The focus of this piece will be on herbal medical cannabis, not pharmaceutical cannabis-based medicines , as the safety considerations for herbal cannabis are less clear in the current literature. However, many of the considerations presented below can be applied to both. Data from Health Canada showed that the majority of people  reporting cannabis use for medical purposes did not have a government authorization for its use, and were acquiring their cannabis through non-medical sources . The lack of healthcare professional  guidance can be problematic in medically complex patients, particularly those with chronic conditions and polypharmacy. Here, we summarize safety considerations for patients being considered for medical cannabis. Although some HCPs do not support the use of medical cannabis based on current evidence, mobile grow system many patients will use cannabis to improve their symptoms.

It is important for each HCP to be able to assess cannabis safety for any patient using from legal or illicit sources. When initiating a patient on medical cannabis a host of factors should be considered . Prior to cannabis initiation, clinicians recommending cannabis  should screen for potential precautions, contraindications, and drug interactions . Further, we encourage the use of validated questionnaires such as General Anxiety Disorder-7 , Patient Health Questionnaire-9 , and Brief Pain Inventory , as these tools can help clinicians to monitor response to therapy and evaluate the risk versus benefit during follow-up. After assessing potential precautions, contraindications, and drug interactions, clinicians should weigh the overall risk vs benefit of medical cannabis use in each patient. Each of these factors could influence the process of initiation and titration. Route of administration and chemovar  selection should be considered taking into account the individual patients safety considerations . Following selection, a low-dose, slow titration strategy should be encouraged . Each patient will commonly require an individualized approach.

The risks and benefits of cannabis should be assessed for each patient. Clinicians should screen for the following considerations and comorbidities that may influence patient safety . Cannabis has the potential of being contaminated with microorganisms. Patients who are immunocompromised  have a higher infection risk when exposed to contaminated cannabis.Cannabis products from a regulated source are always preferred for these patients. Many immuno compromised patients take medications that may interact with cannabis.Caution should be taken when used with a calcineurin inhibitor  as CBD may increase toxicity.CBD may also worsen the efficacy of programmed cell death protein 1  inhibitors, also known as immune checkpoint inhibitors . There is preliminary evidence THC could inhibit the proliferation of lymphocytes and suppress CD8 T-cell and cytotoxic T lymphocyte cytolytic activity . As such,mobile vertical rack both CBD and THC could potentially interfere with immunotherapy in cancer patients. Interactions between monoclonal antibody therapies  and cannabis are unlikely, although it is important to note that no formal drug interaction trials have yet to be completed.

Evidence suggests the predominant impact of cannabis on impairment is mostly due to THC . In patients who work in safety sensitive occupations, defined as one “in which incapacity due to impairment could result in direct and significant risk of injury to the employee, others or the environment”  , or partake in safety-sensitive activities like driving, risk of impairment is an important consideration. It is generally recommended patients using THC should not drive or engage in safety-sensitive activities for at least 4 hours after inhalation, 6 hours after oral ingestion, or 8 hours, if euphoria is experienced . . There is an increasing body of evidence supporting that daily medical cannabis users tend to be more tolerant to the impairing effects of THC . It has previously been demonstrated that at a dose of 0.5 mg/kg THC, daily users did not display acute impairment on most neurocognitive impairment tasks, except for a decrease in impulse control at high THC concentrations  . A review of the duration of impairment found that within 4 hours after THC inhalation, and 6-8 hours if ingestd orally, medical cannabis users were no longer impaired . In contrast, a recent RCT showed that following CBD inhalation of 13.75 mg there was no indiction of neurocognitive impairment, including for measures of driving performance .