Adults can now legally purchase fresh or dried , cannabis oil, seeds and plants for cultivation. Other products, such as edibles and concentrates, will FEATURE REPORT be available for legal sale within one year following enactment of Canada’s New the Cannabis Act. Landscape for Cannabis Use While it has been legal for Canadians to obtain and consume cannabis for medical purposes since 2001, cannabis for recreational purposes became federal law effective October 17, 2018 with the passage of the Cannabis Act.

The Cannabis Act includes regulations for controlling the production, distribution, sale and possession of cannabis, whether medical or recreational, across Canada.

This feature report looks at the legal use of cannabis, for both medicinal and recreational purposes, and how it impacts ONA members in their workplaces, as it relates to their private use and administration of cannabis to their patients, clients or residents. u page 2

Cannabis and the Workplace – What You Need to Know u page 4

About Cannabis u page 6 AUGUST-SEPTEMBER 2019 Part 14 of the Cannabis Regulations specifically addresses access to cannabis for medical purposes, and replaces the Access to Cannabis for Medical Purposes Regulations (ACMPR), which is no longer in force. As a result, cannabis is no longer a controlled substance under Schedule II of the Controlled Drugs and Substances Act.

dults are now able to To obtain , an legally purchase fresh or individual must be evaluated by dried cannabis, cannabis and receive medical documentation A oil, seeds, and plants for from a physician or nurse cultivation. Other products, such practitioner (NP). The individual as products and will then need to register with concentrates, will be legal for sale Health Canada and receive a in Fall 2019, approximately one registration certificate, which grants Recreational Cannabis – year after the Cannabis Act came legal authority to use cannabis for What Has Changed? into force. medical purposes. The Cannabis Act legalized the use of recreational Medical Cannabis Individuals who need access to cannabis effective The production and sale of medical cannabis for medical purposes October 17, 2018. cannabis has been legal since 2001. may do so in three ways: 1) by Under this new federal For those who have been authorized registering with a licensed producer; legislation, individuals 18 to use cannabis for medical 2) by registering with Health years or older are able to: purposes by an authorized health- Canada to produce a limited amount care practitioner, their access will of cannabis for their own medical 1. Possess up to 30 grams not change under the Cannabis Act. purposes; or 3) by designating of dried cannabis or the someone to produce it for them. equivalent in non-dried In health care, medical cannabis form for personal use. use isn’t new. Doctors are finding No matter how individuals obtain 2. Share up to 30 grams that cannabis has a place in the cannabis for medical purposes, their of legal cannabis with treatment of a number of medical possession limit is the lesser of a other adults. conditions that could replace or cut 30-day supply or 150 grams of 3. Purchase dried or fresh back on the use of drugs that have dried marijuana or the equivalent cannabis oil from a debilitating side effects. The science amount if in another form. provincially-licensed underlying the therapeutic use of retailer. cannabis is evolving. 4. Grow, from licensed seed Growing optimism over marijuana legalization’s impact on Canada or seedlings, up to four plants per residence, June 2018 October 2018 provided they are not 51 more than one metre high (from licensed seeds). 38 5. Make cannabis products, 24 such as food and drinks, 20 21 18 17 at home (provided that 11 organic solvents are

Total Total not used). ¢ Positive effect ¢ No effect either way ¢ Negative effect ¢ Don’t know

Source: yougov.com

2 August-September 2019 Strict Legal Framework The Provincial Picture – DID YOU KNOW The Cannabis Act includes Ontario Legislation regulations for controlling the To support the federal legalization production, distribution, sale of cannabis for recreational Not all forms of and possession of cannabis purposes, the Ontario government cannabis are yet across Canada. passed the Cannabis Statute Law available for legal Amendment Act 2018 (Cannabis sale under the Federal, provincial and territorial Control Act) on October 17, Cannabis Act. governments share responsibility for 2018. The law governs the sale, overseeing the cannabis regulation distribution, possession, cultivating, system. The federal government’s propagation and harvesting of responsibilities are to set: . • Strict requirements for producers who grow and manufacture The Cannabis Control Act prohibits cannabis. persons under 19 years of age • Industry-wide rules and from possessing, consuming, Other products, such as edibles standards, including: and purchasing or attempting to and concentrates will be - types of cannabis products purchase, distributing, cultivating, available for legal sale within one year following enactment available for sale, and propagating or harvesting cannabis of the Cannabis Act. - packaging, labelling (or offering to cultivate, propagate requirements and potency. or harvest it). Additionally, only Ontario licensed retailers can sell or distribute cannabis. The legislation On October 17, 2018, it establishes the following: became legal in Canada • The legal limit: Persons under 5.3 million to possess and use 19 are prohibited from cannabis for recreational possessing, consuming and

purposes under the purchasing cannabis. Canadians aged 15 years federal Cannabis Act. • The public possession limit: The and older who reported maximum allowed is 30 grams. using cannabis in the last three months. • Smoking cannabis is legal where Provinces and territories are tobacco smoking is allowed responsible for developing, (“controlled areas” in long-term implementing, maintaining and care homes, retirement homes, enforcing systems to oversee the residential hospices, provincially- % distribution and sale of cannabis. funded supported housing, 13 They are also able to set their own and designated psychiatric or safety measures, such as: veteran’s facilities).

• Increasing the minimum age. • Smoking cannabis in workplaces Canadian workers who • Lowering the personal or on hospital property is consumed cannabis before possession limit. prohibited. or during work. • Creating additional rules for • Cannabis is sold through private growing cannabis at home. retail stores and online under • Restricting where adults can the regulation of the Alcohol and consume cannabis, such as in Gaming Commission of Ontario. 646,000 public or in vehicles. Cannabis users reported trying cannabis for the very first time during the first quarter of 2019. RESOURCES: www.cno.org/en/search/?q=cannabis www.ontario.ca/page/cannabis-laws Source: The National Cannabis www.canada.ca/en/health-canada/services/drugs-medication/cannabis/ Survey (NCS) – May 2019 medical-use-cannabis.html

ONA FEATURE REPORT 3 Cannabis and the Workplace – What You Need to Know

Requirement to Be Fit for Duty Employees have an existing duty to ensure they report fit for duty. This duty is heightened in the case of regulated health professionals. Although recreational cannabis is now allowed under the law, employees are not permitted to be impaired at work.

hey need to consider There are two types of employer If you practice in hospital, long- cognitive impairments policies: term care and hospice settings, and other adverse mental it is important to note that each T effects that could impact 1. Administration of medical can make specific determinations their ability to practice safely cannabis to patients: about access to medical cannabis, at work. The new Cannabis Regulations give and nurses are only authorized all nurses the authority to administer to administer medical cannabis if Cannabis use engages both medical cannabis to patients who hospital, long-term care facility or regulatory standards and employer are authorized to use it, in hospital, hospice policy permits and supports rules to not be impaired or under home-care, long-term care and this activity. Nurses are accountable the influence while at work. hospice settings. for understanding and adhering to employer policies, as well as other Unlike alcohol, there is no current When administering any medication legislation that may relate to the consensus on safe limits for to patients, nurses are accountable administration of medical cannabis. consuming cannabis. The effects for adhering to the College of Nurses’ of cannabis on individuals vary of Ontario (CNO) Medication Practice If you practice in a home-care widely depending on the THC (delta- standard. Nurses must ensure that they setting, specific considerations 9-) content are able to administer the medication apply. Policies to address the use of (the active ingredient in cannabis), safely and competently, and manage cannabis (medical or recreational) frequency of use, and other factors, the potential outcomes of administering in home-care settings must be such as combined use with alcohol it. The CNO’s Medical Decision Toolkit developed to recognize that or other drugs. can assist nurses when faced with the home-care setting is also a decisions regarding medical practices. workplace.

Cannabis use in Canada, by sex and age group, 2013-2017

35 Source: Canada, Health Canada, 30 “Canadian Tobacco, Alcohol and Drugs Survey (CTADS): summary of results for 25 2017” (updated 4 January 2019). 20 Note: The Canadian Tobacco, Alcohol 15 and Drugs Survey was initiated as a biennial survey on tobacco, alcohol and 10 drugs in 2013 and replaced the earlier 5 CADUMS (Canadian drug use monitoring survey); therefore, the results of the 0 two are not entirely comparable, in Overall Male Female 15 to 19 20 to 24 25+ particular, across age groups. Annual Prevalence (percentage) Annual Prevalence ¢ 2013 ¢ 2015 ¢ 2017

4 August-September 2019 Canadians already spend billions on cannabis There is no mandatory self- Total estimated expenditure on legal and illegal reporting obligation to disclose (million CAD) medical or recreational cannabis use 6,000 to the CNO. 5,000 5,526.6 4,000 2017 If an individual is concerned that 3,000 their medical or recreational 2,000 cannabis substance use is affecting 189.3 their ability to provide safe 1,000 1961 0 patient care, it is essential that the 1961 1970 1980 1990 2000 2010 2017 individual speak with their health-

Source: Statistics Canada care practitioner, go off on sick leave, if necessary, and return only when medically cleared to do so by Health and Safety Issues 2. Employer Drug and Alcohol/ a physician or addiction specialist. in Home Care Fit for Duty policies: • The Occupational Health and Following the legalization of Caring for Patients Authorized Safety Act requires employers to recreational cannabis, employers are to Use Medical Cannabis take all reasonable precautions revising these policies to address The new cannabis regulations for the protection of workers. cannabis use by employees. ONA is allow all nurses the legal authority • It is necessary for employers currently reviewing these policies to administer medical cannabis to protect employees from and has provided direction to to patients who are authorized to workplace hazards, such as Servicing Labour Relation Officers as use it. Nurses are authorized to passive inhalation, potentially they relate to management practices administer medical cannabis in all resulting in adverse health and an employee’s right to privacy. effects or impairment due to settings, including hospitals, long- exposure. Medical cannabis should be treated term care facilities, hospices and • Employees who cannot be the same in employer policies as home settings. exposed to second-hand smoke all regularly prescribed medication. or vapours due to conditions The employer should have the When administering any medication such as asthma must be same expectations for employees to patients, residents and clients, accommodated. who use medical cannabis as other nurses are accountable for employees who use any other adhering to the CNO’s practice Employers have a responsibility prescribed medication. standards and legislation. Nurses to ensure the safety of their must ensure they are able to employees through appropriate Disclosure and the Sharing administer medication safely (e.g. policies, protocols, personal of Medical Information labels clearly set out the contents protective equipment and training. There is no mandatory duty in the and the dosage) and competently, If these elements are not in Regulated Health Professions Act that place, nurses may have a right to requires a health-care professional and manage the potential refuse dangerous work, as laid to self-report medical or recreational outcomes of administering it out in occupational health and cannabis use to an employer. in accordance with the CNO’s safety legislation and collective Practice Standard – Medication. agreements. The issue of whether to report this information must be approached Members are to contact their on a case-by-case basis as the use manager and ONA Bargaining Unit of marijuana for medical purposes representative if they believe: is considered personal health • Their health and safety is at risk, information, as is the use of other and/or prescribed medications. Such • They are unable to meet their privacy rights must be balanced professional obligations due to with the need of the employer to health and safety concerns. ensure patient safety.

ONA FEATURE REPORT 5 About Cannabis

Cannabis and its components The potency (concentration or How cannabis is used Cannabis refers to the plant strength) of THC in cannabis is often The cannabis plant is used for its . The cannabis plant shown as a percentage of THC by effects on the mind. It is also used originally comes from Asia. It is now weight (or by volume of an oil). for medical, social or religious grown around the world, including THC potency in dried cannabis has purposes. Marijuana is a slang term in Canada. increased from an average of three for the dried flowers, leaves, stems per cent in the 1980s to around and seeds of the cannabis plant. Chemical substances in cannabis 15 per cent today. Some strains Cannabis contains hundreds of can have an average as high as Results of the 2017 Canadian chemical substances. Over 100 of 30 per cent THC. Cannabis Survey at http://epe.lac- these are known as . bac.gc.ca/100/200/301/pwgsc-tpsgc/ Cannabinoids are made and stored Cannabis that contains very low por-ef/health/2017/102-16-e/index. in the plant’s trichomes. Trichomes amounts of THC in its flowers and html, provide a snapshot of how are tiny, clear hairs that stick out leaves (less than 0.3 per cent) is much cannabis Canadians use, how from the flowers and leaves of the classified as . often they use it and in what form. plant. Cannabinoids have effects on cell receptors in the brain and body. CBD Note: Not all forms of cannabis are They can change how those cells (CBD) is another yet available for legal sale under behave and communicate with . Unlike THC, CBD does the Cannabis Act that came into each other. not produce a high or intoxication. force on October 17, 2018. The There is some evidence that CBD Cannabis Act currently permits THC may block or lower some of the the sale of: The most researched cannabinoid is effects of THC on the mind. This may • Cannabis oil, delta-9-tetrahydrocannabinol (THC). occur when the amount of CBD in • Fresh cannabis, THC is responsible for the way your the cannabis is the same or higher • Dried cannabis, brain and body respond to cannabis, than the amount of THC. CBD is • Cannabis plant seeds, and including the high and intoxication. also being studied for its possible • Cannabis plants. THC has some therapeutic effects but therapeutic uses. it also has harmful effects. Harmful Edible cannabis, cannabis extracts effects may be greater when the Terpenes and cannabis topicals will be strength of THC is higher. Terpenes are chemicals made available for legal sale, effective and stored in the trichomes of October 17, 2019. the cannabis plant, with the cannabinoids. Terpenes give cannabis its distinctive smell.

Source: www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about.html

6 August-September 2019 Cannabis in the Workplace Tips for ONA Members and Leaders

ONA Members ONA Leaders • Obtain medical documentation Contact your Servicing Labour to substantiate the need for Relations Officer if: medical use of cannabis • A member uses medical (i.e. prescription) and cannabis because of a appropriate registration disability and approaches with Health Canada. you regarding a need for • You must be able to practice accommodation. safely at work. If you • A member has questions are concerned that your about disclosing any cannabis use is affecting cannabis use to an employer, your ability to provide safe including for medical patient care, consider taking purposes. sick leave and return only • A member discloses to you when cleared to do so by a that they have an addiction treating physician. to cannabis or you suspect a • There is no legal obligation member has an addiction. to self-report cannabis use • Your employer introduces to your regulatory college. staff policies regarding drug • If you have questions and alcohol use. regarding cannabis use, contact your Bargaining Unit Representative.

ONA FEATURE REPORT 7 For more information

Health effects of cannabis: www.canada.ca/en/health-canada/services/drugs-medication/cannabis/ health-effects/effects.html

About problematic substance use: www.canada.ca/en/health-canada/services/substance-use/about-problematic- substance-use.html

Driving while impaired by a drug: www.canada.ca/en/health-canada/services/substance-use/talking-about- drugs/driving-impaired-drug.html

Canadian Tobacco, Alcohol and Drugs Survey 2015: www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs- survey/2015-summary.html

2017 Canadian Cannabis Survey: epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-ef/health/2017/102-16-e/ index.html

Canadian Student Tobacco, Alcohol and Drugs Survey 2014-2015: www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol- drugs-survey/2014-2015-summary.html

www.ona.org

8 August-September 2019