1. Patient’s Use of Medical Marijuana New Corporate Policy March 20, 2013

2. 1 1 Patient's Use of Medical Marijuana *NEW* Corporate Policy  The goal of this policy is to assist all members of the health care team to safely manage the use of medical marijuana  This policy applies ONLY to inpatients that have a valid authorization to possess medical marijuana from Health Canada

3. 2 Patient's Use of Medical Marijuana On Admission (or in Preadmission Clinic)  Document the use of medical marijuana on the BPMH  The patient will be assessed whether it is appropriate for a patient to continue to use medical marijuana during hospitalization. The assessment must be confirmed with the MRP or Consulting Physician prior to an order being placed.  It will not be appropriate for most patients to continue marijuana in hospital because of their acute condition(s) and/or impaired mobility.  MRP’sare not obligated to order medical marijuana for use during admission.  Sativex® is available for use at LHSC as an alternative product for patients authorized to use medical marijuana. 2

4. 3 Patient's Use of Medical Marijuana Ordering Medical Marijuana  If the patient insists on continuing to use medical marijuana & the MRP is agreeable  MRP’s are encouraged to have a conversation with their Residents and Clinical Fellows regarding their thoughts about in hospital use of medical marijuana  The MRP must order medical marijuana if it is to continue. This order can be delegated via telephone or verbal order to Resident or Clinical Fellow but must be co-signed within 24 hours  Write an order that the patient may use own marijuana during hospitalization specifying route and frequency. 3

5. 4 Patient's Use of Medical Marijuana For Patients Using Medical Marijuana  Patients must be provided a brochure for marijuana use  Patients must sign a contract for use of medical marijuana that outlines the use of medical marijuana under LHSC policy.  The contract is to be completed by the patient with someone from the health care team signing as a witness and placed in the health care record.  A copy of the patient’s authorization to possess marijuana is placed on the chart. 4

6. 5 Patient's Use of Medical Marijuana Handling Marijuana  Patients must use their own supply of medical marijuana.  Patients must keep their authorization card and marijuana product on their person at all times.  It is federal law that only the person that holds an authorization card to possess marijuana may handle the product.  Staff and affiliates may not assist patients in storing or handling their medical marijuana Exception: if a patient is suddenly incapacitated, the policy allows for witnessed, temporary storage of marijuana in the narcotic cupboard. 5

7. 6 Patient's Use of Medical Marijuana Patients Using Marijuana  Notify Security if a patient has been ordered medical marijuana to be continued during hospitalization to advise and escort to a designated smoking area  Marijuana may be used in a patient’s room or hospital building if being ingested (as a tea or in food)  Marijuana MUST be used outside of hospital buildings if being inhaled (smoked, vaporizer)  Use of marijuana (or presumed use, if patient goes outside) is documented on the MAR 6

8. 7 Patient's Use of Medical Marijuana Patients that go outside to use Marijuana  A schedule will be arranged through discussion between the patient and RN  Security will escort patients to a secure location to use their marijuana away from other patients and staff to limit exposure to second hand marijuana smoke.  Document in the health care record as per the policy 7

9. 8 Patient's Use of Medical Marijuana  Discharge  Discharge prescriptions should NOT be written for medical marijuana as they are not valid.  Marijuana can be crossed off the printed discharge prescription 8

10. 9 Patient's Use of Medical Marijuana Questions?  Contacts  Nursing Professional Practice OR  Pharmacy 9