Medical Cannabis in Patients

with Chronic Kidney Disease

Please note that this document is for general information on medical

cannabis use only. It isn’t a substitute for the advice of your physician
or other health care professionals. Please consult your physician or
pharmacist to discuss your individual needs.

1. What are Cannabinoids?.......................................................................................................................................... 2

2. What is Δ-9- tetrahydrocannabinol (THC) and cannabidiol (CBD)?............................................................... 2
3. What forms of cannabinoids are commercially available for medical use?................................................ 2
4. What conditions or symptoms are likely to improve with cannabis use?.................................................... 2
5. When should patients consider cannabis as a treatment option?................................................................ 2
6. Will my health care team support me in using cannabis?................................................................................3
7. What are the different methods of using cannabis? Is one preferred over others?..................................3
8. Who should avoid using cannabis?........................................................................................................................4
9. What are common drug interactions with cannabis?....................................................................................... 5
10. What do I need to monitor for when I’m using cannabis?............................................................................... 6
11. What are the side effects of cannabis?................................................................................................................ 6
12. What happens and what should I do if I take too much cannabis?...............................................................7
13. How can I minimize side effects of cannabis?.....................................................................................................7
14. Can I drive after taking cannabis?..........................................................................................................................7
15. Can I take cannabis with me if I travel across borders?................................................................................... 8
16. Will cannabis affect my work? Do I need to tell my boss if I am using medical cannabis?.................... 8
17. When is the best time to start, adjust, or switch cannabis products?.......................................................... 8
18. Is cannabis addictive? What is cannabis use disorder (CUD)?....................................................................... 8
19. When should I consider stopping cannabis? How do I stop it? Can I get withdrawal symptoms?....... 9
20. Can cannabis affect my kidney function?...........................................................................................................10
21. As kidney function worsens, does the effect of the cannabis change?.....................................................10
22. Does dialysis remove cannabis from my body? Do I need to change the timing of my dialysis?.......10
23. How do I get cannabis?...........................................................................................................................................10
Appendices
Appendix 1. Comparison of Commercially Available Cannabis Products for Medical Use.................. 12
Appendix 2. Cannabis Use and Symptom Diary............................................................................................. 13
Appendix 3. Cannabis Use Disorder Screening Tool – Cannabis Use Disorder Identification TEST – Revised (CUDIT-R)23......... 14

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1. What are Cannabinoids? Note: Some recreational drugs such as
Cannabis refers to a family “K2” and “spice” are also made in a lab
of plants with properties and may be referred to as “synthetics.”
that can affect the mind However, they shouldn’t be confused with
and body. The most man-made pharmaceutical medications
common strains consumed such as nabilone.
are Cannabis sativa,
Cannabis indica, or a blend (hybrid) of 4. What conditions or symptoms are likely
these two types. Cannabis contains over to improve with cannabis use?
100 compounds called cannabinoids that Limited research has been done on
interact with receptors in the body and cannabis because it is new to the
brain to produce an effect. healthcare world. Studies that have been
done show cannabis provides some
2. What is Δ-9- tetrahydrocannabinol (THC) benefit for:
and cannabidiol (CBD)?
• Chronic nerve pain and chronic
The two most common and well-
pain such as cancer or palliative
understood cannabinoids are THC and
pain
CBD. THC produces medicinal effects
such as to relieve pain, nausea and to • Nausea or vomiting (but only
stimulate appetite. However, THC is proven in studies when due to
also responsible for most of cannabis’ chemotherapy)
side effects including feeling “high”, There is less evidence to support that
drowsiness, and an impaired memory, cannabis is effective for treating extreme
concentration or reaction time.1,2 The weight loss and muscle wasting due to
higher the amount of THC in a product, HIV/AIDS, cancer, or end of life.20
the greater the risk of side effects such
as impairment. In contrast, CBD has less Although there may be many other
effects on the brain and can block the conditions where there are claims that
intoxicating effects of THC. It has pain- cannabis is effective, they haven’t been
relieving, anti-inflammatory, and anti- studied or consistently proven in studies
anxiety effects. 1, 2 There are many other (e.g., sleep, anxiety). Cannabis has also
cannabinoids, but their effects aren’t well not been shown to improve kidney
understood. function.

3. What forms of cannabinoids are 5. When should patients consider cannabis

commercially available for medical use? as a treatment option?
• Natural - cannabinoids from cannabis Talk with your healthcare team if you
plants (such as dried cannabis, are considering cannabis as a treatment
extracts) option. Cannabinoids or medical cannabis
• Man-made - cannabinoids that are aren’t considered first or second choice
made in a lab (such as nabilone) treatments for any condition. There

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 are often more effective and safer applied topically or sprayed and then
medications that should be tried first, absorbed through the lining of the mouth:8
but if those treatments don’t provide full • Inhalation (e.g., smoking, vaping/e-
relief, cannabis may be helpful. In some cigarette, hand pipe, bong) This is the
situations, cannabis may have a role when most common way that cannabis has
used together with other treatments and traditionally been used and produces
may allow your health care provider to the most rapid onset of effects (within
reduce the use of other medications. Like 5-10 minutes). Most people will feel
all medications, when using cannabis it “high” within minutes of inhalation.
is important to remember that the risk of While common in recreational use,
side effects needs to be considered (see this is the least preferred method for
side effects on page 5). medical use, as smoking cannabis is
a cancer risk factor, similar to smoking
cigarettes.
Unlike smoking, vaping doesn’t
involve direct burning of cannabis,
but inhalation of contaminants and
other chemicals used in the vaping
liquid of vape pens have been linked
to severe lung injuries requiring
hospitalization. To minimize this risk,
always purchase vape pens with liquid
cartridge refills from reputable sources
such as licensed cannabis suppliers.
While some vape pens don’t require
6. Will my health care team support me in
liquid cartridges (i.e., dry herb or wax
using cannabis?
vaporizers), it is still possible to inhale
If you are interested in medical cannabis
harmful contaminants that may be
or are already using it on your own, we
present in the dried products.
encourage you to discuss its use with your
health care provider. If cannabis is a good • Ingestion (e.g., eating or drinking
therapy for your condition, most health cannabis oil, nabilone, softgels,
care providers will respect your choice baked goods, candy, tea) These
and support your use of it. Using cannabis products are often made using a fat or
products responsibly will not affect your oil infused with cannabis that has been
ability to be considered for a kidney heated to ensure the cannabinoids
transplant. are active when used. This method
of cannabis use has a slower onset
7. What are the different methods of using compared to inhalation (30-120 mins)
cannabis? Is one preferred over others? and peak effects may take up to 4
Cannabis can be inhaled, ingested, hours to occur. Therefore, to avoid

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 experiencing severe side effects from
high doses, it is important to wait for at
least 4 hours after eating or drinking a For a more detailed comparison of
cannabis product before taking more. different methods of cannabis use,
including dosing, cost, and whether
Remember to start low and go a prescription is required, please
slow. In general, cannabis ingestion refer to Appendix 1. For ongoing dose
is preferred over inhalation as it adjustment of cannabis to address
bypasses the harmful effects of individual needs, consider consulting
potentially inhaling harmful chemicals a medical cannabis provider.
with smoking or vaping. For medical
use, we recommend using products
such as cannabis oil or nabilone 8. Who should avoid using cannabis?
(tablets) that have standardized Patients with the following
concentrations and doses that allow conditions shouldn’t use cannabis or
for easy, consistent dosing. For cannabinoids:4,5,6
instance, the CBD/THC content may
• Personal or family history of mental
be more variable between individual
health disorder(s), particularly
servings of baked goods and tea.
schizophrenia
• Oral-mucosal (e.g., Sativex oral-
• Patients younger than 25 years
mucosal spray, tinctures) This method
of age due to concerns of a still-
involves applying or spraying a liquid
developing brain
cannabis extract under the tongue or
into the mouth. The medication is then • History of drug addiction or alcohol
absorbed through the lining of the dependency
mouth. The onset of the effects can • Pregnancy, contemplating
vary from 20-150 mins, but is usually pregnancy, or breastfeeding
quicker than ingestion (30-120 mins).
• Severe liver disease, including
Similar to ingestion, it is preferred over
chronic hepatitis C.
inhalation due to the lack of potential
harmful effects to the lungs.
In addition, patients with the following
• Topical (e.g., CBD oil, creams, lotions) conditions should specifically avoid
These products are usually in the smoking cannabis, but may consider using
form of a thick oil extract containing other methods or forms, in discussion with
active cannabinoids, which are applied their physician:
and absorbed through the skin. The
• Severe heart disease or stroke
effects of topical cannabinoids are
localized and don’t generally cause • History of lung disease such as
any intoxicating effects or side effects asthma or chronic obstructive
beyond the application site. This pulmonary disease
method is ideal for providing localized
relief from pain.

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 Cannabis hasn’t been well-studied in There are medication interactions that can
patients with severe kidney disease, both increase and decrease the effects of
therefore it should be taken cautiously THC and CBC.
with a full understanding of the benefits
and harms. Cannabis mainly relies on the
liver to be removed from the body, so it is
Warfarin
unlikely that it would abnormally build up
THC and CBD may increase the
in the body if a patient has kidney disease
blood thinning effects of warfarin
(including in those patients receiving
and increase the risk of bleeding. It
dialysis). If cannabis is used in chronic
is important to inform your doctor if
kidney disease, it is advised to start low
you’re using cannabis and to have
and go slow.
your bloodwork (INR) monitored.
Intermittent cannabis use may result
9. What are common drug interactions with
in unsafe bleeding times if you do
cannabis?
bleed.
Please consult with a pharmacist or
physician before starting any new
medications (including cannabis), so
that they can check for interactions and
monitor the benefits or harms to you.
Medications that can increase the
Due to the wide variety in products, effects of THC and CBD:
strength, content of THC and CBD, Clarithromycin, ketoconazole,
methods of administration, and patient itraconazole, posaconazole,
medical conditions, the significance voriconazole, fluoxetine, fluvoxamine,
and effects of drug interactions can be gemfibrozil, ritonavir, lopinavir,
very hard to predict with cannabis and darunavir, atazanavir
cannabinoids. Listed below and in the side
bar are some of the more important drug
interactions: 5, 7, 20
• Alcohol and medications that
cause drowsiness (e.g., seizure
medications, medications for Medications that can decrease the
mood or anxiety, opioids, sleeping effects of THC and CBD:
pills, some nausea and allergy Carbamazepine, phenytoin, St. John’s
medications) wort, rifampin, phenobarbital
Where possible, avoid taking
cannabis along with these
medications as this combination
can further increase drowsiness,
confusion, and impair your motor
skills.

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10. What do I need to monitor for when I’m Note: There are additional side effects to
using cannabis? consider with smoking cannabis compared
The type of monitoring your physician or to other methods. Side effects specific to
pharmacist will provide (physical exam, smoking cannabis: coughing, development
blood test or other) depends on the of chronic lung conditions such as chronic
reason for cannabis therapy. To help your obstructive pulmonary disease (COPD), and
care team determine if cannabis is safe fungal infection of the lung. 20 Although it
and effective for you, consider keeping isn’t clearly shown that smoking cannabis
a cannabis diary to track your cannabis causes cancer, cannabis smoke is known to
dose, response (e.g., use a scale of 1 to 10 contain the same cancer-causing and toxic
to rate symptom), and unwanted effects substances as tobacco.
you may be experiencing (see Appendix 2
for a diary template). Share this diary with Also note that people who are exposed to
your health care provider. second-hand cannabis smoke can have
detectable levels of THC in their blood and
11. What are the side effects of cannabis? urine. The impact of second-hand cannabis
The known side effects of smoke may potentially have health risks
cannabis are described below. and may be similar to second-hand tobacco
However, more long-term and smoke.
rare effects of cannabis may
still be unknown because most cannabis
studies are small and short-term. 8,20

Very Common (> 10%) Common (1-10%) Uncommon (< 1%)

• Drowsiness (50%) • Loss of touch with reality • Intense and
• Dizziness (32%) or self prolonged vomiting
• Low mood, anxiety, • Irritability or agitation • Loss of motivation
paranoia, hallucinations • Anger or aggression with
(27%) CBD
• Feeling “high” (35%) • Blurred vision
• Impaired memory (11%) • Dry mouth
• Diarrhea (20%) • Mouth irritation (mouth
• Vomiting (15%) with CBD spray)
• Low appetite (22%) with • Increased appetite with
CBD THC
• Rapid heart rate and • Problematic cannabis
changes in blood use (e.g., difficulty
pressure cutting down, continued
use, despite harm)

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12. What happens and what should I do if I 13. How can I minimize side effects of
take too much cannabis? cannabis?
While overdoses with cannabis can The higher the THC content in a product,
occur, it is uncommon that this leads to the greater the risk of side effects such
death on its own. Cannabis consumed as feeling high. Products with lower THC
with other substances (alcohol, for content and equal or higher CBD content,9
instance) may result in harm. However, which blocks the effects of THC, can
consuming too much cannabis can lead lower the risk of side effects. A general
to hospitalizations and motor vehicle recommendation is to limit THC to 30mg/
accidents, which can then result in day or less to avoid side effects that
serious injuries or death. The signs of affect your mind. For oral cannabis, the
using too much cannabis are similar to effects may be delayed (e.g., 4 hours after
typical side effects of cannabis but more consuming cannabis). To avoid taking too
severe. These signs and symptoms may much, it is important to wait for up to 4
include significant confusion, delusions or hours when peak effects have occurred
hallucinations, anxiety, paranoia, fast heart before taking more.
rate, elevated blood pressure or severe
nausea and vomiting. If you suspect that 14. Can I drive after taking cannabis?
you may have overdosed on cannabis, Like driving after drinking
it is important that you’re in a safe and alcohol, driving after
monitored environment. If needed, call 911 consuming cannabis
and seek medical attention. Don’t operate isn’t safe. It is illegal to
any vehicles or dangerous machinery. drive while impaired by drugs including
cannabis, alcohol, or a combination of
Most cases of cannabis overdose are both.10 The risk of car crashes greatly
associated with consuming too much increases when driving impaired from
cannabis in edibles because their effects cannabis. 5 Driving impaired by cannabis
don’t occur soon enough. In an attempt can also lead to very serious penalties
to speed up such effects, there is a including possible life imprisonment if a
tendency for people to frequently dose death is involved.11
and take large amounts of edibles, which
actually doesn’t impact how soon the Some studies and experts suggest you
effects occur. Peak effects of edibles can avoid driving or operating dangerous
take up to four hours to occur and the machinery for at least 6 hours within using
dose shouldn’t be increased until you cannabis or 8 hours if you felt “high.” 5,
are familiar with the effects of the initial 9, 15
However, since cannabis can impair
dose that was taken. If a faster onset of each person differently depending on
cannabis effects is desired, other methods the method of consumption, quantity
of administration such as oral-mucosal consumed and the variety of cannabis
spray or inhaled method should be and its THC levels, these durations can
explored. potentially vary for different individuals. It
is important to recognize that there is no

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 absolute guaranteed amount of cannabis your medication can affect your ability to
that can be consumed before it is safe function at work, for example, if your job
to drive or duration to wait to drive after involves driving or operating dangerous
consuming cannabis. It is safer to plan machinery that can pose a safety issue.
ahead and have a designated driver or
take public transit, a cab or a ride sharing 17. When is the best time to start, adjust, or
service. switch cannabis products?
The best time to start or adjust your
15. Can I take cannabis with me if I travel cannabis product is in the evenings right
across borders? before you go to bed and right before a
You cannot take cannabis in or out of weekend or on days you don’t need to
Canada, even if the cannabis is prescribed work or have medical treatment. This will
by a physician. It is a criminal offense. allow you time to recover and adjust your
“Don’t bring it in. Don’t take it out!” To cannabis dose in the event you develop
learn more, go to www.cbsa-asfc.gc.ca/ any side effects. You should also do
travel-voyage/cannabis-eng.html this in a safe and preferably monitored
environment in case you become unaware
You can take up to 30 grams of cannabis of your surroundings. You should avoid
with you when travelling within Canada. making changes to your cannabis use
The rules for use, however, vary by during activities that require your full
province. To learn more, go to www. attention.
canada.ca/en/health-canada/services/
drugs-medication/cannabis/laws- 18. Is cannabis addictive? What is cannabis
regulations/provinces-territories.html. use disorder (CUD)?
It is estimated that 1 in 11 (9%) patients
16. Will cannabis affect my work? Do I need using recreational cannabis will develop
to tell my boss if I am using medical addiction, and this increases to 1 in 6
cannabis? (17%) for those who start using cannabis
Cannabis can affect your ability to as a teenager. The highest risk is among
remember, concentrate, pay attention and those who smoke cannabis daily. In
react quickly. In addition, it may lower your this group, the risk of addiction is 25 to
motivation to complete tasks or cause 50%.12 Although the risk of addiction
drowsiness. To eliminate or reduce these from other administration methods hasn’t
effects, consider alternative therapies, been studied, consuming higher levels
avoid consuming cannabis before/during of THC is known to be more addictive. 13
work hours, or use products with a lower Risk of addiction is also greater in those
THC and a higher CBD content, or CBD on with a personal or family history of drug
its own. addiction.

While you don’t need to tell your boss The evidence comparing cannabis to
what medications you use, there are opioid addiction is currently limited.
situations where you should tell them that With prescription opioids, the risk of

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 addiction is estimated to be 5.5%. 20 • Strong urges or cravings to use
The risk with medical cannabinoids is cannabis
understudied, which makes it difficult to If you experience at least two of the above
directly compare. Although the addiction situations with cannabis use, you may
risk with non-medical opioid use isn’t have possible CUD. Alternatively, the
known, it is likely higher than prescription CUDIT-R cannabis screening tool can be
use. Moreover, the risk of fatal overdose used to determine if an individual is at risk
with prescription opioids is known to be of or has possible CUD (see Appendix 3).
higher than that of cannabis use, which is If you are concerned that you or someone
negligible in comparison. 20 you are caring for may be at risk of
CUD or has possible CUD, consult your
Cannabis Use Disorder (CUD) refers to healthcare team.
what was previously known as “cannabis
dependence.” It describes the ongoing
use of cannabis even when it causes
unwanted side effects or affects day-
to-day activities. To be diagnosed with
CUD, you would need at least two of the
following symptoms or behaviors within a
12-month period: 13
• increased tolerance
• withdrawal
• consuming much more than
intended
• unsuccessful attempts to quit 19. When should I consider stopping
• a lot of time lost consuming or cannabis? How do I stop it? Can I get
recovering withdrawal symptoms?
In addition to the risk of developing
• reduced activities
psychological dependence (see previous
• ongoing use despite persistent section), patients consuming cannabis can
physical or psychological problems develop physical dependence, where the
caused or worsened by cannabis body is adapted to the effects of cannabis
use and immediately stopping it, or quickly
• failure to fulfill major roles at work, reducing the dose, can lead to withdrawal.
school or home Withdrawal symptoms can include anxiety,
loss of aptpetite, restlessness, inability
• use in physically hazardous
to sleep, and low mood. Generally, these
situations
symptoms can occur in 1 to 2 days, peak
• ongoing use, despite social or at 2 to 6 days, and disappear in 1 to 2
interpersonal problems caused or weeks after stopping cannabis. 20
intensified by cannabis use

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 If you want to stop using cannabis At this time, a decline in kidney function
because you feel that you are alone isn’t thought to impact the effects
experiencing more harm than benefit of cannabis, since cannabis is mainly
from it, gradually weaning off it (gradually removed from the body by the liver.
reducing it) instead of abruptly stopping
it is strongly advised to avoid withdrawal 22. Does dialysis remove cannabis from my
symptoms. This is especially advised if body? Do I need to change the timing of
you have been using cannabis daily for my dialysis?
a few weeks to months. If you are using Cannabis is unlikely to be effectively
cannabis only occasionally, a gradual removed from the body by hemodialysis
approach to weaning off it may not be or peritoneal dialysis. However, if you
needed. consume large and frequent amounts of
cannabis, you may feel some withdrawal
Consult your physician or pharmacist to effects toward the end of a 4-hour
create a plan that works for you based hemodialysis session, depending on the
on how much cannabis you use regularly. timing and method of your last dose.
A general approach may be to reduce
your dose by 25% every 1 to 2 weeks 23. How do I get cannabis?
depending on how you feel. In BC, various forms of cannabis are
available through prescription mail-order,
20. Can cannabis affect my kidney function? licensed companies and unlicensed
In one study, patients who used cannabis dealers.
and already had diminished kidney
function were at a higher risk of kidney Prescription licensed and regulated
disease progression compared to those cannabis is the safest way to get reliable,
who didn’t use cannabis.14 However, tested cannabis with advisors helping
patients with normal kidney function didn’t you find the cannabis type, method and
experience any differences in kidney amount that will work best for you. A
function compared to non-cannabis users. prescriber (e.g., your family physician) will
The cause of the kidney function decline need to write a prescription to get you
is unknown, but it might be related to started. Some private insurance providers
inhaling cannabis smoke. Cannabis by will cover this form of medicinal cannabis,
vaping or edibles may not present the so it is worthwhile checking. The advisors
same harm. (licensed medical cannabis producers) can
help you navigate the most cost-effective
21. As kidney function worsens, does the solution for you. Medicinal cannabis is
effect of the cannabis change? only available by phone consult and
The effect of cannabis is related to the delivered by mail. These companies
dose, method and variety of cannabis typically have comprehensive websites to
used. It is also related to the experience help you both choose and use wisely, with
or “tolerance” of the person consuming it. many helpful tools.

BC Renal • BCRenal.ca November 2021

10
 Recreational licensed and regulated
cannabis retailers sell tested and licensed
products in store or online. While this
may be a convenient way to buy safe
cannabis, it is difficult to find the variety,
dose and method that works best for
you. Insurance providers typically will
not cover recreationally purchased
cannabis. Licensed cannabis may be more
expensive than unlicensed cannabis but
carries quality assurance and is legal.
Make sure the retailer is licenced by the
BC Liquor Distribution Branch.

Unlicensed and unregulated cannabis

usually doesn’t undergo rigorous testing
for purity, strength and composition.
Concentration of active ingredients may
vary from batch to batch. This is the least
preferred method for obtaining cannabis.
It remains illegal, may be of poorer
quality and is unregulated. Be aware that
sometimes the strain or variety may be
different than labelled. There is also a
risk of harm from potential exposure to
contaminants such as lead, pesticides or
other drugs (e.g., fentanyl) in unregulated
dried cannabis products.

Other useful guides for the patient:

Cannabis 101- University of Waterloo

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Appendix 1. Comparison of Commercially Available Cannabis Products for Medical Use

Prescription Cannabinoids Medical Cannabis

Nabilone Nabiximols
Dried Cannabis Cannabis Oil
(Cesamet) (Sativex)
Manufactured Natural extract Natural Natural extract of
THC of THC & CBD CBD ± THC

Oral capsules Mouth spray • Smoke (joints, bongs, pipes, etc.) Oil that can be swallowed or
given under • Vape (cannabis is heated with a device into aero- applied on the skin
tongue or on sol and inhaled)
side of cheek
Preferred over medical canna- • Smoking isn’t recommended. Cannabis smoke Preferred over dried cannabis.
bis. contains cancer-causing agents and can affect • No harmful effects to the
the lungs. 15, 16 lungs.
• Product is standardized and • Vaping may have less harmful chemicals than • Easier to dose (sold as
regulated, making it easy to smoking but has been linked to serious lung specific concentration).
dose and a safer product to injury. This is likely due to the use of modified
use (i.e., tested for contam- chemicals in vaping devices. If used, consider
inants). Health Canada approved devices. Inhalation from
vaping is stronger than from smoking.
• Concentrations and effects of dried cannabis can
vary quite a bit, making it hard to dose.

60-90 mins 20-150 mins to Works quickly, within 5-10 mins 30-120 mins to work
to work Lasts work Lasts 6-8 Effects lasts 2-6 hrs 17, 20 Effects lasts 4-12 hrs17, 20
8-12 hrs 20 hrs 20
Starting Starting dose: • No standard recommended dose or ratio. Starting dose (oral):
dose: 1 spray under • Dose usually based on CBD to THC ratio 2-3mg of CBD +/- THC at bed-
0.25-0.5mg the tongue at • THC and CBD may be measured in mg/g or %. time (e.g., 0.1mL of 20mg/mL
once daily at bedtime 20 CBD),20 then increase slowly as
bedtime 20 Starting dose: If you are new to cannabis, try a prod- tolerated to desired effect over
Usual dose: 1 uct that is 10% THC (100mg/g) or less with an equal or few days.
Usual dose spray under the higher amount of CBD. 17
for nerve tongue every 4 Note: It may take up to 4
pain: hours (up to 12 Start with 1 inhalation and wait 15 mins. Then, may hours to feel peak effects from
1mg twice sprays/day) increase by 1 inhalation every 15-30 mins until desired eating or drinking cannabis.
daily symptom control is achieved. 9 Taking more within this time
period can cause severe side
1 puff of joint = 1-10mg THC, strength varies depending effects. 17
on THC %, joint size, how deep you inhale. 20 Topical cannabis isn’t well stud-
ied and there is no available
THC as low as 2.5-3mg/dose may have medicinal dosing recommendation.
benefit with little intoxicating effect. 18,19

Cost: $22- Cost: $84- Cannabis oil- $20-45/bottle21 (minimum $7-15/30d based on above starting dose)
112/30d using 1008/30d Dried cannabis- $7-11/g, average daily dose for medical purposes= 0.65-3g 22
above doses Using above (~$135-1000/30d, depending on daily dose)
doses
Covered by Not covered by Pharmacare.
Pharmacare Not covered by Coverage available for some with Veteran’s Affairs or private insurance if purchased with
and occa- Pharmacare, but a prescription. No coverage if purchased in retail without prescription.
sional private occasional pri-
insurance vate insurance
coverage coverage

BC Renal • BCRenal.ca November 2021

12
Appendix 2. Cannabis Use and Symptom Diary

Other What effects did

Symptom Cannabis Symptom
medication(s) you feel after
Date & score before product or score after
Symptom that were used cannabis use?
Time medication (0 strain used and cannabis use
for symptom at What time did you
to 10) dose (0 to 10)
the same time experience them?

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13
Appendix 3. Cannabis Use Disorder Screening Tool – Cannabis Use Disorder Identification
TEST – Revised (CUDIT-R)23

• Have you used any cannabis over the past six months? YES / NO
• If YES, please answer the following questions about your cannabis use. Circle the response
that is most correct for you in relation to your cannabis use over the past six months:

• Scores of 8 or more indicate hazardous cannabis use.

• Scores of 12 or more indicate a possible cannabis use disorder, for which further
intervention may be required.

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14
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disease symptom management. interactions with cannabinoids. CMAJ.
Can J Kidney Health Dis. 2019; 6: 2020 Mar 2;192(9):E206
2054358119828391.
8. Grindrod K, Beazely M. Cannabis
2. Lucas CJ, Galettis P, Schneider 101 [Internet]. University of Waterloo
J. The pharmacokinetics and the Faculty of Science School of
pharmacodynamics of cannabinoids. Pharmacy; 2018 [cited 2 April 2021].
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