still considered a schedule I controlled substance that is illegal under federal regulations. “In health systems that permit it, security of the medical cannabis products is a risk point” Roussel said.
Pharmacists can take a leadership role in policies concerning patients taking medical cannabis, Roussel said.
“My top recommendation is for hospital pharmacists to pull together clinical and safety information, with details focusing on drug interactions, and to present this information to the pharmacy and therapeutics committee of their health system,” Roussel said. “Risks and benefits should be analyzed with the physician and pharmacist committee regarding the impact on the management of an individual patient’s care. The next step is to expand the discussion to hospital administration as to potential risk within the institution.”
In addition, medical cannabis should be included in hospitals’ medication reconciliation practices. At the 250-bed Doylestown Hospital, the pharmacy and therapeutics committee “felt strongly that medical cannabis should be documented during medication reconciliation,” Roussel said. “There are many clinically significant drug interactions that impact disease state management.”
For example, when a child is administered medical cannabis for epilepsy, it is known to affect the levels of other medications in their system, such as increasing the levels of clobazam (brand names Urbanol, Frisium, Tapclob, and Onfi) and its active metabolites up to 500%, Roussel said.
If patients are taking medical cannabis, they should be asked which form of the drug they are taking and by what route it is being taken, as well as specifics about the tetrahydrocannabinol (THC) and cannabidiol (CBD) content, Roussel recommended. THC is the primary psychoactive component in medical cannabis, and CBD “has emerged as a non-psychoactive modulator with effects in the immune and neuro-hormone systems.”
“Cannabis is another drug, and needs to be treated as such, with an understanding of the pharmacokinetics of different formulations, but also with the understanding of the current heterogeneity due to the lack of national standards,” Roussel added.