The pharmacy and the pharmacist fulfill a major role in the new medical cannabis reform established by the IMCA. The dispensing of its products in the pharmacy enables the required dissociations in the chain of supply, encourages the supply only from approved sources which have passed all the quality tests and facilitates a direct contact with the patient and his needs.
Among the conditions and responsibilities written by IMCA in Procedure 153, there is a requirement that the pharmacist may dispense cannabis and consult the patient only after going successfully through a training course (created by IMCA and an academic institution) with a final test.
The Unit for Continuing Education at the School of Pharmacy at the Hebrew University of Jerusalem, was a pioneer in creating such a training course for pharmacists and will offer it for the seventh time in November of this year. This will contribute to having sufficient number of pharmacists to help with the transition from getting the cannabis products straight from the grower to getting it in the pharmacy.
The advantages of a pharmacist are quite clear. He is experienced with: practicing personalized medicine, collecting and documenting information, monitoring the patient’s entire medication regimen, applying knowledge of drug-drug interactions (the effects of other drugs on the pharmacodynamics and pharmacokinetics of cannabis as well as the effects of cannabis on other drugs), interacting with other health care professionals, handling sensitive medicinal products, dealing with suppliers, maintaining inventory control, complying with strict rules and regulations, including security measures relevant to narcotics.
After identification of the patient or his messenger, the prescription (dispensing order) and the patient’s license are reviewed and verified with the computerized record. The order should specify at least the dosage form, monthly amount and THC and CBD ratios.
The patient is questioned by the pharmacist about the goals of therapy decided together with the physician, about possible contraindications (absolute or relative, including family history) such as addiction, psychosis, schizophrenia, schizoaffective disorder, anxiety disorder, depression, cardiac disease, reduced liver or kidney functions, diabetes, hypertension, pregnancy and nursing and about side effects, preference of administration, the other drugs which are taken concurrently and his satisfaction or dissatisfaction with the product.
According to the answers it is decided together if to switch to another supplier and if there is a need to change the speed of dose elevation. It is always emphasized to start low and slow.
Recently, IMCA has started a pilot to study the possibility of allowing pharmacists to make fine tuning in the cannabis orders, limited to a reduction in the concentrations of the major cannabinoids, to switching from products with sativa characteristics to indica characteristics and vice versa and to switching from inflorescence to oil.
Advising and educating the patient by a pharmacist is a very important part in the triangle of physician –patient-pharmacist. In the USA, where a clinical pharmacist is a natural part of the health care team almost in every ward or clinic, it is not practiced yet when consultation about medical cannabis use is required. All health care professionals are allowed to dispense medical cannabis and to do so in any dispensary facility.
Recently a delegation from Israel was invited to the FDA to share the Israeli experiences with the unique rules and regulations. The role of the pharmacist was very much appreciated.
Pharmacies are very accessible in the Israeli health care system, and thus the role of the pharmacy and the pharmacist could be expanded even further to include being a documenting contributor to the Big Data of the Israeli medical grade cannabis treatment as well as a contributor to its pharmacovigilance activities.