No gatekeeping here, we share our skills and knowledge acquired from 10 years of experience in medical cannabis care.

Santé Cannabis has been at the forefront of medical cannabis consultation and research in Québec since 2014. With over 7500 physicians and nurse practitioners having referred more than 20,000 patients, our multidisciplinary team comprises family physicians, specialists in chronic pain, oncology, palliative care, gastroenterology, endocrinology, psychiatry, pediatrics, and nurses with expertise in cannabis medicine. Beyond patient care, we are dedicated to educating healthcare professionals, researchers, and policymakers through both online and onsite training programs.

Over the last 10 years, we saw growing interest from the Quebec patient community for medical cannabis treatments and very few doctors were open to prescribing it. Often due to a lack of knowledge about this treatment, poor scientific evidence being available, and ongoing stigma.

A 2018-2019 survey of medical students in Quebec revealed that cannabis-related topics were minimally covered in their curricula, leading to low comfort levels among them. The majority felt unprepared to address cannabis-related issues in their future practices, highlighting a need for enhanced medical education on cannabis in Quebec’s medical schools.

Addressing the Gap in Medical Cannabis Education

As strong advocates for patient rights and medical cannabis access, we needed to address the gap in medical cannabis education. In 2019, we launched the Prescriber Training Program for healthcare professionals. Initially created for Quebec physicians, interested in learning more about clinical guidelines for medical cannabis and developing individualized treatment plans, it sparked interest from Canadian and international physicians.

With the legalization of recreational cannabis in 2018 came changes and challenges for Quebec’s medical cannabis landscape. Santé Cannabis is always adapting to the evolving industry and staying on the frontline to provide the best care to the community. Some negative points of this legalization were medical cannabis patients turning to self-medicating and accessing their medicine through recreational outlets like the SQDC. While some of the positives are less stigmatization around cannabis and more interest in training from healthcare professionals, guidance from trained healthcare practitioners remains essential to safe access.

Importance of Specialized Training

As Dr. Michael Dworkind, Medical Director of Santé Cannabis and Associate Professor of Family Medicine at McGill University, emphasizes, “It is our duty as physicians to understand the available treatment options for our patients, and medical cannabis treatments have emerged as an important clinical tool.” This sentiment underscores the necessity for healthcare professionals to engage in specialized training to effectively meet patient needs.

With the launch of our online boutique in 2024, a platform created to provide healthcare professionals direct access to a wealth of educational and training resources, we bridge the educational gap and facilitate medical cannabis education.

Through our practical education materials, we aim to empower general practitioners, specialists and, nurse practitioners and enable them to deliver the best care possible. These learning tools are accessible from anywhere at any time and adaptive to your needs and your calendar.

Additionally, we offer in-person training opportunities to help professionals enhance their skills and knowledge.

Together, let’s explore all the possibilities!

Virtual and In-Person Training

Prescriber Training Program

Recognizing the growing demand for medical cannabis education, Santé Cannabis offers a transformative training initiative for Québec healthcare professionals. The Prescriber Training Program, meticulously designed by clinicians, provides a practical approach to medical cannabis education. Developed from our years of clinical care and research we have based on real-world data and the latest research on medical cannabis treatments.

The complete Prescriber program package comprises 10 self-learning modules. In these modules, you will learn about Cannabis as a medical treatment, Patient assessment, and Prescribing. You will find treatment evidence for specific conditions and symptoms, allowing physicians to customize learning based on their professional needs. The virtual program can be followed at your own pace, however, if someone wants to focus on one subject, selected modules can be purchased separately.

For reference module 3 The Prescription Guide covers initial and follow-up treatment protocols for each indication and treatment objective, as well as product format details and drug interaction information.

The Prescriber Package also includes: a Clinical toolkit, and a starter kit of clinic forms, available for customization to your practice, including our referral form, patient evaluation, follow-up form, treatment plan form, and authorization form (Medical Document).

Viewing access to an educational video and presentation, about determining the appropriate medical cannabis treatment, also available for purchase separately.

Personal Mentorship Sessions: Group or 1 on 1 sessions to address all of yours and your teams’ training questions.

Shared Care

This service allows your medical team to request support from our nursing team on a patient-by-patient basis. Available Monday to Friday and includes direct (our nurse to your patient) or indirect (our nurse to your clinical team member) support to develop treatment plans and dosing schedules, source product recommendations, insurance coverage questions or any other needs.

The program was designed for Quebec clinics and practitioners as it includes regulatory information and guidance specific to the Quebec healthcare system. However, the medical cannabis content can be adapted and integrated into your local practice.

“I turned to Santé Cannabis in order to train myself and be able to respond correctly to demand. It gives me the opportunity to prescribe cannabis and also to follow up with my patients properly.  I’ve noticed that a deeper relationship of mutual trust has developed because they don’t feel judged.” – Dr.Jerome Lopez

The course will teach you all the essentials of medical cannabis-based treatments and care, and you’ll leave with the knowledge you need to prescribe with confidence.

“They clearly put a ton of effort into setting up this training program, which demonstrates their commitment to advancing the field of medical cannabis for the health care profession. As well, Dr. Dworkind specially tailored certain aspects of my rotation to me based on my interest in palliative care and chronic pain management, as he has expertise in this area after his long clinical career. ” -Dr.Lorne Wiseblatt

Ask the Expert Sessions

One might wonder what is an “Ask the Expert” session? These 1-1 sessions are the perfect opportunity to get answers to all your questions about medical cannabis as well as to review and discuss complex patient files. They can be done virtually or by phone with one of our physicians or nurses.

In-person Training

We offer onsite preceptorships for doctors, nurse practitioners, pharmacists, nurses or clinic directors that want to learn in a clinical setting. During their preceptorship, they will observe initial and follow-up patient consultations and see our model of care in action.

They can participate in patient file reviews and attend patient education sessions led by a nurse.

The trainees may debate cases and collaborate on patient care decisions and personalized treatment plans. Our team will adapt to the trainees’ needs and their schedule, whether they can commit to a full day or a half day, we will make the most of their time spent in our practice.

“Thanks to their expertise, I feel fully equipped to support my patients in the safe and effective use of medical cannabis. Thank you to Santé Cannabis for their commitment to the training of healthcare professionals and the accessibility of this therapy in Quebec.”  – Dr. G. Lemire, Global MD – Saguenay, completed our prescriber training program and onsite preceptorship and will be integrating a medical cannabis consultation service into her practice.

Educational Tools and Videos

To make our training program more accessible, we have broken down the program into 10 self-learning modules. You can choose the modules you want specific to your field of practice. The self-learning modules Sleep Disturbances and Post Traumatic Stress Disorder are gaining in popularity and meet a growing demand to support these patient populations suffering from uncontrolled symptoms. Other modules like Neurologic Indications or Gastrointestinal Indications can provide valuable insight and evidence-based data about these disorders.

Our educational videos are a fun way to learn, presented by a Santé Cannabis physician or nurse, they are a simple and effective way to understand the fundamentals of providing medical cannabis care in a clinical setting.

Introduction to medical cannabis covers the following concepts: medical cannabis status, the endocannabinoid system, main Phyto cannabinoids and chemovars, indications and relative contra-indications, treatment options and titration, adverse effects and drug interactions, main regulations as well as patient education.

The Santé Cannabis Model of Care; through our peer-reviewed model of care, we’ve achieved standardized patient care. Get to know the secret of our inner workings and our success as a free clinic.

The 5 Common Myths about medical cannabis and the supporting evidence to debunk them:

• The only way to take medical cannabis is to smoke it
• Medical cannabis is harmless and impossible to overdose
• There are no drug interactions with medical cannabis
• Medical cannabis causes addiction and makes you high
• CBD can be converted to THC

Clinical Tools

Our clinical materials will get you to a place where you are ready to prescribe to your community of patients. With our customizable clinic forms, you get to integrate this treatment seamlessly into your practice.

• The Patient Evaluation Form can provide targeted data collection for healthcare professionals and allow you to organize their symptoms more effectively.
• The Patient Treatment Plan Form is a clear and simple formulated document explaining the patient’s medical cannabis treatment containing valuable information like the name of the licensed seller, the name of products, dosage instructions and titration protocol and relevant precautions.
• The Patient Follow-up Form allows you to monitor a patient’s health and make adjustments to their treatment as required.

With the right tools, you can achieve your prescriber goals.

International Offering

International practitioners too can benefit from our trainings, by adapting the Prescriber Training Program, signing up for a preceptorship or a session with a mentor and using the International Prescriber Guidebook. We will help you build your confidence in patient screening and assessment for medical cannabis treatment.

“Santé Cannabis provided me with the most comprehensive training that I have ever received.  The doctors and nurses welcomed me and made me feel part of the team.  I am excited to take my knowledge home and to start prescribing confidently in my practice.” -Dr. Paula Martinez, MD (Neurology), Bogota, Colombia

The International Prescriber Guidebook is a complete and practical training resource for medical cannabis prescription and education, applicable across Canada and international jurisdictions.

It features:

• Active Therapeutic Compounds
• Methods of Administration
• Patient Evaluation and Prescribing Instructions
• Detailed Treatment Protocols and Product Selection by Indication
• Dosing Instructions
• Titration tables
• Follow-up and Monitoring
• Frequently Asked Questions
• Options for Prescriber Support

The guidebook is a valuable asset for international prescribers to navigate medical cannabis care with clarity and certainty.

Our Commitment

Why does medical cannabis education remain so important?

Under the Cannabis Act, the current recreational market has threatened the viability of the medical cannabis access program. This treatment option needs to stay available and be considered as a complementary and adjuvant treatment when conventional medications fail. It can support medication substitution including opioids, benzos, etc, and even improve the quality of life of countless patients.

Santé Cannabis remains steadfast in its commitment to empowering healthcare professionals with the knowledge and tools needed to integrate medical cannabis into patient care safely and effectively.

Through clinical research and real-world data, together we can bring progress to medical cannabis care.

The landscape of medical cannabis is rapidly evolving, and staying informed is crucial for healthcare providers aiming to offer comprehensive patient care. Santé Cannabis’s training materials serve as a valuable resource, equipping professionals with the knowledge and skills required to navigate this field confidently.

We know you can find your medical cannabis community of practice with us.

Ready? Train with us!

Visit our boutique

For more continuing education opportunities

Author:
Alexia Bellemare

(Rosa) lives in a retirement home. She seemed earnest about having dominion over her “secret”. On that day, she had maintenance workers attending her floor and an orderly was due to help her get dressed. She withholds her cannabis bottles from prying eyes, only to be laid open to view behind an old Brillo soap box.  

She says she would be represented dramatically by other dwellers as ‘’a habitual user of drugs ” if they knew. Her peers are still very observant of the common perceptions and other existing states. She has learned the intimacy of the daily in-and-out of caregivers and so, she dispenses her CBD oil in due course.   

Half a year later, I sensed she became more defiant, a contemporary moving ahead against the waves of the current stream. She explained. She made a definitive undertaking, testing the water so to speak. During an afternoon tea, she quoted to her fellow guests a news coverage about the benefits of medical cannabis. The feedback hit a schism, as expected. Personal opinions and so-called ‘’common sense “ dinged off each other like kids to broccoli. But amidst all that dissonance, (Rosa) was reassured that those who were in goodwill were assertive about appealing for medical cannabis. She felt not alone. Although encouraged, she isn’t ready to display her CBD bottles openly just yet.  

Little steps toward changing public perception. One (Rosa) at a time. 

Author: Pheng Lim, LPN 

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Seeing that welcoming face first when patients come into the clinic will set the tone for their entire visit.   

Helping is the true nature of an MOA, this could not be truer at a medical cannabis clinic that conducts studies. The research component of our clinic requires special attention to detail in the tasks at hand and providing further assistance to patients and their caregivers. Being a medical cannabis advocate for our research but also for patient access becomes second nature to a Santé Cannabis MOA.   

We asked our team of medical office assistants to share with us their feelings and experiences of working at Santé Cannabis. Let’s look at their work diary:  

“My story at Santé Cannabis began as a patient and over time I was able to manage my illness to a point I could maintain employment. I wanted to give back to a community that gave me so much. Each patient I met needed their own individual support and I felt as if I could be this person to provide that for them.  

We are the first intervention if a patient is overwhelmed with emotions. I remember a past encounter with a patient that left a powerful impression when she told me ‘Today you saved a life, I hope you realize this. I cannot thank you enough for talking me off the ledge today. You are an amazing human being.’ 

We are the first voice of reason when a patient calls because they have lost hope in our medical system. As an MOA, we have a vital role to play in a patient’s care from the moment the clinic receives their referral.   

Not many people realize that the MOA is the glue that holds the clinic together.    

Being an MOA for the last 4 years has brought me so much joy and fulfillment, I am beyond grateful for the opportunity Santé Cannabis gave me.”  

– Rebecca Fogel, MOA 

“Seeing our patients satisfied and confident when leaving the clinic with new information and the ability to pass this information on to others that may be suffering is probably the best part of my job. 

I recently received a phone call from a patient, and the amount of joy, relief, and gratefulness that was coming through the phone was truly inspiring. They felt their treatment had helped them so much and they wanted to express the difference it made in their life. It was what I was here for; to hear that it helped someone to that extent was absolutely rewarding.  

Seeing what our patients have gone through has really opened my heart with much more compassion. The best part is that when the treatment really works for them. This gives me more motivation to push and reach my goals and help the people that need access to medical cannabis.”   

–Tamara, MOA 

“Working at a clinic whose goals are to improve access, educate, and treat patients, and taking part in those projects makes me feel like my time and efforts are worthwhile when compared to previous jobs. It has been eye opening to see the extent that patients must go to be able to acquire medical cannabis. The regulations, laws and policies put forth by our government when it comes to prescribing medical cannabis can really make it hard for patients to get the care they need. It’s not easy, and it needs to be improved.  

There is one anecdote that marked me was when booking an initial appointment for a palliative cancer patient. The patient told me they were about to undergo immunotherapy. Studies have shown immunotherapy treatment is not as effective when taking cannabis: medically or recreationally. In that moment, it hit me how important it is to educate people about the effects cannabis has on the body. Previously unaware of the risks, this patient could have gone to the SQDC and put their health and cancer treatment at risk.”  

– Shant, MOA and Research Assistant 

“I came to Santé Cannabis for a new beginning. My family doctor and I had a conversation about a new clinic that was opening neighboring his practice, and so I applied without hesitation. I knew nothing about cannabis. Since I was a little girl, I have always been there for others. I like to feel useful and no matter how small the help I can provide, I can still make a difference in people’s lives.  

In the early days working during Dr. Watier’s clinic, I asked him to follow a patient with autism, which he accepted. I’m impressed to see how much this young man’s life has changed with his cannabis treatment as well as the life of his parents. He is still a patient with us today.”  

– Manon, MOA 

“I take pleasure and pride in being the first line of contact for people who request our services. Being the first person who ensures each individual feels acknowledged and attended to with the utmost dignity, empathy and compassion is a responsibility that is integral to this position and that I greatly value.  In my work, a moment that always grounds me is the shared conversations with patients during phone calls. Their openness to be vulnerable and to discuss their personal struggles, their view on life and contemplation about the afterlife are always subjects of reflection and empathy that make me appreciate those moments.”

– Jessica, MOA 

“Santé Cannabis allows me to use my skills and experience to contribute to a worthy cause. I am also lucky to work among an incredible team of professionals in a field that’s always striving for improvement and building a standard for patient care, research, and education.  

One of my fondest memories, since I work here; was amid the pandemic; we had all been working from home for months – a difficult time for many – and we were preparing for our virtual Christmas party. I was helping organize our staff events and had to come into the office (a rarity at the time) to assemble care packages that were to be sent out to all the employees. Besides the fact that the packages were particularly generous, it was great to feel part of an organization that truly operated like a family caring for its members during tough times.”  

– David, Clinic Coordinator 

We also asked one of our founders and the manager of our nursing team to write a few words about our team of MOAs whom they work closely with and rely on to complete a successful clinic day. 

“I’m happy to recognize the work that our medical office assistants do on a daily basis.  You should be proud of what you do every day!  

 You are the first contact with the patient. You are there to assist them, to guide them through their journey, to ease their concerns, to respond to their needs. It is because of you that we can provide services to patients.  With your empathy, your kindness, and your listening, you contribute to improve their experience in the process of relieving their symptoms.   

You help both the patients and your colleagues during the course of care.  

It is not uncommon for me to hear patients say, ‘The staff is very welcoming’, ‘I felt taken care of as soon as I arrived’, ‘I had a lot of help from the medical office assistants while filling out the questionnaires’.  

The nurses are proud to work with you.”

 – Naomie Parrot, Nurse Manager 

“This initiative to recognize our team of MOAs is invaluable to building community.   

We are an organization that embraces all the workers as important contributors to the success of its operation. This is at all levels of our mandate: clinical, research, education, and advocacy.  

Our powerfully talented group of MOAs are contributing through their commitment to our vision of relieving the suffering of patients with chronic pain and other diseases that medical cannabis can treat.  

This positive interdependence is appreciated by everyone involved and leads to greater job satisfaction and dedication.  

We all need each other to get the job done.  

I am so grateful to have our MOA team, and to be able to rely on them for the smooth and efficient work that we achieve. ”  

 - Dr.Michael. A. Dworkind, Medical Director and Co-Founder.  

Whether their motivation is to educate, advocate or spread awareness on the importance of medical cannabis treatments and access, we know the empathy of our MOAs help build the patient’s trust. This trust is often the beginning to a long-term relationship. 

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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Pain is part of life, but for some people there is simply no respite from pain. When pain becomes chronic, it’s difficult to make it go away completely. Therefore, it’s no surprise that chronic pain is an enormous global public health problem. About one in four Canadians aged 15 or older (or an estimated 7.63 million people) live with chronic pain, and it is about one in five people in the United States. [1, 2] It is the leading cause of disability in working-age adults, impacting activities of daily living and quality of life. [3] 

We know how chronic pain can be difficult to manage, as most of our patients have chronic pain, or pain as part of a chronic condition. 

REAL-WORLD DATA FROM SANTÉ CANNABIS’ OBSERVATIONAL STUDY 

Chronic pain conditions are frequent in patients seen at Santé Cannabis’ clinics: pain-related diagnoses make over 50% of all diagnoses (figure 1) and pain symptoms affect 80% of the 1275 patients assessed between July 2020 and March 2021. 

Figure 1: Primary diagnoses proportions from 1275 patients followed at Santé Cannabis (July 14, 2020—March 31, 2021) 

Furthermore, chronic pain is frequently associated with a myriad of other frequent symptoms that are directly impacted by pain, such as sleep disturbances, [4, 5] anxiety and depression, [6, 7] fatigue, nausea, etc. The following graphic (figure 2) shows the most common secondary symptoms reported by patients living with pain at our clinics. 

Figure 2: Secondary symptoms in 1019 patients living with pain and followed at Santé Cannabis (July 14, 2020—March 31, 2021). 

CHRONIC PAIN IS NOT A MONOLITH 

Chronic pain is pain that persists or recurs for more than three months.[8] It is a convenient umbrella term, regrouping widely different pain types. 

Chronic pain is classified according to its cause, cancer and non-cancer origin, and by the way the pain is produced (its mechanism) in neuropathic pain, nociceptive pain, and mixed pain (including both neuropathic and nociceptive pain).  

Figure 3: Classification of pain  

We see a wide array of chronic pain conditions at our Santé Cannabis clinics, from neuropathic pain in multiple sclerosis to cancer pain, fibromyalgia and chronic low-back pain. It is common that patients consider our clinic as a last option to manage their chronic pain – and it makes sense, since there are several conventional treatments for chronic pain supported by better evidence than cannabinoid-based medicines currently are. 

MANAGEMENT OF CHRONIC PAIN 

The modern pharmacopeia possesses more than a few options for pain management. Cannabinoid-based medicines have their use in pain management as a third- or fourth-line treatment, [9] and generally recommended as adjunctive treatment. [10, 11] There are both pharmacological and non-pharmacological treatment options that can work in combination to relieve and cope with pain.  

Non-pharmacological therapies include (but are not limited to) physiotherapy, exercise, cognitive behavioural therapy (CBT), occupational therapy, acceptance and commitment therapy (ACT), mindfulness, massage, osteopathic manipulation, etc. [12-15] 

As for pharmacological treatments, the following analgesic ladder shows a simple strategy (figure 4); it is adapted from the World Health Organization analgesic ladder, initially intended for cancer pain, but now also applied to chronic non-cancer pain. [12, 16] 

NSAIDS: nonsteroidal anti-inflammatory drugs; TCAs: tricyclic antidepressants; SNRIs: serotonin-norepinephrine reuptake inhibitors 

Figure 4: Analgesic ladder (adapted from [12, 16]) 

When considering cannabinoid-based medicines, it is important that a discussion takes place between the healthcare provider and the patient in a shared decision-making process. [9] Indeed, cannabinoids efficacy, potential adverse effects, cost, and related stigma should be addressed so that patients are adequately informed.   

MULTIMODAL TREATMENT 

Chronic pain treatment includes more than pharmaceuticals, as these are often not as effective when used alone. Behavioural and other psychology-based therapies play an important role in chronic pain management to help patients cope with the emotions that accompany pain, such as anxiety, depression, frustration, etc. 

Furthermore, our medical team observes that chronic pain often occurs in individuals who underwent emotional trauma (resulting from violence, abuse, neglect, etc.)—highlighting the need for a multimodal therapy to help improve the combination of emotional and physical pain. 

We also believe that chronic pain patients benefit more from a holistic approach incorporating lifestyle changes, as pain and anxiety/stress act one upon another in a vicious circle. Indeed, patients living with unrelieved chronic pain often are trapped in a pain-centered pattern, where anxiety—and decreased activity, deconditioning and fatigue—contributes to worsening pain and reduce their quality of life (see figure 5). 

Chronic pain is generally recognized to impact sleep and contribute to depression, but it may not be common knowledge that persistent pain is also associated with memory decline. [17, 18] 

Figure 5: Pain-centered life 

At Santé Cannabis, the role of our medical team is to help patients help themselves. In our experience, patients who undertake a multimodal treatment obtain better therapeutic results. Promoting the practice of physical activities, providing strategies to manage stress, and improving sleep can prove extremely helpful to guide patients out of their pain-centred life (see figure 6). 

Some of our patients reported better coping with the practice of mindfulness—an example of simple, inexpensive, and empowering therapy for which we provide information and support through virtual talks and support groups meeting. Patients often do not realize how they can be empowered in their own healthcare and get control over their pain, rather than being victimized by it. 

“When their functionality improves, my patients say that they feel like they can control their pain instead of the pain controlling them.  

Some tell me they feel as if they had regained their lives.” Dr Michael Dworkind 

Figure 6: Function-centered life 

On a last note, the environment in which patients live also impacts pain levels directly or indirectly (e.g., through work-related stress levels). Evaluating the context and situation of a patient helps to better assess pain and pain-related symptoms, since they fluctuate according to what happens to the body and the mind. For example, if context has changed, it will likely affect the patient’s condition and, therefore, their response to treatment. 

PAIN AND STIGMA 

Chronic pain is incredibly hard to treat, and it is difficult for patients to find a treatment that will help them manage or overcome their pain. Many healthcare professionals do not receive extensive enough training on chronic pain; this affects their ability to provide adequate recommendations on pain management and in turn poses a serious threat to patients’ safety. [19, 20] 

Chronic pain patients need access to multimodal treatments, and they need to be able to have an honest discussion about their treatment expectations and outcomes with their healthcare provider. Due to the challenges and lengthy commitment needed with treating pain, stigma may affect perceptions about pain conditions and the patients who suffer from them. 

One example of stigma is when some healthcare professionals are dismissive about fibromyalgia, as the condition is hard to manage with success, and there has been an influencing notion passed around that it is a condition mainly caused by a patient’s mental state. 

If there is no measure to diagnose fibromyalgia, does it exist? 

Often, fibromyalgia patients must be very persistent in seeking treatment as well as in getting recognition for their condition. While remaining a diagnosis of exclusion—which means patients spend a long time with their physician and specialist(s) trying to determine the cause of their pain and other symptoms—more and more scientific evidence supports the validity of fibromyalgia as a pain disorder and its treatment. 

There is also persistent stigma associated with pain expression, in particular with those that are vocal about their pain (emotional outburst, cries) being often perceived as exaggerating. It is vital to acknowledge the cultural and gender-related differences in pain communication. If a patient is reporting pain, we as a medical clinic believe that healthcare professionals should remain sensitive and respectful, and provide a proper, objective and attentive assessment of the reported pain and symptoms. Ignoring or downplaying reported pain and symptoms is counterproductive and does not help patients get better. 

At Santé Cannabis, we know what stigma is – just read our name-, and we mean to push forward and fight stigmatization. We wish our patients to be heard, so we advocate for their rights; we want cannabinoid-based treatments to be prescribed and dispensed like other medications, so we advocate for improved access. We want more research on medical cannabis, so we contribute to the growing body of evidence on cannabinoid-based medicines with our ongoing observational study. To all the patients who accept to be part of this study, we thank you for your contribution to Science. We hope that our collective effort will help to improve patient care. 

Stay tuned for Part 2 of this blogpost, where we’ll go over the current evidence supporting cannabinoid-based medicines for pain management and much more!   

Author: Charlotte Bastin 

You are a healthcare professional and you found valuable information in this blogpost?

We have more for you! Check out our Modules written specifically for healthcare professionals participating in our Prescriber Training Program 

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REFERENCES 

1. Health Canada, Canadian Pain Task Force Report: September 2020. aem, 2020.
2. Zelaya, C.E., et al. Chronic Pain and High-impact Chronic Pain Among U.S. Adults, 2019. NCHS Data Brief No. 390 2020 2020/12/02/T04:47:29Z; Available from: https://www.cdc.gov/nchs/products/databriefs/db390.htm.
3. Busse, J.W., et al., Guideline for opioid therapy and chronic noncancer pain. Cmaj, 2017. 189(18): p. E659-e666.
4. Gottschling, S., et al., Safety Considerations in Cannabinoid-Based Medicine. International journal of general medicine, 2020. 13: p. 1317-1333.
5. Ferguson, G. and M. Ware, Review Article: Sleep, Pain and Cannabis. Journal of Sleep Disorders & Therapy, 2015. 04(02).
6. Dominick, C.H., F.M. Blyth, and M.K. Nicholas, Unpacking the burden: Understanding the relationships between chronic pain and comorbidity in the general population. PAIN, 2012. 153(2): p. 293-304.
7. IsHak, W.W., et al., Pain and Depression: A Systematic Review. Harv Rev Psychiatry, 2018. 26(6): p. 352-363.
8. Treede, R.-D., et al., Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). PAIN, 2019. 160(1).
9. Chang, Y., et al., Medical Cannabis for Chronic Noncancer Pain: A Systematic Review of Health Care Recommendations. Pain research & management, 2021. 2021: p. 8857948-8857948.
10. Häuser, W., et al., European Pain Federation (EFIC) position paper on appropriate use of cannabis-based medicines and medical cannabis for chronic pain management. European Journal of Pain, 2018. 22(9): p. 1547-1564.
11. Haleem, R. and R. Wright, A Scoping Review on Clinical Trials of Pain Reduction With Cannabis Administration in Adults. 2020. 2020.
12. Hylands-White, N., R.V. Duarte, and J.H. Raphael, An overview of treatment approaches for chronic pain management. Rheumatol Int, 2017. 37(1): p. 29-42.
13. Canadian Agency for Drugs Technologies in Health. Research Gaps: Chronic Pain Management: Non-Pharmacologic Treatments. CADTH.ca 2019 2019/01/22; Available from: https://www.cadth.ca/tools/research-gaps-chronic-pain-management-non-pharmacologic-treatments.
14. Welsh, T.P., A.E. Yang, and U.E. Makris, Musculoskeletal Pain in Older Adults: A Clinical Review. The Medical clinics of North America, 2020. 104(5): p. 855-872.
15. Busse, J., The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain. Cancer Pain, 2017: p. 105.
16. Anekar, A.A. and M. Cascella, WHO Analgesic Ladder, in StatPearls. 2020, StatPearls Publishing: Treasure Island (FL).
17. Dick, B.D. and S. Rashiq, Disruption of attention and working memory traces in individuals with chronic pain. Anesth Analg, 2007. 104(5): p. 1223-9, tables of contents.
18. Whitlock, E.L., et al., Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med, 2017. 177(8): p. 1146-1153.
19. Zhao, J., et al., Health Care Providers’ Experiences and Perceptions Participating in a Chronic Pain Telementoring Education Program: A Qualitative Study. Canadian Journal of Pain, 2020. 4.
20. McGillion, M.H. and J. Watt-Watson, Pain Assessment and Management in Canada: We’ve Come a Long Way but there are Challenges on the Road Ahead. Can J Nurs Res, 2015. 47(1): p. 9-16.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

It’s the tale of two patients.

As I engage the second set of questions and even though we are exchanging over the phone, I can discern (Paul) ‘s impending impatience. Our congenial banter of the local hockey team has stopped. The mood has strayed away from the initial merriment. The answers now come out more imperatively and with haste. As he reminds me that he is here for PAIN, I take a moment to figure out how to convince him. How to argue the importance of these data for research purposes. As I try to push through as quickly as possible, I now find myself stressed out having to ‘’interrogate’’ him about the state of his emotions, which has no correlation with his primary symptom. Should I just skip this entire section just to mediate?

As I sum up the numbers, the total would involves breaking her budget.  (Rose) explains to me with attentive solicitude she’s on a fixed income. Her negligeable monthly pension would have her committed to choose between insulin and medical cannabis. As she’s holding back her emotions, she is compelled by necessity to stop her treatment with us. She is holding dearly to her half empty bottle of CBD oil, 1 drop at a time so it could last her until this winter when her pain flares up the most.

The importance of (Paul) to (Rose). The research data collected is intended toward validating the therapeutic effects of medical cannabis, to be accepted as a medical treatment therefore covered by the RAMQ.

Author:

Pheng Lim, LPN

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Leading Patient Service, Clinical Care Standards and Clinical Research Data Collection in Cannabinoid-Based Medicines

By Erin Prosk, President and Co-Founder of Santé Cannabis

As the President and Co-founder of Santé Cannabis, an organization at the forefront of medical cannabis clinical practice and research since 2014, I could not be more proud of what we have accomplished and the advancements that we have made to establish evidence-based practices in medical cannabis care.

The last decade has been both challenging and deeply rewarding and as Canadian leaders, we have a responsibility to share our experience, to support medical cannabis programs worldwide to build on our strong foundation to accelerate safe, supported access to cannabinoid-based medicines worldwide.

To that goal, I am excited to share that a detailed description of the Santé Cannabis clinical practice model has been published in the journal Complementary Therapies in Medicine. Our entire Santé Cannabis team has contributed to this achievement, the article is the first peer-reviewed publication describing a dedicated medical cannabis clinic.

This publication shares our clinic development experience and evolution of our clinic model and practice since 2014. It serves as a reference for physicians and allied healthcare professionals who are developing their own dedicated medical cannabis practice with details such as clinical organization, healthcare team, annual clinic data as well a discussion of the strengths, weaknesses and future directions of the clinic model.

Prosk E, Arboleda M, Rapin L, El Hage C, Dworkind M. The model of care at a leading medical cannabis clinic in Canada. Complementary Therapies in Medicine. 2021; 60.

Dedicated medical cannabis clinics have become an essential service delivery model in global jurisdictions such as Canada, Australia, the United Kingdom, Colombia and other Latin American countries and across several state jurisdictions in the US. The emergence of dedicated clinics is due to still-remaining critical gaps between patient needs and the traditional healthcare system. Medical cannabis assessment, prescription and follow-up remains service provided by a limited number of physicians, with the majority citing lack of training, limited amount of high-quality research, complex regulatory frameworks and lack of clinical guidelines for medical cannabis products.

As the primary point of access for the majority of the 300 000 registered medical cannabis patients in Canada, dedicated clinics have provided a critical source of evidence-based information, personalized medical support and treatment recommendations and ongoing follow-up. Several initiatives are underway in Canada to increase knowledge, including several that are described in the article.

Santé Cannabis assesses almost all of its patients on referral from their primary care physician or specialist, supporting patients to discuss the referral with their treating physician in order to integrate their care. Following a patient’s initial visit at Santé Cannabis, our team provides a consultation report to the referring physician. By this initiative, the clinic has introduced medical cannabis treatments to more than 5000 physicians since we opened our doors in 2014. Such commitments provide required integration between medical cannabis clinics and the “traditional” healthcare services and improve patient outcomes by sharing information between the healthcare team. The consultation reports support knowledge transfer between healthcare professionals and continued learning for the referring physicians as they continue to follow the patients in their care.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Similarly, this article breaks down practices at a medical cannabis clinic that are often viewed as a black box. Concerns have been raised about why these clinics exist and questions of the care provided; dedicated service is often required to meet patient and medical community needs within a complex regulatory system and lack of professional training for healthcare professionals.

As there have been to date no peer-reviewed publications describing a medical cannabis clinic model, the development of an article was critical to share practices. With limited resources, it is not always possible to maintain such advocacy. At minimum, practice standards must adhere to regulatory guidelines and clinics must operate in transparently, encouraging communication with regulators while raising any challenges to providing safe, effective patient care. Patients and partners of the medical cannabis clinic must be aware of its practices and of any funding relationships that may present a conflict of interest. Such relationships can be difficult to navigate, especially in emergent medical cannabis industries and collaboration with experience medical cannabis clinics is recommended.

Despite 20 years of legal access to medical cannabis in Canada, the majority of patients still rely on dedicated medical cannabis clinics as the availability of training opportunities on cannabinoid-based medicines remain limited and outside the standard medical curriculum at Canadian institutions.

Santé Cannabis is a unique medical cannabis clinic as its purpose and leadership extends beyond direct patient care. Operating as a clinical research site since 2015, Santé Cannabis emerged as Canada’s first Contract Research Organization dedicated to medical cannabis in 2018 and has since continued to expand its services to support the development of high-quality research. Santé Cannabis is also dedicated to training healthcare professionals and supporting the development of leading medical cannabis clinics worldwide.

As a still unapproved medical treatment, consideration of medical cannabis often emerges at the end of a long patient journey. Patient needs are high and long-standing stigma demands a responsive support service and dedicated patient education. This delivery is resource-intensive, especially when few details are available to clinic operators. This article introduces several available resources developed to support efficient, high-quality care and tested by our Santé Cannabis team.

Getting started with a medical cannabis practice introduces several challenges and little guidance is available from experienced clinicians and operators. Physicians and allied healthcare professionals who are developing a dedicated medical cannabis practice will benefit from the sharing of years of experience outlined in this article from our Santé Cannabis team, including the development of an operational plan that integrates objectives and community needs with available resources.

When well-developed, medical cannabis clinics provide an unparalleled opportunity for the collection of Real-World-Data and even the recruitment and operation of clinical trials. Whether clinical research is a priority initiative on clinic launch or in later years, considered planning is critical to ensure efficient collection of high-quality data.

The significant global evolution of regulatory frameworks in recent years indicates the validation of an essential treatment option for patients, one that patient advocates, physicians and supporting healthcare professionals for access to cannabinoid-based medicines have been pushing for decades.

It is clear that medical cannabis access will continue to expand worldwide, and with that the need to establish clinical practice standards to support patients and medical communities. Effective service delivery will only be possible with increased international collaboration between healthcare professionals to exchange knowledge, share experience and optimize resource development in the coming years.

Look to Santé Cannabis for this collaboration and to find innovative, practical training opportunities for international physicians and healthcare professionals and access personalized consultation from our expert team.

To discuss your project and find out if Santé Cannabis might accelerate your development, please contact us. From one innovative team to another, we’re looking forward to hearing from you.

Author

Erin Prosk

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

On World MS day (May 30th), we’re exploring the latest on Multiple Sclerosis and cannabinoid-based medicines (CBM). 

As clinicians and researchers, we’re sharing our takeaways for healthcare professionals, up-to-date literature on MS and CBMs, information from our clinics and the perspective from one of our active patient advocates.  

What is Multiple Sclerosis (MS)?

Multiple Sclerosis is an autoimmune and neurodegenerative disease affecting the spinal cord and the brain, which can lead to a variety of symptoms depending on what exact part of the central nervous system is affected. An autoimmune disease is a disease in which the immune system attacks healthy parts of the body. 

In MS, cells involved in neuro-inflammation mistake myelin (the protective barrier around neurons) for a foreign antigen and attack it repeatedly. As the myelin sheath can be repaired but not seamlessly, the accumulation of scars in multiple areas causes a wide range of symptoms. 

Most frequent symptoms include spasticity, pain, tremor, impaired balance and coordination, gait difficulties, fatigue, depression, bowel and bladder dysfunction, cognitive impairment, sensory impairment. No two cases are exactly alike, and different people will experience different symptoms in different severities. 

MS is separated into four subtypes according to the disease progression including the frequency of relapses (attacks): clinically isolated syndrome (CIS), relapsing-remitting (RRMS), secondary progressive (SPMS) and primary progressive (PPMS). 

Multiple sclerosis is one of the most common neurological diseases affecting 2.8 million people worldwide. Multiple sclerosis can occur at any age, however is typically diagnosed in individuals aged 20 to 49 years old. It is most frequently seen in women compared to men. 

Canada has one of the highest rates of MS with an estimated prevalence of 250 per 100,000 inhabitants. 

Top 9 takeaways for clinicians from the clinicians at Santé Cannabis:

1. In Quebec, medical cannabis should be considered only after first-line treatments are deemed ineffective. After attempting other treatments, you may want to discuss cannabinoid-based medicines  with your patient. If you don’t know where to start, you can sign up for our Prescriber Training Program for educational resources and access to a medical hotline. 
2. There is conclusive scientific evidence that supports the use of medical cannabis for MS related spasticity. (GW Pharma Ltd 2012)
3. Delta-9-Tetrahydrocannabinol (THC) is the cannabinoid identified in studies as being beneficial for spasticity in MS patients. Clinically, we typically see that THC can help with spasticity and MS related pain. However, cannabidiol (CBD) can help some patients with spasticity or pain. CBD has the advantage of not having many side effects and does not include the typical “euphoric” side effect associated with cannabis. 
4. THC has more side effects than CBD, including euphoria and the feeling of being “high”. However, it is possible to take THC medically without having side effects or being high: the key is starting at very low doses and titrating up very slowly.
5. The different treatment plans for the various MS-related symptoms are described in the educational material we offer within our Prescriber Training Program. 
6. Because of the very low amount of cannabinoid receptors in the medulla, it is impossible to die from a cannabis overdose (World Health Organization). However, accidents can be associated with impaired faculties due to cannabis side effects.  
7. Cannabis has contraindications like many other medications, it is important to know the contraindications and to assess patients prior to initiating a cannabinoid-based medicines treatment.
8. Capsules are concentrated oil placed in a capsule at specific doses and can replace cannabis oil for an ingested method of administration (long acting). This can make it a preferred method for certain patients.
9. Patients with multiple sclerosis often have trouble sleeping, cannabis at bedtime may help with sleep without worrying as much about side effects consequences (Zajicek et al. 2003; Schabas et al., 2019). 

“As a nurse myself, I know how important it is to seek out and research treatment options for the patients I see. As healthcare professionals we all have the responsibility to keep ourselves well informed for the sake of our patients’ safety and quality of life and this includes educating ourselves on cannabinoid-based medicines.” 

-Andrée Charbonneau, RN, Nurse coordinator

Current available treatments

There is currently no cure for MS however several pharmaceutical treatments exist to control inflammation, manage relapses and concomitant MS symptoms. Disease-modifying therapies alter the course of the disease; they are generally effective for RRMS and early treatment may  be helpful to prevent long-term disability. Symptomatic therapies are used to alleviate specific symptoms, notably neuropathic pain may be treated with antidepressants, antiepileptics and opioids and spasticity may be treated with muscle relaxants. 

General lifestyle recommendations such as exercise and balanced nutrition may also benefit patients.

Cannabinoid-based Medicines in MS 

Research on MS and cannabinoids started over fifteen years ago with a large randomized, placebo-controlled trial on 630 patients with stable multiple sclerosis and muscle spasticity (Zajicek et al. 2003, 2005). Patients were randomized to placebo, oral cannabis extract (THC:CBD), or delta-9-THC, starting with a daily dose of 5 mg to a maximum dose of 25 mg/day of active medication for a total duration of 15 weeks. 

The objective of the study was to ascertain the efficacy of cannabis extract or delta-9-THC for the treatment of spasticity and other MS symptoms. The findings indicated a reduction in patients’ perceptions of the effect of spasticity.  An unexpected secondary outcome result was a reduction of hospital admissions for relapses in both cannabis extract and delta-9-THC groups. Authors mentioned that trial patients had a slowly progressing MS, and since there are cannabinoid receptors on immune system cells, the reduced relapse rate in such an autoimmune condition is a finding that would benefit from further investigation.

Spasticity, pain, bladder dysfunction

Since then, the potential efficacy of cannabinoid-based medicines has been investigated mostly for spasticity, pain and bladder dysfunction symptoms (read more about MS spasticity and cannabinoid treatments here). Cannabinoids, and the endocannabinoid system, have been demonstrated to play a role in reducing spasticity in animal models (Chiurchiù et al. 2018; Baker et al. 2001; Nielsen et al. 2018; Zettl et al. 2016). Delta-9-Tetrahydrocannabinol (THC) appears to be effective in reducing spasticity in animal models and humans (Nielsen et al. 2018).

Systematic Reviews 

Two recent systematic reviews provide details: 

Nielsen and colleagues (2019) reviewed 27 studies and examined spasticity in adult patients with a range of conditions including multiple sclerosis (21 studies). 

• The reviewed studies examined the effect of THC, CBD, THC:CBD formulations, synthetic cannabinoids dronabinol and nabilone, inhaled (smoked) cannabis, and oral cannabinoid extracts. 
• Results were inconsistent between studies identified in the review, with many reporting positive effects on some but not all measures of spasticity and with most positive effects based on patient-rated measures rather than clinician-rated measures.

Nielsen and colleagues (2018), in their review of 11 reviews (32 studies) on MS symptoms and cannabis/cannabinoids, concluded that reviews identified evidence that would support trials of cannabinoids for the treatment of spasticity in patients with MS.

Torres-Moreno and colleagues (2018) reviewed 17 randomized clinical trials to assess the

efficacy and tolerability of cannabinoid-based medicines compared to placebo for symptom

(spasticity, pain, and bladder dysfunction) treatment in patients with MS. 

• The studied experimental interventions were oral cannabis extract; oromucosal cannabis extract/nabiximols; oral dronabinol; and oral nabilone evaluated as an adjunctive treatment to gabapentin (anticonvulsant). 
• Results for the pain symptom showed statistically significant differences in favor of cannabis extract, nabilone, and dronabinol. 
• There were statistically significant differences in favor of cannabis extract and dronabinol vs placebo for bladder dysfunction. 
• Nevertheless, most of the reported therapeutic effects for both symptoms were small. 

Overall, studies demonstrate cannabinoids have therapeutic properties useful for the treatment of some symptoms in MS. Cannabinoid-based medicines, whether plant-based or synthetic appear to improve patients’ perception of spasticity, pain and bladder dysfunction symptoms. Yet this perceived effectiveness is not clearly demonstrated in objective clinicians-based measures. This is both a downside, as it limits the supporting evidence for cannabinoid-based medicines, and an interesting indicator, as patients may be more sensitive to symptom improvement than clinician measuring tools.

Expectations for clinicians

Clinicians should have realistic expectations about cannabinoids’ efficacy, as the therapeutic effects may be small. There are other applications/MS symptoms in which cannabinoids could help (disease-modifying properties, bladder function), but the supporting evidence is mixed.

Research on MS and CBM is a good example of where we can go when we pursue rigorous studies; after several randomized clinical trials the oromucosal formulation of nabiximols was approved in Canada for the indication of spasms in this disease. (GW Pharma Ltd 2012). However, a recent notice from Health Canada stated nabiximols is no longer recognized as neuropathic pain management therapy in MS due to lack of evidence.

As is the case with most medical indications, research on CBMs and MS must continue to further these findings. There are currently very few (two) recruiting phase III clinical trials on multiple sclerosis and cannabinoid-based medicines. 

At Santé Cannabis, our clinicians use the ongoing research findings to provide treatment recommendations for their patients with MS. 

MS at Santé Cannabis

From our most recent database review of 1,275 patients between July 2020 and March 2021, 34 (2.7%) patients had a primary diagnosis of MS, and were aged from 23 to 68 years old (average 49 years). 25 of them (73.5%) identified as women. 

Of these patients with MS, 70% (24 patients) came to Sante Cannabis to evaluate CBM treatment for pain and 15% for spasticity. The others (5 patients) came for sleep disorders, headaches, numbness in legs and muscle rigidity. All patients also experienced secondary symptoms including sleep disturbances (19%), fatigue (18%), anxiety (14%), spasticity (14%), depression (10%), migraines and headaches (6%), stress (4%), nutrition-related issues (3%),  and muscle stiffness (3%). This multiple symptom presentation corroborates the wide spectrum of MS profiles in individuals and confirms patients are looking to alleviate multiple symptoms simultaneously. 

With regards to cannabis use history, most patients were not cannabis-naive: 50% had tried cannabis as a self-attempted medical treatment, 26.5% had tried it recreationally and 14.7% had never tried it.

Almost all patients were authorized with at least one ingested oil extract. 65% of patients were prescribed balanced CBD-THC, as while the literature suggests using THC to manage some MS symptoms, CBD can help to offset some of the side effects of THC.

With the use of our real-world data, our clinic is dedicated to offer better patient care through better science.  

“I have been living with multiple sclerosis for 42 years now. I took all kinds of medications and little by little my doses had to increase and I ended up with very high doses of several medications. I had many side effects and sometimes I felt like a zombie. I was still in a lot of pain and yet I was on the highest doses. That’s when my neurologist told me about a very serious study on medical cannabis and suggested that I participate. So I took a chance despite my apprehensions about cannabis in general… Eventually, …, I was able to both reduce my medication and control my pain. I feel fortunate that my neurologist sent me in this direction. ” Read more from Joanne, a patient at Santé Cannabis here

The combination of formal healthcare professional training and high-quality research is key to increasing the selection of treatments for MS and providing the best patient care.

Join us as we work towards the highest quality treatment for people with multiple sclerosis. Santé Cannabis is committed to advancing the knowledge on MS and CBM, and as such, we offer research services to companies and institutions interested in developing clinical studies. 

For clinicians currently treating people with MS who are interested in adding medical cannabis to their practice, our Preceptorships are available for any local and international physicians. For prescribers in Quebec we also offer a free Training Program more about CBM, and how to prescribe it.

Author

Dr. Lucile Rapin

with special thanks to the Clinical Education Team

Resources

https://mssociety.ca/

https://mssociety.ca/hot-topics/cannabis

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Most of us have experienced the healthcare system, in times of darkness, stress, confusion, and often, in those dark places we find nurses as a beacon of light. At Santé Cannabis, our nurses are a primary point in our model of care. They’re the first medical professional our patients see, and the ones who stay by their sides through their treatment plans.

Medical cannabis is a journey, and for many patients, it’s one filled with unknowns and pitfalls, and our nurses are expert navigators. Our nurses listen. They get asked the tough, scary and embarrassing questions. They educate. They guide. They advocate. We wouldn’t be anywhere without them.

This year’s National Nursing Week’s theme is “We Answer The Call”, which speaks to the deep calling and commitment that our nurses have for their role in patient care. But during COVID many of these calls are literal – from patients from across Quebec, who are looking to access a treatment from someone who understands, cares and holds the highest level of expertise. Our nurses have shown incredible tenacity and spirit as they shifted from our clinics and into their homes as we began telemedicine last March, and soon back to the clinic. 

Our nurses at Santé Cannabis are a dedicated and diverse group of individuals that are driven by our purpose to positively impact the health of our community. Their compassion and dedication to see improvements in their patient’s lives is demonstrated by the positive feedback that is received from our patients and through the increasing demand of our services. 

Santé Cannabis would like to thank our nurses for their exceptional work and continued dedication to our purpose, not only for this week but every day.

Meet some of our nursing team

Naomie Parrot, Nurse Coordinator

I work at Santé Cannabis to have a unique experience as a nurse in a private practice. I feel valued at work and am challenged every day; with a team that is stimulating and we feel very close to each other. The most significant and rewarding part of my job is accompanying patients in the relief of their symptoms and improving their quality of life. 

We adapt treatment plans to be specific to each patient, and provide them with comprehensive education about medical cannabis as well as support for their treatment. We teach about the different molecules (THC/CBD), indications, side effects, precautions/contraindications as well as titration and administration of the product, allowing patients to be guided in their journey.

I enjoy the progress I’ve made at Santé Cannabis over the years, from nurse, to team lead to coordinator. I found flexibility and a balanced lifestyle working in private practice rather than the hospital. 

I’d also like to introduce Gigi, a little 4lb toy poodle, who arrived at my house during Covid. Telecommuting, I now have a new co-worker who fills my days with even more happiness. She makes a few surprise appearances in some meetings and gives us a good laugh!

Derek English, Research Nurse

I’m passionate about helping people, chronic pain and medical cannabis. I come from a background in orthopaedic surgery where I had experience treating people with all kinds of pain conditions, which helped be more understanding, patient and compassionate. I dealt with many frustrated patients who were not getting what they needed out of the healthcare system and I began to understand that traditional medicine isn’t always the answer for everyone. 

Since joining Sante Cannabis I’ve been fortunate to have many meaningful and amazing experiences, but being able to contribute to many of our patients having a more active life, increasing their overall health-related quality of life has revitalized my enthusiasm for nursing.

Since COVID, I’ve been keeping busy with all sorts of exciting new hobbies, from making yogurt in with the instant pot, and diving into the world of art via blogs, smarthistory youtube channel, and art apps and developing my interest drawing animation.

Tania Pellegrino, Educator/Team Lead

It’s meaningful to me to make an impact in our patients’ wellbeing. I believe that cannabis is a complementary medicine that helps a lot of people suffering from different medical issues. The legalization of cannabis in October of 2018 was really a milestone for us, giving medical cannabis much more credibility and interest. At that point the clinic also got involved in more meaningful research, which allowed us to hire many more employees. It’s been incredible to see this transition and growth.

I’ve always enjoyed making impactful bonds with clients and prior to graduating from nursing I worked in telecommunications in sales for 10 years where I got to make many connections with clients. I continue to make those bonds, with both the clients and the team I work with daily. My team is a great pleasure, and I appreciate the flexibility in our schedules and working from home during the pandemic. 

I’d like to introduce Sophie, my 2 and a half year old French Bulldog. She is great because she is playful, energetic and silly. In addition to everything that makes her great, she unfortunately suffers from anxiety. She is totally dreading my return to the office and staying alone all day – I’ll miss her too, but will be happy to see our clients again in person. 

Isabelle Fournier, Nursing Assistant/Educator

I work at Santé Cannabis to help people. For many, we are the last resort and we often hear from our patients that we have given them back a quality of life that they no longer thought possible. I really enjoy the respect and support within the entire medical team, and think our patients do as well.   

I’ve had many important experiences, but one that stands out for me is a pediatric case, where we were able to work towards the family’s health goals. One day I received a call from the father of the child who explained with tears in his eyes the difference he had experienced. 

I feel I am uniquely qualified to work at Sante Cannabis, as I experienced a work injury that has given me permanent limitations. I live with constant pain, insomnia and anxiety, and so can relate to many of our patients on a personal level. I’ve appreciated the ability to work from home over COVID, and to be able to meet with our patients on telemedicine, as for many of them travelling can be a barrier. I hope that post-COVID the government will continue to fund telemedicine visits, as has been a positive for our patients, many of whom have told me about reduced anxiety with their visits. 

Words of appreciation 

Vi Dam, RN, Director of Clinical Education

I am so happy to be celebrating our nursing team this week! Nurses and auxiliary nurses at Santé Cannabis play such a vital role in our operations and their actions stretch across all departments, they are really our essential workers! For me, particularly this past year with the pandemic, they have really embodied totally and absolutely what it is to be a nurse. 

I cannot express the immense appreciation I have for our nursing team; and for nursing coordinators who take on so much and have marked themselves as true leaders. They showed professionalism and adaptability when we needed to switch to virtual consultations. It was not an easy task, and they were a true support for our physician colleagues as well as for our patients. 

We put in them our trust and rely on their empathy, compassion and skills as advocates and communicators for our patients and for medical cannabis as a treatment. I couldn’t be prouder of the team we have put together. Happy Nursing Week 2021!

Erin Prosk, President

We wanted to take time to emphasize our respect and appreciation for the individual and team contribution that our nurses make to Santé Cannabis and to the thousands of patients who have benefited from the care, compassion and informed education that they provide. Our nurse team is the backbone of Santé Cannabis, from each individual patient consultation to the critical role that they play in the medical community to support the thousands of referring doctors and nurses across Quebec who trust our team. I can say emphatically that I am in awe of your work on a daily basis.

Please know that from myself and our entire team, we have this appreciation in all weeks, not just this one. Wishing you a great week!

Michael Dworkind, MD, Medical Director

I know that it goes without saying that I appreciate our nursing team immensely, on this week and every week, every day and sometimes every minute for all of the support and expertise that they provide to me and the other doctors to provide excellent care to our patients. I feel so privileged to work in their company and with such passion together towards our important purpose. 

I hope each nurse feels proud of their contribution and their medical cannabis leadership for all nurses and auxiliary nurses across Quebec.

Thank you to all our nurses from all of us. 

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