Practice Resource: Cannabis
On October 17, 2018, recreational cannabis became legal for adult use in Canada under the Cannabis Act, 2018. Amendments to the Cannabis Act in June 2018, which came into force on October 17, 2019, permit the regulated production and sale of three new categories of cannabis: edible cannabis, cannabis extracts and cannabis topicals.
This practice resource is intended to address questions that Registered Massage Therapists (RMTs) and clients may have about cannabis and Massage Therapy. The two most well-known components in cannabis are tetrahydrocannabinol (THC) and cannabidiol (CBD). For the purposes of this guidance, “cannabis” refers to the cannabis plant and any substance containing part of the cannabis plant (including THC and/or CBD). While cannabis is legal for both recreational and medical use in Canada, the regulatory regime for cannabis is very new and additional government regulations may still be developed. CMTO offers the following guidance on cannabis in Massage Therapy practice situations. This guidance will be updated as new information becomes available.
Pursuant to CMTO standards and the Health Care Consent Act, 1996, clients must be fully informed and able to consent to treatment, and RMTs must obtain informed consent before assessing or treating clients. An RMT should not assess or treat a client who is impaired by a substance that is affecting the client’s ability to provide informed consent, regardless of the source of the impairment. In other words, an RMT should view obtaining consent from a client who may have used cannabis the same way they would obtain consent from a client who may have used any other impairing substance (whether legal or illegal). RMTs must use their professional judgement to determine if the client can understand the potential benefits and risks of Massage Therapy treatment as explained, and whether the client’s perception of pain or pressure levels, or indeed of what occurred during the treatment itself, could be impacted.
Though the Cannabis Act changes how cannabis is managed, it does not change the Scope of Practice for RMTs. Providing advice or recommendations to clients about cannabis is not within the Scope of Practice of Massage Therapy. If a client has questions about cannabis, an RMT should refer the client to the client’s primary health care provider (such as a physician or nurse practitioner) who can assess the client’s needs and determine a course of action.
Selling and distributing cannabis is strictly regulated under the Cannabis Act. RMTs are not permitted to offer or sell cannabis products in their practice, because that is distribution, which is prohibited under the Cannabis Act. Further, as discussed below, RMTs should not apply a client’s own cannabis topical (in any form) to the client during treatment due to insufficient information available (at this time) regarding the risks associated with the use of topicals.
While using cannabis recreationally is now legal, little research on topical products exists to inform health implications and outcomes. A client may request the use of their own topical cannabis product during Massage Therapy treatment, however current research does not address the risks, benefits and contraindications. Without such information, the risk to clients cannot be determined, so informed consent cannot be obtained.
To obtain informed consent, an RMT must understand and be able to explain the risks and benefits to the client prior to providing a treatment. For this reason, at this time RMTs should not apply a client’s own cannabis topical (in any form) to the client during treatment. CMTO’s current position is consistent with the College of Massage Therapists of British Columbia, and CMTO will continue to monitor the changing climate around cannabis and review this position as appropriate.
Treating Clients While Under the Influence of Cannabis
The Professional Misconduct Regulation under the Massage Therapy Act, 1991 states that practising the profession while the RMT’s ability to do so is impaired by any substance is an act of professional misconduct. This means RMTs must not practise under the influence of cannabis (or any substance that may impair their judgement).
CMTO hopes this information is helpful. CMTO will continue to monitor regulatory changes involving cannabis, and will provide timely updates on new developments. Please contact
CMTO’s Practice Specialist with questions at firstname.lastname@example.org or (416) 489-2626 / 1-800-465-1933 extension 4124.
Related Standard of Practice:
Under the Cannabis Act, 2018 distribute includes “administering, giving, transferring, transporting, sending, delivering, providing or otherwise making available in any manner, whether directly or indirectly, and offering to distribute”.