Legal cannabis isn’t new to Canada—in fact it’s been available to patients with qualifying medical conditions since 2001. There’s no doubt that when cannabis became legal to all adults in 2018, it was made possible in large part by the persistence and advocacy of patients.
“We have to remember that it was medical patients who have allowed us to have a legal framework in Canada in the first place,” says Sabrina Ramkellawan, vice president of clinical affairs at licensed producer Terrascend.
But legalization for all adults hasn’t necessarily benefited medical users. In fact, some cannabis industry experts say increased barriers to access and affordability are setting patients back.
The most common barrier to medical cannabis for patients is price, says Max Monahan-Ellison, vice president of Canadians for Fair Access to Medical Marijuana (CFAMM).
“The cost is especially challenging for patients who have little access to insurance benefits for their treatment, so these expenses come completely out of pocket,” he says, adding that in his experience, patient costs can range anywhere from $50 to over $2000 per month.
Cannabis is taxed twice in Canada, provincially and federally; since there is currently no tax exemption for medical patients, they are taxed at the same rate as recreational consumers. “No other medicine is taxed in this manner; treating medical cannabis in the same way as a recreational or adult product makes it much more difficult for patients,” says Ramkellawan.
There are no pharmaceutical points of access for medical cannabis, products are only available through mail delivery. Despite existing prior to legalization, mail delivery became more of an issue after adult-use cannabis became legal says Caryma Sa’d, a Toronto lawyer specializing in cannabis and tenant law. Both Sa’d and Monahan-Ellison shared multiple accounts of patient access issues ranging from condo security refusing packages to delivery issues.
Medical patients face further issues of access in the form of product shortages resulting from legalization. According to Ramkellawan, there were no requirements in the new legislation to guarantee cannabis availability or priority placement for medical patients. “Although there is a lot of cannabis product inventory in Canada, the products that many medical patients want were— and sometimes still are—in limited supply,” she elaborates.
Dosing inconsistency and restrictions
Whether a person is using cannabis for medicine or for fun, potency limits are the same. While capping potency to 10mg per serving may save recreational consumers from getting too high, Ramkellawan explains that current edible and concentrate limits don’t account for the unique needs of medical patients, who may require dosages above the regulated thresholds.
Patients also need a better system for precise, measured dosing; Monahan-Ellison explains that due to uneven THC distribution, regulations allow up to a 25% margin of error in edibles or concentrates below 5 mg. “How can we expect medical cannabis patients to reliably dose with up to 25% variability in the potency of their medication?” aks Monahan-Ellison.
“Legalization not only created legal barriers for patients, it also intensified social ones,” says Sa’d. She explains that patients found themselves under an undesirable spotlight, which was jarring for those who had been living under the public radar for years. At home, apartments and condos updated their by-laws to include bans on cannabis after legalization. At work, employers added cannabis use to their impairment policies leaving medical patients feeling exposed.
According to Sa’d, some patients find themselves in a situation where they feel they have to choose between their right to privacy and playing it by the book. Patients face the dilemma of disclosing personal medical information to employers, landlords, and the possibility of having that private data kept on file—which Sa’d explains can feel particularly unnerving to groups that have been disproportionately affected by prohibition.
The future of medical cannabis
It isn’t all bad news for medical consumers. Ramkellawan says patients can look forward to the development of a wider variety of products such as topicals, patches, suppositories, inhalers, and more. “I like to think of medical product innovation as “Cannabis 3.0” of the cannabis evolution,” she says.
Ramkellawan believes these new products will transform the current trial-and-error approach to medicating with consistent doses and outcomes. In turn, this will likely lead more doctors to consider cannabis a viable medical treatment, ultimately easing social stigma for those who already do.