Amanda Siebert:

Step one in scrapping medical cannabis: confuse retailers for service providers

Photo credit: Thought Catalog via Unsplash

No matter how you slice it, recreational legalization has had a major—and largely negative—effect on Canadians who use cannabis for medical purposes, and it could be getting worse.

One of the first indications that the Cannabis Act was ignoring medical cannabis users was the government’s decision to include a federal excise tax on both recreational and medical cannabis products. And even before October 17, 2018, proponents of medical cannabis in Canada expressed concerns that the government’s promise to “revisit” the status of the program within five years was simply a gentle way of suggesting that the program could be scrapped entirely.

A number of recent reports have shown patients who acquire cannabis through the Access to Cannabis for Medical Purposes Regulations (ACMPR) are having trouble obtaining their medicine. There are growing concerns that legalization has caused licensed producers (LPs) operating in both streams to divert product from the medical to the recreational market.

Some patients have reported that product selection has changed, with items becoming more expensive and even disappearing from LP websites entirely. It’s understandable why this is problematic: imagine going to the pharmacy for your monthly refill and finding that the medications you’ve relied on for years are no longer in your budget—or, not available at all.

The continued closure of compassion clubs and unlicensed medicinal dispensaries by enforcement teams like British Columbia’s Community Safety Unit (CSU) has limited access further, particularly for those who aren’t able to obtain cannabis through the federal program.

On top of it all, the vast majority of health insurance plans do not cover the cost of medical cannabis, making price one of the biggest barriers to patients who want to use it.

Those who work within the cannabis space might be more likely to recognize how problematic the conflation of medical and recreational use of cannabis is, because for the most part, we have first or second-hand experience with the plant’s therapeutic uses. We might use it ourselves, or have a family member or friend who relies on it. We might also have a better understanding of the legalities surrounding medical cannabis, and that being able to access it in all its forms is protected under the Canadian constitution.

But there are others who seem content to lump an epileptic who requires a daily, potent dose of cannabidiol (CBD) in with the weekend toker looking to smoke a joint, melt into the couch, and watch a movie. While there is obviously no issue with the latter, the former requires a different type of care and attention that can’t be provided in a strictly recreational retail setting. (This is particularly true of government stores, where any mention of the medical properties of cannabis is often strictly prohibited.)

The Canadian Association of Police Chiefs (CAPC) is another association that supports ending the separation between medical and recreational streams. In a discussion paper on legalization, the CAPC recommends “the merger of the medical marijuana regime with the legalized regime to provide consistency and assist in reducing opportunities for diversion”. What the CAPC doesn’t seem to realize is that, while such a move might provide more consistency for law enforcement, it would effectively remove any shred of consistency for patients who require a regular supply of the same products to treat their conditions. If patients are already speaking out about inconsistent access to the products that work best for them, how will they manage if they’re forced to compete with recreational consumers for the same products?

The Canadian Medical Association (CMA), too, has recommended the government scrap the two-tiered system, citing problems in other jurisdictions where similar approaches are in place in its 2018 submission to Health Canada: “Those… in Washington and Colorado have remarked on the challenges of having dual standards and regulations (e.g., purchase and possession quantities, taxation levels) and the contribution to the grey market.”

At a medical conference in Toronto in April 2018, CMA vice president Dr. Jeff Blackmer reiterated CMA’s position, saying, “Our view is really that now that the government is obviously intending to legalize this, once this is a substance that’s available to all Canadians, there’s really no need for physicians to continue to serve in that gatekeeper role.”

Without doctors and other service providers to help answer vital questions about medicinal use, ones that certainly cannot be answered at a recreational storefront, the CMA’s suggestion seems incredibly short-sighted. Both associations fail to realize that where compassion clubs, medicinal dispensaries, and LPs with medical brands provide a service to patients, retail stores and online purchasing do not. This is where patients, and arguably, consumers looking to learn more about the medicinal properties of cannabis, are continually failed.

Let’s be frank: the idea that we should simply send patients to recreational stores, where emphasis is more on decor than accurate information and product knowledge, is ludicrous. The other option for patients under the ACMPR is to cultivate their own cannabis, or have it done for them by a designated grower, but these patients, too, are facing opposition. Municipalities that have struggled to deal with grow operations have expressed fear that, in addition to patients who are authorized to grow large numbers of plants, the personal four-plant cultivation limit will lead to an increase in household hazards and potential theft. On their behalf, the Federation of Canadian Municipalities (FCM) has asked Health Canada to make stronger rules around residential cannabis cultivation.

“The use of residential premises for the cultivation of medical cannabis plants has caused major problems for Canadian municipalities over the past several decades,” writes the FCM in its municipal guide to legalization. “It has meant a significantly compromised housing stock, heavy demands on policing resources, local nuisance complaints, and erosion of the culture of compliance on which the effectiveness of local bylaws largely depends… many of these licences actually authorized cannabis production at a scale (hundreds of plants) that is simply inappropriate for a typical residential dwelling.” It is unclear what level of attention a federation tasked with representing municipalities has put into understanding patient needs, or the complex process of grower designation.

The FCM is eager to implement a system that would require any individual who wants to grow cannabis for personal use to obtain a compliance certificate from their municipality. For patients, this would be in addition to the arduous paperwork that comes with applying for a licence to grow under the ACMPR.

As we get closer to the day the government plans to reassess the status of the ACMPR, it’s vital that we continue to speak to the therapeutic qualities of this plant. We are witnessing the slow chipping away at a program that is used by nearly 400,000 Canadians, with thousands more obtaining cannabis for medical purposes through designated growers or other, less official streams. Politicians, industry groups, and associations might think that branding cannabis and making it available to consumers with credit cards and home addresses is enough for those who require it to treat their conditions, but it isn’t.

My hope, surely held by many others reading this, is that for the sake of patients who rely on cannabis, politicians aren’t pushed in the direction of eliminating the program. But I fear we’re already watching it happen. Doctors may be sending their patients to recreational stores, and municipalities may want to increase barriers to at-home cultivation, but a constitutionally protected right is a constitutionally protected right. Let’s just hope this doesn’t result in another long, drawn-out court battle.