Canada has two systems for cannabis use, but they’re at risk of blending into one

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Canada’s medical cannabis system effectively prioritizes safety and transparency. But from the patient perspective, the experience is not ideal.

People with a medical concern that could potentially be helped by cannabis must go through a multi-step process. It begins with talking to their healthcare practitioner; however, only a small percentage of Canadian physicians have experience with cannabinoid-based medicines or easy access to the latest evidence and dosing recommendations.
The Canadian system allows patients to obtain authorization from a healthcare professional via a medical document that then allows them to purchase products through a licensed producer online. When it’s time to refill their prescription, patients can’t always get the same product, and their healthcare professional may struggle to help them sort out an alternative. As for the cost, patients are largely on their own. There is no provincial reimbursement and its estimated that less than two per cent of employer health benefit plans in Canada cover medical cannabis directly.

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In sharp contrast is the ease of Canada’s legal, recreational market. These same patients — who may be dealing with anything from chronic pain due to arthritis, seizures because of epilepsy, or night terrors as a result of post-traumatic stress disorder – can visit a cannabis retail outlet and simply buy a product — often without the knowledge or guidance of their healthcare professional.

This gap between recreational convenience and medical accessibility may contribute to a change in how some Canadian medical cannabis patients obtain care. According to Health Canada, Canada’s medical cannabis program had 370,000 registered patients last September, yet just nine months later that had declined to 303,000. A report from cannabinoid research group BDSA predicts Canadians will spend just $402 million on medical cannabis in 2020, down from its previous estimate of $470 million.

The Canadian Cannabis Survey, conducted by Health Canada in 2019, found that 73 per cent of people using cannabis for medical purposes did not obtain a medical document from a healthcare practitioner.

‘Driving people to the illegal recreational market is criminal’
Canada has two systems for cannabis use, but they’re at risk of blending into one. In fact, the Canadian Medical Association and the Canadian Association of Police Chiefs have both recommended the government merge these streams.

“The goals of the two systems are very different,” says Dr. Alan Bell, a Toronto-based family physician and assistant professor of family and community medicine at the University of Toronto. Bell is comfortable treating patients with cannabis and is active in delivering continuing medical education on medical cannabis to other doctors.

“The goal of recreational cannabis is to get high. The goal of medical cannabis is to treat illness. You can’t have two more different goals. The only thing they have in common is they both relate to the same plant.”
If Canada’s medical system continues to decline because of these barriers, or it disappears altogether, it will affect the health of many vulnerable Canadians.

When people consume recreational cannabis for medical needs, they likely aren’t effectively optimizing cannabinoid-based medicines to treat their illnesses — meaning at best, they are guessing the right dosage or strain. In addition, if they don’t keep their doctor informed, they risk cannabis interacting with other medications, or masking conditions that a more conventional drug could help. The Medical Cannabis Canada survey confirms that patients with medical documentation see healthcare professionals more often — and they reduce their use of other medications more.

Recreational products also tend to be THC-rich. “Most medical cannabis patients don’t want to get high,” says Dr. Bell, noting that many patients trying cannabis are seniors, and they don’t want to feel intoxicated, plus it’s a safety issue related to falls and a problem for drivers and people engaged in hazardous occupations of all ages.

medical marijuana in the hand of a doctor. cannabis alternative medicine
When people consume recreational cannabis for medical needs, they likely aren’t effectively optimizing cannabinoid-based medicines to treat their illnesses. PHOTO BY ISTOCK / GETTY IMAGES PLUS
A doctor properly prescribing cannabis will work with a “start low and go slow” approach that involves gradually increasing the dose of CBD, and adding in THC if needed. Patients doing the do-it-yourself (DIY) won’t know how to do this, nor will the clerk behind the counter at the local dispensary. A doctor monitors for cannabis use disorder as well, which is a risk for medical cannabis patients.

Meanwhile, many people who self prescribe end up visiting ubiquitous and affordable illegal dispensaries. Product in this system can be contaminated with pesticides and fungus, or spiked with serious substances such as fentanyl. “Driving people to the illegal recreational market is criminal in my mind,” says Dr. Bell.

‘If we let our medical system slip away, we’re compromising the health of Canadians’
The health and safety of such patients have been long ignored by our dysfunctional dual system, but there are fixes. First of all, governments need to address the inherent obstacles in the medical system. That could include eliminating the sales and excise tax — there are no taxes on prescriptions, yet medical cannabis patients pay tax.

Governments need to bolster the medical system by opening up more research dollars for studies into medical cannabis — research that delves not just into harms, but its use for a wider range of conditions.

Physician organizations could consider supporting research too, addressing stigma and a lack of supports within the medical community. Medical cannabis has shown promise in controlling pain and is typically less dangerous than opioids. While some medical organizations include cannabis in their guidelines for its benefits in controlling pain and other medical issues, many of these documents highlight the downsides and suggest caution more so than highlighting positive outcomes. Cannabis needs to be addressed as part of medical school education, plus continuing education programs for doctors, to help them understand this unique treatment, and how to use it safely.

With so many other competing public health priorities, we risk taking our eyes off our medical cannabis system. The legal, recreational cannabis market plays an important function, and it should operate separately but in harmony with an accessible and evidence-based medical system. We need both: and if we let our medical system slip away, we’re compromising the health of Canadians.

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