Practice Resource: Cannabis

On October 17, 2018, recreational cannabis became legal for adult use in Canada under the Cannabis Act. This practice resource is intended to address questions that Registered Massage Therapists (RMTs) and clients have raised about cannabis and Massage Therapy. The two main substances in cannabis are tetrahydrocannabinol (THC) and cannabidiol (CBD), and for the purposes of this guidance cannabis refers to plants and products with either or both ingredients. While cannabis is now legal for both recreational use and medical purposes, the regulatory regime for cannabis is very new and government regulations may still be developed. CMTO offers the following guidance on cannabis (of any form) in Massage Therapy practice situations. This guidance will be updated as new information becomes available.

I Think My Client is Under the Influence of Cannabis
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 that 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 to 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.

My Client Asked Me for Advice about Using Cannabis
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 substances such as 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.

Can I Offer Cannabis Oil or a Topical Product Containing Cannabis in My Treatments?
Selling and distributing cannabis is strictly regulated under the Cannabis Act. Therefore, offering treatments using cannabis oil or a topical product containing cannabis is prohibited (by law) for RMTs. Further, as discussed below, RMTs should not administer or apply cannabis in any form to a client during treatment at this time due to insufficient information regarding the potency and quality of topical cannabis applications and the possibility of interaction with other medications the client may be taking.

Can I Treat Clients Using the Client’s Own Cannabis Oil or Topical Product Containing Cannabis?
While using cannabis recreationally is now legal, little research on topical products exists to inform health implications and outcomes (risks, benefits and contraindications). If a client requests the use of their own topical cannabis product during Massage Therapy treatment, current research and regulations do not address the potency or quality of the product. Without such information, the risk to clients cannot be determined.

To obtain informed consent, an RMT must understand and be able to explain health implications to a client before administering a treatment. For this reason, at this time RMTs should not administer or apply cannabis in any form to a 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 monitor regulatory changes involving cannabis, and will provide updates on new developments. Please contact CMTO’s Practice Specialist with questions at practicespecialist@cmto.com or (416) 489-2626 / 1-800-465-1933 extension 124.

For additional information about cannabis, please see:
Government of Canada – https://www.canada.ca/en/services/health/campaigns/cannabis.html
Government of Ontario – https://www.ontario.ca/page/cannabis-legalization