Between 420,000 and a million Canadians use cannabis (marijuana) for medical purposes to alleviate symptoms such as pain, nausea, appetite loss and muscle spasms associated with medical conditions such as cancer, HIV/AIDS, arthritis, multiple sclerosis, glaucoma, migraines, and epilepsy, to name a few. In 2001, the Marihuana Medical Access Regulations (MMAR) were established by the federal government allowing Canadians to possess cannabis for medical purposes without fear of criminal sanction. With this authorization to possess cannabis, Canadians had three legal options to obtain a source of cannabis: 1) purchase cannabis grown under contract for Health Canada, 2) obtain a license to produce their own or 3) designate a person to produce cannabis for them.
Since that time, approximately 35,000 Canadians have obtained authorizations under the MMAR. This still only represents a small fraction of the actual number of medical users of cannabis in Canada, suggesting that there are barriers for access in this program. Barriers include difficulty finding a physician to support an application, dissatisfaction with the quality of the cannabis available from Health Canada’s supplier (which only offers only one strain of cannabis), and cost, among others.
As a result, many people rely on unauthorized sources of cannabis such as friends, acquaintances or street dealers for their supply. In addition, Canada has approximately 50 medical cannabis dispensaries (a.k.a. compassion clubs) which currently serve about 40,000 Canadians upon recommendation of a healthcare provider. Despite court decisions which recognized the value of the services provided by dispensaries, they are not included in the legal framework.
In June 2013, the government of Canada enacted new Marihuana for Medical Purposes Regulations (MMPR), and the existing Marihuana Medical Access Regulations (MMAR) will be repealed as of March 31, 2014. So what does this mean for Canadians who wish to use cannabis to alleviate their symptoms?
The good news is that under the new MMPR, people who wish to use cannabis for medical purposes will need to get a much more simplified medical document, similar to a prescription, directly from their physician or from a nurse practitioner. This document will then be submitted to one of several new licensed commercial producers which will provide a variety of strains to several clients. However, physicians continue to be reluctant to support the use of cannabis for medical purposes since their professional associations, colleges and insurers express concerns about the lack of sufficient information on risks, benefits, and appropriate use of cannabis for medical purposes. It remains to be seen whether a simplified process will address this barrier.
The bad news for many is that the 28,000 Canadians who currently are licenced to grow their own cannabis or have a designated grower will no longer be allowed to do so. Of particular concern if people continue to produce their own is the Safe Streets & Communities Act: Increased Penalties for Serious Drug Crime currently in effect in Canada which imposes Mandatory Minimum Sentences of six months to 14 years for the production of six or more cannabis plants. There is already a court challenge brewing to prevent the phasing out of these licenses.
More bad news is that with the new commercialized model of distribution of cannabis for medical purposes, the cost of cannabis will increase significantly, which will be prohibitive for many. Cost effectiveness is a major consideration for those who produce their own cannabis. Medical cannabis dispensaries, especially the not-for-profit ones, often offer cannabis at a reasonable price, and in some cases will even offer some donations to their lower-income members depending on the supply.
Public support for the use of cannabis for medical purposes is strong and there is international momentum to reform existing laws and policies regarding cannabis in general. How restrictive and commercial should access be? Is reducing options for access to cannabis for medical purposes the best way to reduce barriers to access? How can a well-established network of existing medical cannabis dispensaries with a rigorous accreditation program continue to be left out of the regulations? How much do stigma and a history of criminalization play a role in the direction of these new regulations? Where is the best interest of the patient in all of this?
*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC
Lynne Belle-Isle is a PhD candidate in the Social Dimensions of Health Program at the Centre for Addictions Research of BC at the University of Victoria. She is a National Programs Consultant with the Canadian AIDS Society and the Chair of the Canadian Drug Policy Coalition.