Health Canada is wise to re­tain the old med­i­cal-cannabis regime

The Globe and Mail (Prairie Edition) - - NEWS - AN­DRÉ PI­CARD

With so much at­ten­tion on Oct. 17, the day recre­ational cannabis will be­come le­gal in Canada, it has been largely over­looked that a sep­a­rate, decades-old sys­tem will con­tinue to op­er­ate for users of med­i­cal cannabis.

This is not with­out con­tro­versy, but Health Canada has wisely de­cided that the Ac­cess to Cannabis for Med­i­cal Pur­poses Reg­u­la­tions (ACMPR) will re­main in place for at least five more years to al­low med­i­cal cannabis to find its place in this brave new world of weed. There are cur­rently 330,000 reg­is­tered users of med­i­cal cannabis across Canada. That num­ber will no doubt fall in the com­ing months as ac­cess with­out a pre­scrip­tion be­comes eas­ier. Yet the num­ber of ac­tual users of med­i­cal cannabis is ex­pected to rise sharply in the com­ing years.

To un­der­stand that para­dox, a lit­tle back­ground is re­quired.

Un­der the cur­rent ACMPR sys­tem, pa­tients get pre­scrip­tions from physi­cians and pur­chase their drugs – dried cannabis, oils or seeds to grow their own – from 120 li­censed pro­duc­ers.

But it’s not clear how many of those reg­is­tered users are ac­tu­ally us­ing cannabis to treat a med­i­cal con­di­tion.

Some peo­ple with pre­scrip­tions were seek­ing a le­gal way of pur­chas­ing the recre­ational prod­uct and will now be able to get it more read­ily on­line or at re­tail out­lets.

For some pa­tients, too, it will be eas­ier to buy medic­i­nal prod­ucts with­out a pre­scrip­tion.

Fur­ther­more, it is an open se­cret that there is a cer­tain amount of di­ver­sion tak­ing place un­der the cur­rent rules. Some pre­scrip­tion mills have “pa­tients” who have been pre­scribed mas­sive quan­ti­ties of cannabis and who of­ten as­sign the right to grow their own to a third party– prod­uct that ends up on the shelves in dis­pen­saries, which are still il­le­gal.

Yet, there are good rea­sons for le­git­i­mate pa­tients suf­fer­ing from ev­ery­thing from arthri­tis to shin­gles pain to con­tinue us­ing the cur­rent ACMPR sys­tem.

When drugs are pre­scribed, the costs are some­times re­im­bursed by pri­vate in­sur­ers and can be claimed as med­i­cal ex­penses for in­come-tax pur­poses. In many ju­ris­dic­tions, med­i­cal cannabis is not taxed; in Canada, pa­tients will pay the same ex­cise tax as recre­ational users – about $1 a gram – and that’s a sore point.

Cannabis has been used medic­i­nally for al­most 5,000 years – in Canada, right up to pro­hi­bi­tion in 1923. It re-en­tered the main­stream a cou­ple of decades ago af­ter le­gal chal­lenges from pa­tients us­ing the prod­uct il­le­gally.

In July, 2000, the On­tario Court of Ap­peal threw out charges of pos­ses­sion and cul­ti­va­tion against Terry Parker, a man who had used cannabis for many years to con­trol his se­vere epilepsy. The court said deny­ing pa­tients ac­cess to med­i­cal mar­i­juana vi­o­lated their con­sti­tu­tional rights.

In re­sponse, the fed­eral govern­ment cre­ated the Med­i­cal Mar­i­juana Ac­cess Pro­gram. It was be­set with prob­lems and le­gal chal­lenges that, with no small amount of grow­ing pains, led to the cur­rent ACMPR sys­tem.

The ap­proach works fairly well – ex­cept that, other than a hand­ful of spe­cial­ized clin­ics, only about 10 per cent of physi­cians are will­ing to pre­scribe cannabis.

The Cana­dian Med­i­cal As­so­ci­a­tion has never been en­thused about med­i­cal cannabis and has asked for the cur­rent regime to be dis­man­tled, ar­gu­ing that med­i­cal cannabis lacks good ev­i­dence.

It is true that ev­i­dence is lack­ing, but re­search has been stymied by crim­i­nal­iza­tion. Le­gal­iza­tion should, among other things, al­low more and bet­ter re­search.

While anec­dote is not ev­i­dence, we should not dis­miss the well-doc­u­mented ex­pe­ri­ences of pa­tients with med­i­cal cannabis (sup­planted by some re­search), es­pe­cially in treat­ing chronic pain, nau­sea dur­ing can­cer treat­ment, some forms of epilepsy and post-trau­matic stress dis­or­der.

Of course, that doesn’t mean med­i­cal cannabis is a mir­a­cle cure-all. Like ev­ery drug, it has some po­ten­tial ben­e­fits and harms. The re­al­ity is that many pa­tients, young and old, are us­ing med­i­cal cannabis. As the stigma falls and the ev­i­dence grows, many more will be join­ing their ranks. They shouldn’t be get­ting ad­vice from bud keep­ers and cannabis som­me­liers.

The cur­rent sys­tem isn’t per­fect, but it’s worth main­tain­ing be­cause it pro­vides a clear de­lin­eation be­tween recre­ational and medic­i­nal users. Pa­tients want the re­lief cannabis can some­times pro­vide, but they des­per­ately need med­i­cal over­sight from physi­cians and phar­ma­cists, par­tic­u­larly when they are us­ing other pre­scrip­tion drugs, as in­ter­ac­tions can be dan­ger­ous.

They also need bet­ter for­mu­la­tions – not just weed to smoke, but oils, sprays, drops, sup­pos­i­to­ries and pills with proper in­di­ca­tions and clear dosages.

Canada is al­ready, in many ways, a leader in the field of med­i­cal cannabis. In the com­ing years, it needs to grow up a lit­tle bit, with well-trained physi­cians pre­scrib­ing, well-versed phar­ma­cists dis­pens­ing and well-in­formed pa­tients us­ing cannabis prod­ucts ap­pro­pri­ately and re­spon­si­bly.

GRAEME ROY/THE CANA­DIAN PRESS

Cannabis has been used medic­i­nally for al­most 5,000 years. It re-en­tered the main­stream mar­ket a cou­ple of decades ago af­ter le­gal chal­lenges from pa­tients us­ing the prod­uct il­le­gally.

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