medical cannabis solutions

N A T U R A L C A R E G R O U P. C O M

support@naturalcaregroup.com

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HEALTHCARE PROFESSIONALS GUIDE

insideWorking with Natural Care 2

How Natural Care works for patients 5

How Natural Care works in senior care 7

Prescribing and administering medical cannabis 9

Why medical cannabis? 16

What’s

N A T U R A L C A R E G R O U P. C O M 2

We offer ongoing, on-demand support.  

Our nurses and educators are on call to answer

your questions. Your patients, residents and

their caregivers can also call us directly for

help with their personalized cannabis plans,

licensed producer registration, orders, refills

and more.

We create personalized cannabis plans.

Whether you prescribe medical cannabis

or refer to a Natural Care prescriber, we’ll

incorporate your recommendations into

a personalized patient plan that includes

a careful dosing and titration schedule.

We’ll follow up with regular calls to your

patient, resident or their caregiver to ensure

everything’s on track.

Working with Natural Care

It’s simple: we’re here to improve your patients’ or residents’ quality of life, and to lighten your workload. 

N A T U R A L C A R E G R O U P. C O M 4

We provide up-to-date  cannabis education. 

The Natural Care advantage

starts with education:

we offer comprehensive

cannabis education

for doctors, nurses and

healthcare providers; we

also conduct sessions at

retirement and long-term

care homes, community

groups and more.

We are experts in senior care and cannabis. 

Our team combines decades

of retirement and long-

term care management

experience with senior-

specific healthcare expertise

and medical cannabis savvy.

We work directly with  retirement and long-term care homes. 

We provide customized

education sessions, as well

as policy and administrative

support. We make managing

medical cannabis easy for

homes and staff.

We don’t charge for our services. 

No matter how complex your

patients’ or residents’ needs,

our comprehensive services

are always free.

firstWe put patients

We recommend the most suitable products for individual patients.

We are completely licensed producer-agnostic.

N A T U R A L C A R E G R O U P. C O M 6

We guide patients through every step of the prescription, registration, ordering and refill process.  

Meet with a nurse practitioner or doctor in person or online.

Based on the cannabis medication plan, Natural Care completes registration with the most suitable licensed producer(s).

If medical cannabis is suitable, the patient’s MD or a Natural Care MD or NP generates a prescription.

Natural Care’s patient care team offers guidance throughout the ordering and refill process.

Natural Care provides ongoing support for the life of every prescription.

Based on the prescription notes, a Natural Care nurse creates an individualized cannabis medication plan.

ASSESS REGISTERPRESCRIBE ORDERPERSONALIZE SUPPORT

How Natural Care works for patients 

N A T U R A L C A R E G R O U P. C O M 8

Provide medical cannabis

prescriptions

Create

personalized

cannabis

medication

plans

Update home

and residence

policies and

procedures

as needed

Complete

patients’ LP

registration

Provide on-

demand

phone and

email support

to staff, residents,

families and

caregivers

Provide ongoing education with

staff, residents, families and

caregivers

How Natural Care works in senior care

NATURAL CARE’S COMPLIMENTARY

SERVICES

Every home is different, and we work quickly to implement a

customized medical cannabis program designed to improve

residents’ quality of life and lighten staff workload. From

training to policy implementation, medical administration,

documentation and more, we’ve got it covered.

Medical cannabis and its legal bureaucracy can be complicated.

WE MAKE IT SEAMLESS.

N A T U R A L C A R E G R O U P. C O M 10

fast facts

CBD CBD:THC

Cannabidiol only Cannabidiol and tetrahydrocannabinol blends

Potential medical benefits

• Analgesic

• Anti-inflammatory

• Antiemetic

• Antispasmodic

• Anti-epileptic

• Anxiolytic

• Reduces THC-induced psychoactivity/anxiety

• Analgesic

• Anti-inflammatory

• Antispasmodic

• Antiemetic

• Appetite stimulant

• Soporific

• Mood elevator

• Decreases intestinal motility

Likely beneficial for

• Anxiety

• Depression

• Chronic pain

• Spasticity associated with MS, ALS and spinal cord

injury

• Epilepsy

• Inflammation & inflammatory conditions, including

IBS, ulcerative colitis, Crohn’s, fibromyalgia, rheumatoid

arthritis

• PTSD

• Chronic pain

• Nausea & vomiting

• Anorexia

• Spasticity associated with MS, ALS and spinal cord injury

• Inflammation & inflammatory conditions, including IBS, ulcerative colitis,

Crohn’s, fibromyalgia, rheumatoid arthritis

• Limited evidence suggests that THC in particular may be beneficial for

insomnia, neuropathic pain, nausea/vomiting and PTSD. It is recommended to

start with CBD and introduce 1:1 in the evenings if needed for insomnia, PTSD,

etc.

Potential side effects

Cannabidiol exhibits biphasic properties – most therapeutic effects are found at lower doses; slow titration may mitigate potential side effects.

• Somnolence, changes in appetite/weight

• In rare cases, may cause diarrhea

Tetrahydrocannabinol exhibits biphasic properties – most therapeutic effects are found at lower doses; slow titration may mitigate potential side effects.

• Anxiety, disorientation, intoxication, somnolence

• May induce psychosis in susceptible individuals (personal or family history)

• In rare cases, may cause orthostatic hypotension, depression, ataxia/

dyscoordination, tachycardia, cannabis hyperemesis, diarrhea

Prescribing and administering medical cannabis

The rules and best practices around medical

cannabis are just like other prescribed drugs.

N A T U R A L C A R E G R O U P. C O M 12

CBD CBD:THC

Cannabidiol only Cannabidiol and tetrahydrocannabinol blends

Contra-indications

• Unsuitable for pregnant and breastfeeding patients • Acute psychosis, severe/unstable psychiatric conditions, actively suicidal

• History of THC-induced hyperemesis

• Under age 25

• Severe cardiovascular, immunological, liver or kidney disease (especially in

acute illness – can exacerbate arrhythmias)

• Caution should be exercised in patients with history of drug or alcohol

addiction (although recent evidence points to cannabis as potential harm

reduction substitution)

• Unsuitable for pregnant and breastfeeding patients

Drug interactions

Many interactions can be mitigated in complex patients with polypharmacy by slowly titrating.

• CYP450 enzyme inhibitor

• May interact with anti-epileptic drugs; close monitoring of

AED levels and LFTs advised

• Potent inhibitor of CYP3A4 and CYP2D6; may increase

serum concentrations of macrolides, calcium channel

blockers, benzodiazepines, cyclosporine, sildenafil (and

other PDE5 inhibitors), antihistamines, haloperidol,

antiretrovirals, and some statins (atorvastatin and

simvastatin, but not pravastatin or rosuvastatin);

may increase serum concentrations of SSRIs, tricyclic

antidepressants, antipsychotics, beta blockers and opioids

(including codeine and oxycodone)

Many interactions can be mitigated in complex patients with polypharmacy by slowly titrating.

• CYP450 enzyme inhibitor

• CYP1A2 inducer (theoretically can decrease serum concentrations of

clozapine, duloxetine, naproxen, cyclobenzaprine, olanzapine, haloperidol, and

chlorpromazine)

• Potential interaction with medications metabolized by P450 enzymes (2C9,

2C19, 3A4), including antidepressants, proton pump inhibitors, cimetidine,

macrolides, antimycotics, calcium antagonists, HIV protease inhibitors,

amiodarone, isoniazid

• The following drugs may decrease the availability of THC: carbamazepine,

rifampicin, phenobarbital, phenytoin, primidone, rifabutin, St. John’s wort

Safety No reports of abuse or dependence; no public health risk. Minimal risk of dependence, similar to anxyolitics at 9%.

(Versus 21% for opioids, 23% for alcohol and 68% for tobacco.)

Dosing Oils & capsules/softgels

• Daytime dosing, non-intoxicating

• Daily dosing

• Start at 8-10mg/day

• Titrate by 5 mg as tolerated

*Unless you wish otherwise, a Natural Care nurse will create a

personalized dosing and titration schedule for every patient, with

regular telephone check-ins and follow-up, at no charge.

Oils & capsules/softgels

• Nighttime dosing, mild psychoactive, sedating effects

• At hs only to start

• Start at 2.5 mg, titrate by 1mg q 2-3 days as tolerated and to desired effect

*Unless you wish otherwise, a Natural Care nurse will create a personalized dosing and

titration schedule for every patient, with regular telephone check-ins and follow-up, at no

charge.

N A T U R A L C A R E G R O U P. C O M 14

INHALATION ORAL INGESTION

Product Flower Oils, capsules, softgels

Onset Less than 5 min 30 min to 2 hrs

Peak effect Less than 15 min 2 to 4 hrs

Duration 2 to 4 hrs 4 to 8 hrs

Notes Ingestion methods are

generally preferred for

consistent dosing and

longer impact. Some

patients may desire

inhalation for acute and

breakout pain.

Vapourizing

recommended

(not smoking).

OilsAdministered

sublingually, swallowed or

mixed with food.

Capsules & softgelsIngested as usual.

Driving after cannabis use

Patients should be

counselled not to

drive for 4 hours after

inhalation, or for 8

hours if euphoria is

experienced.

Patients should be

counselled not to drive for

6 hours after ingestion, or

for 8 hours if euphoria is

experienced.

Onset and duration of effects

N A T U R A L C A R E G R O U P. C O M 16

Cannabis treats so many symptoms and conditions that a single cannabis prescription may reduce total prescription load.

whycannabis?medical

According to the Canadian Institute for Health Information,

nearly a quarter of Canadians 65 and up take 10 or more

prescription drugs: “Seniors who were prescribed 10+ drugs

were more likely to be hospitalized for an adverse drug

reaction – over five times more likely than seniors who were prescribed fewer drugs.”1

N A T U R A L C A R E G R O U P. C O M 18

it's

sF EaA cannabis prescription can significantly

reduce opioid reliance, sometimes replacing opioid drugs entirely. 

18.1% of older adult patients stopped using

opioid analgesics or reduced their dose after

six months.3

Medical cannabis is safe. Fatal cannabis overdose is impossible.4

The results of the Israel nursing home study

were published in The European Journal of

Internal Medicine.5 “Conclusion: Our study finds that the therapeutic use of cannabis is safe and efficacious in the elderly population.”

Medical cannabis patients report significant pain relief.

In an observational study of over 2700

medical cannabis patients, conducted over

three years at a nursing home in Israel2, 93.7

% of respondents reported an improvement

in their condition after six months. On a scale

of one to 10, reported pain levels decreased

from a median of eight to a median of four,

representing a 50% REDUCTION IN PAIN.

Why medical cannabis?

N A T U R A L C A R E G R O U P. C O M 20

Cannabis use is associated with better quality of life in patients with chronic pain.6

In a 2016 retrospective study of chronic pain patients,

published in The Clinical Journal of Pain, researchers found a

clinically significant association between cannabis use and

better quality of life, as well as reduced opioid use and a better

side effect profile when compared with opioid drugs.7 A

National Academies review also found that cannabis has a

clinically meaningful effect on pain.8

Get your life back

Cannabis treatment in agitated patients may reduce caregiver burnout.  

In a 14-week trial of Alzheimer’s patients treated with the

synthetic cannabinoid nabilone9, Sunnybrook Hospital

researchers found significantly reduced agitation compared

with a placebo group and significantly improved behavioural

symptoms overall. Researchers also found that this reduced

patient agitation and aggression was associated with a

“clinically meaningful” reduction in caregiver stress.

N A T U R A L C A R E G R O U P. C O M 22

usPlease visit naturalcaregroup.com/forms  to download new forms, or call or email us and

we’ll send some your way.

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Contact usNo matter how complex your patients’ or residents’ needs, our comprehensive services are always free.

Email us at:support@naturalcaregroup.com 

Call us at:1.888.671.8022 to learn more

Ji No

Join the growing number of healthcare professionals referring to Natural Care. Your patients and residents will thank you!

N A T U R A L C A R E G R O U P. C O M

This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practioners for professional advice pertaining to your particular condition.

1. The Canadian Institute for Health Information. May 17, 2018. 1 in 4 Canadian seniors prescribed 10 or more drugs. Available online at: https://www.cihi.ca/en/1-in-4-canadian-seniors-is-prescribed-10-or-more-drugs

2. Abuhasira R et al. 2018. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly, European Journal of Internal Medicine. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/29398248

3. Ibid

4. To date, there has never been a recorded death from ingesting too much cannabis. It is estimated that “a fatal dose of marijuana would require the (physically impossible) ingestion of fifteen hundred pounds in fifteen minutes,” according to David Schmader, author of “Weed: The User’s Guide” and published at www.businessinsider.com/can-marijuana-kill-you-2016-11.

5. Abuhasira R et al. 2018. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. European Journal of Internal Medicine. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/29398248 FO

OTN

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S6. Bellnier T et al. 2018.Preliminary evaluation of the efficacy, safety, and costs associated with

the treatment of chronic pain with medical cannabis. Mental Health Clinician. Available online at: http://mhc.cpnp.org/doi/10.9740/mhc.2018.05.110 Elliott DA, et al. 2016. Medical marijuana use in head and neck squamous cell carcinoma patients treated with radiotherapy. Supportive Care in Cancer. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/27005465 Fiz J et al. 2011. Cannabis use in patients with fibromyalgia: effect on symptoms relief and health-related quality of life. PLoS One. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/21533029 Haroutounian S et al. 2016. The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study. The Clinical Journal of Pain. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/26889611 National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. The National Academies Press. Available online at: http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx

7. Haroutounian S et al. 2016. The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open-label Study. The Clinical Journal of Pain. Available online at: https://www.ncbi.nlm.nih.gov/pubmed/26889611

8. National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. The National Academies Press. Available online at: http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx

9. Funded by The Alzheimer’s Drug Discovery Foundation, the trial was conducted at Sunnybrook Hospital using the synthetic cannabinoid nabilone. Researchers noted that although it is too soon to extend the results to medical cannabis, the results are nevertheless promising. Learn more from the study’s authors here: http://alzheimersocietyblog.ca/clearing-the-air-about-cannabis-and-dementia/ and here http://health.sunnybrook.ca/alzheimers/alzheimers-patients-agitation-cannabinoids

support@naturalcaregroup.com

1.888.671.8022

N A T U R A L C A R E G R O U P. C O M