From 2014–2016, Canadian health authorities were forced to address the issue of medical marijuana, even as activist groups and industry sought to influence the decision-making process and its place in the medical marketplace. First, the system was privatized, then issues of use and access, not to mention the full-on legalization of recreational marijuana, dominated headlines.
In light of last week’s shocking medical marijuana report, the policy debate will certainly grow more heated here in the UK. The All Party Parliamentary Group on Drug Policy Reform stated there is “good evidence” cannabis can help alleviate the symptoms of several health conditions, including chronic pain and anxiety. According to Prof Mike Barnes, a leading consultant neurologist who contributed to the report, “We must legalise access to medical cannabis as a matter of urgency.”
In a recently co-edited series on Canadian cannabis called Waiting to Inhale, it became clear that medical marijuana was a supremely complex policy issue. Some of the questions included, but were not limited to, the tenuous balance between consumers and regulators, Canadian physicians as unwanted gatekeepers, marijuana as a measure (and potential leveller) of inequities, and the major struggles between Big Cannabis and craft cannabis.
Looking ahead, the UK can learn lessons from other countries, including Canada.
Background: Canadian medical cannabis
Medical marijuana has been available in Canada since 2001, after the Canadian Court of Appeal declared that sufferers from epilepsy, AIDS, cancer and other ailments had a constitutional right to light up. Prohibition of this “medicine” was, in short, unconstitutional.
The original regulation that allowed patients to access medical marijuana in Canada was enacted in 2001 and called the Marihuana Medical Access Regulations (MMAR). It allowed patients to possess dried marijuana flower/bud with a license issued by the government, provided that the application was signed off by a physician.
One strain of medicine was available for purchase from one single government supplier, Prairie Plant Systems, but optional licenses were available for patients to grow their own plants or to designate a grower to supply medicine to them.
The MMAR was repealed and replaced by the Marihuana for Medical Purposes Regulations (MMPR), enacted on Apr. 1, 2014. With this, medical marijuana was officially opened for business. And the new rules generated a craze as dozens of new entrants jumped into the marketplace.
As of Aug. 24, 2016 the MMPR was replaced with the Access to Cannabis for Medical Purposes Regulation (ACMPR). These new regulations included legislation that satisfied the latest Supreme Court decision to allow patients who possess a prescription from a doctor to grow their own medicine.
During this period, certain problems have hindered the medical marijuana industry’s growth in Canada, and Britain could learn from these.
Dispensaries vs. Big Cannabis
These stores and clubs are illegal because they procure and sell their products outside the federal medical marijuana system, which was overhauled and expanded last year to allow industrial-scale production of pot products that are mailed directly to licensed patients.
The pushback against dispensaries has come from national and local law enforcement as well as the Canadian Medical Cannabis Industry Association. Yet, the Cannabis Growers of Canada, a trade association representing “unlicensed” growers and dispensaries, have fought to be included at the table. Along with several other organizations, the CGC has lobbied the government to be included in the new legal regime.
As the New York Times put it, “a lobbying battle is raging between the new entrepreneurs and the licensed medical marijuana producers, who were the only ones allowed to grow and provide the plant under the old regulations. One side complains about being shut out by a politically connected cartel, while the other complains about unfair and damaging competition from those who are breaking the law.”
Physicians
Medical marijuana has not approved as a medicine by Health Canada, although there is a growing body of clinical evidence regarding its pain-alleviating effects.
As such, physicians in Canada have struggled with the science and ethics of medical marijuana. At the 147th annual meeting of the Canadian Medical Association in Ottawa last August, many doctors expressed serious reservations about prescribing marijuana.
Some doctors said they felt threatened or intimidated into signing prescriptions, whereas others felt as though patients were shopping for doctors. Worst of all, there were reported cases of malfeasance, where doctors charged their patients for a prescription.
The result is that the CMA remains divided on, if not outright opposed to, being the gatekeepers of medical marijuana.
Workplace Safety and Performance
With more relaxed rules around medical marijuana (along with federal legislation looking to legalize cannabis), employers are wondering whether this will grow as an issue when it comes to pre-employment or on-the-job testing.
Aside from certain industries, such as transportation, most provinces don’t have clear policies or precedents for dealing with medical marijuana.
Besides that, workplace screening of marijuana is a mediocre indicator of performance in the workplace as it doesn’t actually test for impairment. Rather, it tests for by-products excreted from the body after the drug’s been ingested.
Looking ahead, human resource departments will be forced to develop a raft of new policies.
Veterans
The core problem rests with the amount of cannabis veterans are authorized to take. In 2014, Veterans Affairs doubled the amount to 10 grams per day for eligible veterans. Yet, this is twice the amount Health Canada considers safe.
An internal Health Canada document showed that more than five grams has the potential to increase risks to the cardiovascular, pulmonary and immune systems, as well as psychomotor performance and has a chance of increasing the risk of drug dependence.
Ferguson’s office could not find any evidence to support this decision to increase the threshold. Veterans Affairs Minister Kent Hehr expressed shock in March that his department lacked an “informed policy” on the use of medical cannabis, even as the number of claims by veterans for medical marijuana grew more than tenfold over the past two years.
Vaping
The intersection of vaping and medical marijuana has also caused tension. As vaping has moved from a niche presence to mainstream practice, its unregulated nature – at the federal level – poses problems to policy-makers.
For example, the Ontario government exempted medical marijuana users in mid-November from a law that bans the use of e-cigarettes anywhere regular cigarettes are prohibited. These regulations were set to come into effect Jan. 1. This exemption meant medical marijuana users could vape in restaurants, at work or on playgrounds. However, Ontario’s associate health minister Dipika Damerla stated that the government would remove the exemption.
Local governments in various cities recently voted to implement a vaping bans in public spaces, with only a vape shop exemption predicated on “safety” concerns, specifically for the uninitiated e-cigarette user who doesn’t know how to install batteries in the device. But it was also predicated on the notion that buyers should be able to see what they’re getting, which is the same argument made by authorized medical cannabis users about the value of a local pot dispensary.
The Future
Marijuana remains a highly contested medicine for various scientific, political and social reasons. That is obvious.
Policy makers from government, industry leaders, and physicians will face considerable question marks. Cutting through all the haze won’t be an easy task, yet all participants, including the public, would be wise to use recent examples from Canada to light the way.