OBJECTIVE: To examine a case series of 70 disability claimants who were referred to a clinic for multidisciplinary medical evaluation for physician compliance with cannabis prescription guidelines for pre-existing cannabis prescriptions.
METHODS: Retrospective case series analysis.
METHODS: A private clinic in New Brunswick specializing in multidisciplinary medical assessment for institutional third-party insurers.
METHODS: All referrals for independent review of cannabis prescriptions between May 2016 and February 2018 (N = 70).
METHODS: Compliance with the cannabis prescription guidelines.
RESULTS: Treating physicians were found to have not adhered to the guidelines in 53 of 61 patients (86.9%) who were prescribed cannabis products for pain management and in 8 of 9 patients (88.9%) who were prescribed cannabis products for treatment of posttraumatic stress disorder. Clinical assessment and radiologic review failed to identify a neuropathic cause of pain in 70.5% of pain cases. Adequate trials of noncannabinoid medications had not been attempted for 72.1% of patients with pain nor for any of the patients with posttraumatic stress disorder. Contraindications to cannabis were identified in 65.7% of cases, including evidence suggesting a past or present cannabis use disorder or currently active substance use disorder in 34.3% of cases. The prescriptions were found to be consistent with prescription guidelines in just 12.9% of cases.
CONCLUSIONS: Very few of the reviewed cannabis prescriptions were found to be consistent with cannabis prescription guidelines. Respectful attention to guidelines might avoid unwarranted overprescribing, limit the secondary increase in comorbidity, and facilitate future scientific study and evaluation of medical cannabis.

Chronic hepatitis C virus (HCV) infection increases all-cause mortality, rates of cirrhosis, hepatocellular carcinoma, liver transplantation and overall health care utilization. Morbidity and mortality disproportionately affect individuals born between 1945 and 1975. The recent development of well-tolerated and highly effective therapies for chronic HCV infection represents a unique opportunity to dramatically reduce rates of HCV-related complications and their costs. Critical to the introduction of such therapies will be well-designed provincial programming to ensure immediate treatment access to individuals at highest risk for complication, and well-defined strategies to address the global treatment needs of traditionally high-risk and marginalized populations. HCV practitioners in New Brunswick created a provincial strategy that stratifies treatment according to those at highest need, measures clinical impact, and creates evaluation strategies to demonstrate the significant direct and indirect cost savings anticipated with curative treatments.

This article is based on the results of a qualitative study examining educational reforms in New Brunswick, Canada, during the 1980s. Using the province of New Brunswick as a case study, three issues related to the baccalaureate entry-to-practice policy are examined. First, the process of upgrading nursing education to a baccalaureate degree and the conflict this change created between the Nurses Association of New Brunswick and the New Brunswick Nursing Union are described. Second, the reasons leaders of the professional nursing organization desired to upgrade nursing education are examined, and third, the issues underlying the conflict over nursing education are discussed.

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