Access to Medical Cannabis in 2023 : The Cannabis Act Review

It’s already been five years since recreational cannabis was legalized in Canada. The Cannabis Act was enacted in 2018 and also governs how Canadians can access cannabis for medical purposes.

As part of this historic step, the federal government committed to conducting a review of the Cannabis Act within five years. This was to include a review of the medical cannabis framework in Canada.

It’s important to note that in Canada, medical cannabis is accessible only via a federal program where authorized patients can purchase products from federally licensed companies under specific requirements. Medical cannabis is not available in pharmacies and must be shipped by mail order to patients’ homes or residences.

When cannabis was legalized for non-medical or ‘recreational’ use in 2018, licensed storefronts sprang up all across Canada. These stores now total over 3,800 which represents a very significant growth rate in just 5 years.

In contrast, implementation of the Cannabis Act brought no significant access changes to medical cannabis. The mail order system, in place since 2013, remains the only option for patients and caregivers to access regulated cannabis products for medical use.

While adult Canadians may choose to purchase cannabis from recreational stores and utilize those products for therapeutic purposes, such products are not eligible for insurance coverage, medical expense tax credits.

The complexity of this one aspect of accessing medical cannabis demonstrates the barriers faced by Canadian patients today.

THE NEED FOR RESEARCH ON PATIENT EXPERIENCES

To inform the Cannabis Act review, and to ensure the needs of Canadians who access medical cannabis, or may benefit from it are well understood, our research team joined forces with collaborators to develop a nation-wide study, the Medical Cannabis Access Survey (MCAS). The study was launched in March 2022 to provide an opportunity for Canadians with lived experience of accessing medical cannabis to share their experiences, challenges and suggestions regarding future improvements to the medical cannabis framework in Canada.

Eligible participants included Canadian residents aged 16 years and older, who were currently, previously, or considering taking cannabis for medical purposes.

The survey asked about their current medical cannabis use, purpose, and reasons for taking medical cannabis, their authorization and access experiences, insurance coverage and costs associated with medical cannabis, and changes experienced since legalization of non-medical cannabis in 2018.

A total of 5,744 individuals from across Canada (62% woman) completed the survey, making it one of the largest ever done from the perspective of Canadians accessing cannabis for medical purposes.

Overall, 5,433 participants (95%) reported currently taking medical cannabis and 54% of these individuals held current medical authorization.Here we share the main findings of this study.

USE OF MEDICAL CANNABIS

Most of the participants had a lengthy history of taking medical cannabis and reported taking it every day for such health conditions as chronic pain, anxiety, and sleep issues.

With the growing medical and non-medical cannabis market in Canada, respondents currently taking medical cannabis reported utilizing a variety of cannabis products, with dried flower and oil being the most frequently reported.

In addition, participants with medical authorization were more likely to take oils and capsules than those without (68% vs. 44% and 35% vs 21% respectively). This finding highlights the potential importance of medical authorization in educating and directing individuals towards alternative and complementary medical cannabis products.

Estimating how much medical cannabis product they consumed on average each day, including the amount of tetrahydrocannabinol (THC) and cannabidiol (CBD), was difficult for most individuals to report.

The uncertainty surrounding dose and THC and CBD levels raises several concerns from a safety and harm reduction perspective. Furthermore, it’s possible that many individuals are not taking an optimal dose for their individual needs and may not achieve potential benefits.

Understanding the efficacy and side effects of medical cannabis in the absence of dosing information creates challenges for healthcare practitioners. So those care providers who are attempting to engage in shared treatment decision making with individuals may also experience significant challenges. In addition, documenting the efficacy of different doses of medical cannabis and THC and CBD levels across health conditions provides valuable clinical data for healthcare practitioners working in such a nascent field as medical cannabis, and offers an important starting point for future clinical trial research. In the context of harm reduction, the lack of dose and THC and CBD level information prevents healthcare practitioners from understanding the thresholds at which severe side effects may arise for certain individuals.

CHANGES SINCE LEGALISATION

Not surprisingly, considering the proliferation of cannabis stores, the most significant shift in medical cannabis since the legalization of non-medical cannabis was where individuals obtained their medical cannabis products.

Regulated sales points such as recreational stores, licensed sellers and growing at home has become more popular compared to unregulated sources such as dealers and family/friends.

More than half of individuals with authorization indicated accessing medical cannabis at a legal recreational store, where it is prohibited to provide medical advice about cannabis.

Even more striking was the fact that over 20% of individuals using medical cannabis before 2018 made the decision to no longer access it through the medical cannabis access program at all, highlighting the perceived and experienced barriers.

Legalization also brought a perceived change in attitudes towards medical cannabis, with respondents reporting feeling more comfortable discussing and suggesting medical cannabis to others, except for their employers. Given the continued reports of discrimination experienced by workers who take medical cannabis, restrictive workplace and human resources policies related to medical cannabis, and the continued public education campaign that emphasizes the harms of cannabis, this hesitancy to disclose to employers is understandable.

RETAINING THE MEDICAL PROGRAM

Despite the challenges experienced by participants in accessing the medical cannabis system and their use of the recreational market to obtain medical cannabis, nearly 57% of individuals with medical authorization agreed that there was a need to retain the medical cannabis program as separate from the recreational cannabis market. Policies exclusive to the medical cannabis framework that were most relevant to these individuals included being able to claim medical cannabis on federal tax forms (47%), receiving compassionate pricing (36%), and possession limits (29%).

Individuals identified numerous improvements that can be made to the medical cannabis program in Canada, including:

reduction of costs by eliminating applicable taxes,
introduction of access via community-based pharmacies,
protections for use in public and private spaces,
review of THC limits for edible products for therapeutic use, and
an increased focus on medical cannabis research and education.

These study findings highlight the complex landscape of medical cannabis, access challenges and unmet needs among the patient community, supporting the importance of locating patients at the heart of consultations.

NEXT STEPS

The Cannabis Act review is still underway, and stakeholders can contact Health Canada and the Expert Panel at legreview-examenleg@hc-sc.gc.ca to give their feedback on what they would like to see changed.

Once again, we would like to thank the participants who took the time to share their experiences and take part in this research, as well as the patient advocacy groups who circulated the study.

The full report is available here.

How to cite the report: Balneaves, L.G., Brown, A., Green, M., et al. (2023). Medical cannabis access and experiences in Canada. Retrieved from: medicalcannabissurvey.ca.