Back to Blog

A Clinical Framework on Evaluating Cannabis Product Quality and Safety

Topic: Patient Information

With the rise in medical cannabis demand and product availability, establishing if a product fulfils acceptable quality standards has become more important. Patients can use the proposed framework when evaluating a cannabis product.

1.     Type of product

Common product types used for medical purposes are ingestibles (i.e., Oil capsules, oral spray, edibles), topicals (i.e., Compounds & transdermal patches), and inhalation (i.e., dried cannabis flower and vapes). Dabs, waxes, and shatters, among other typical cannabis concentrates, are considered higher-risk products and are generally not recommended for medical usage.

2.     Product labelling

Adequate health warning labels should be given for any health product, including cannabis. Indications of appropriate storage requirements can help in product quality preservation.

3.     Listed Cannabinoid content

The content of cannabinoids is crucial in determining the appropriateness of cannabis and the risk associated with it. It’s important to think about the amount of THC and/or CBD listed, whether it’s in percentages, concentrations, or weight. According to Health Canada, the maximum amount of cannabis allowed in a medicinal cannabis format is as follows:

–       Dried flower: <30g per package.
–       Topicals/Extracts: THC level is <1000mg per container.
–       Edibles: THC quantity <10mg per package.

4.     Listed product/manufacturing details

Product specifications that are detailed are useful in ensuring product quality. Components of labelling include:

–       packaging date
–       expiry date
–       lot number
–       net weight/volume
–       listed ingredients
–       decontamination methods
–       evidence of third-party testing

The aforementioned information can be found on product packaging or in the Licensed Provider’s own website’s product description.

5.     Product packaging

Health Canada requires particular packaging considerations or security elements. The following factors should be considered when determining whether or not the package is safe to use

–       Child-resistant
–       Made of Opaque material
–       Designed with Non-desirable image or logo
–       Sealed and secure before use

References:
Health Canada. (209). Final Regulations: edible cannabis, cannabis extracts, cannabis topicals. Retrieved from https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/resources/final-regulations-edible-cannabis-extracts-topical-eng.pdf
MacCallum CA, Lo LA, Pistawka CA, Boivin M (2022) A clinical framework for evaluating cannabis product quality and safety, Cannabis and Cannabinoid Research X:X, 1–8, DOI: 10.1089/can.2021.0137.
Previous Article
Ways to cope with Chronic Pain
Chronic pain is best treated through multi-modal therapies including physical therapies, psychotherapy, spiritual care, lifestyle management, and interventional therapies. Start by setting goals that are SMART (specific, measurable, action oriented, realistic, and time-based). For example, “I want to reduce my pain from an 8/10 to a 6/10 so I can walk the dog around the block within 4 weeks after starting treatment”. The drug classes that correlate to the three pillars of the pain triangle – Chronic Pain, Insomnia and Stress are listed below. Medical cannabis is a promising alternative for all, and it is likely to avoid the negative side effects associated with these drugs, particularly opioids. Retrieved from: http://nationalpaincentre.mcmaster.ca/documents/Opioid%20GL%20for%20CMAJ_01may2017.pdf   Medical Cannabis as an Alternative Therapy for Chronic Pain Alternative pain treatment options are necessary to address the opioid crisis and the high prevalence of chronic pain. There is an increasing number of chronic pain patients not achieving their pain management goals, and there is a lack safe options to address chronic pain1. Cannabis has better safety profile than opioids, with no reported deaths directly due to overdose. In the U.S, in the states with legalized cannabis, there was a reduction in opioid-related mortality and opioid prescriptions2. Furthermore, our body’s own endocannabinoid system and opioid system interact synergistically with major pain pathways. Cannabinoids have several mechanisms of action to produce pain relief, whereby cannabinoid receptors are present in the peripheral and central nervous system, and in immune cells. References: [1] Stucke, A. G. et al. Opioid Receptors on Bulbospinal Respiratory Neurons Are Not Activated During Neuronal Depression by Clinically Relevant Opioid Concentrations. J Neurophysiol 100, 2878–2888 (2008). [2] Bradford, A. C., Bradford, W. D., Abraham, A. & Adams, G. B. Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population. JAMA Intern Med (2018) [3] Wen, H. & Hockenberry, J. M. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees. JAMA Intern Med (2018).
Next Article
An overview of Cannabis Use in Canada
Nearly 8% of Canadians aged 15 and up report using cannabis daily, and 15% have used cannabis in the previous 12 months.1 Canadians who reported using cannabis over the past 12 months were asked how frequently they used the substance. Over half (54%) reported using cannabis three days per month or less, and 18% reported daily cannabis use. According to a recent survey of Canadians aged 18 and above, most people, including those who are new to cannabis, as well as those who have been using it for a long time, report using it for medical purposes.2 Cannabis for Medical Purposes Of people who reported using cannabis for medical purposes in the past 12 months, the majority (76%) did not have a medical document from a healthcare professional. The most common frequency of use reported was daily (35%). The three main products used were dried flower (54%), cannabis oil for oral use (48%), and edibles (33%). Other products that weren’t used as often included vape pens, topical compounds, and beverages. For people using cannabis for medical purposes: 1.     26% reported consuming higher CBD and lower THC 2.     21% reported consuming higher THC and lower CBD 3.     12% reported consuming equal levels of THC and CBD 4.     15% reported consuming CBD only 5.     14% reported consuming mix of different products 6.     7% indicates they did not know the THC and CBD levels The top five sources to obtain cannabis for medical purposes were: 1.     Legal storefront (44%) 2.     Legal online source (23%) 3.     Health Canada Licensed producer (22%) 4.     A friend (17%) 5.     Growing their own (16%) Common clinical indications for medical cannabis 3 •       Pain and Inflammation -  Chronic musculoskeletal pain - Neuropathic pain - Arthritic inflammation - IBS / IBD •       Sleep, Anxiety, & Seizures - Certain anxiety, PTSD, and sleep disorders - Seizures (Dravet Syndrome) •       Nausea & Vomiting - N&V due to chemotherapy (CINV) - Anorexia due to HIV or other treatments - Appetite stimulant •       Movement & Spasticity - Motor disorders (PD, Huntington’s, Tourette’s) - Spasticity due to MS The above conditions broadly represent the areas where cannabinoids have demonstrated the most efficacy in symptom management. As you can see, many of these conditions come under the 'Pain Triad' arms. See Canada’s opioid overdose crisis and living with chronic pain blog posts for more information. 4 References: [1] Government of Canada. (2021). Canadian Cannabis Survey 2020: Summary. Retrieved from: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2020-summary.html [2] Deloitte. (2021). Seeding new opportunities: Listening to Canada’s cannabis consumer. 2021 Cannabis Consumer Report. Retrieved from https://www2.deloitte.com/ca/en/pages/consumer-business/articles/listening-to-canadas-cannabis-consumer.html?icid=listening-to-canadas-cannabis-consumer_en [3] National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice & Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. (National Academies Press (US), 2017). [4] CMHA. (2019). Impairment in the workplace: what your organization needs to know. Toronto, ON: CMHA. Retrieved from https://ontario.cmha.ca/wp-content/uploads/2019/05/CMHAOntarioImpairmentPolicy2019.pdf

Loading