It is with great regret and a heavy heart that we must announce the suspension of a large part of our services for financial reasons.

As of Monday, September 5th, we must unfortunately suspend initial appointments for all new patients. We must also suspend our training activities for health professionals and patients. Therefore, all announced fall events are cancelled. We will however continue to ensure the renewal of medical cannabis authorizations for existing patients.

We want to assure you that we will be here for our current patients. Our phones and emails will be open, however, we will have fewer staff to support them. Your doctors are here to provide continued care. Follow-up appointments will be a little different, but we are fighting to bring back our full level of care.

Here are ways that you can help:

• Make a contribution to our cause

• Share our campaign with your friends and family, or share on social media

• Continue with us – Moving to the recreational cannabis stream hurts our cause

• Send us a testimonial that you would be willing to share in our public campaigns – Rest assured, we won’t disclose any identifying information. 

•  Be patient with us during this difficult time, we will need more time to return your calls and your emails, we’re here for you but we are under-resourced

You might be wondering how this happened- Santé Cannabis has been a mainstay of medical cannabis access in Quebec since 2014. 

We’ve been struggling with the same question. Medical cannabis is not a priority for our government, for our healthcare industry, and we’ve tried everything we can to maintain our service, but we’re at our breaking point.

We’ve been slammed by the COVID-19 pandemic and increasing costs. And we now operate in the shadow of a recreational cannabis market entirely disconnected from its roots in medicine and patient advocacy. We now lack the resources required to continue providing our essential medical service. The RAMQ billings and educational grants we receive do not cover the costs of the care that we provide, and we must restructure in order to survive. We also receive no additional public funding in a province that profited $65 Million from recreational cannabis sales last year.

To date, none of these public funds are earmarked for medical cannabis research or improving medical cannabis access in Quebec. Many people will wonder, why do we still need medical cannabis clinics now that cannabis is sold legally?

There are many, many reasons:

• Patients using cannabis for medical purposes require care and education that cannot be provided by cannabis store clerks
• Physicians, nurse practitioners and pharmacists identify potential risk factors and drug interactions that require monitoring
• Vulnerable populations require personalized professional support to ensure they use cannabis safely and appropriately
• Cannabis purchased on the recreational market cannot be declared as a medical expense on income tax
• Medical cannabis authorizations provide protection to individuals who depend on it to work, to live and to care for their families
• Children and young persons can only access cannabis for medical purposes, and require personalized professional support
• Some patients receive reimbursement for their medical cannabis purchases, such as through Veterans Affairs Canada, CSST, SAAQ, and health insurance spending accounts. 
• Patients who grow their own cannabis require medical authorization, especially in Quebec where home cultivation is otherwise prohibited
• Specific Higher potency products for medical use are not available at the SQDC and can only be accessed via medical authorization

Once more, here are the ways you can help:

We are about to launch a media campaign to let the public know of this situation. We’ve protected our patients from these financial difficulties until now and avoided voicing them publicly. We are now at a point where we can no longer stay silent. As patients, you can help shed light on the importance of patient access to reliable information, educated medical evaluations and proper follow-ups. If any of the reasons for medical cannabis clinics to exist apply to you and you want to share your experience, send us your testimonial at info@santecannabis.ca.

We have also launched a donation campaign that we invite you to share with your connexions. We believe in our mission. We hope this situation is temporary, and thank you for your patience and support.

– Dr. Dworkind

Donate here

*Please note that this blog dates back to 2022. We restarted initial appointments for new patients in November 2022 and are still taking new patients.

In Quebec, whether one is for or against its therapeutic use, medical cannabis is now one more tool in the modern pharmacopoeia. We believe that it is now essential to recognize the multidisciplinarity of the stakeholders involved in medical cannabis treatments, whether it is in relation to authorization, services and care provided to patients or in relation to research. More importantly, we want to bring these stakeholders together to discuss the integration of this additional tool into clinical practice in Quebec. 

This conference aimed to provide a better understanding of some of the challenges surrounding medical cannabis and to offer resources, including our training program, to overcome these challenges and increase general medical cannabis knowledge. 

We hold this event every year because we believe that medical cannabis is an essential service that must be free of stigma and integrated into medical practice. By hosting we hope to bring together the diverse perspectives of our presenters and audience to encourage innovative medical cannabis patient care, and do so by expanding on the learning beyond each participant’s specialization.

Highlights from the talks:

If you weren’t able to attend we’re excited to share some of the highlights that our staff shared from each of the talks. 

Lack of knowledge of the endocannabinoid system: An important obstacle to overcome

Vi Dam, RN, MSc

Ms. Dam’s presentation was highlighted by a patient testimony that was very powerful and touched other presenters as well as attendees. It showed how complex and difficult it is for patients to find the right treatment and highlighted the lack of healthcare professional training and support for patients for whom conventional treatments do not work. It reminded us why we do what we do and how essential our services are. 

Testimony of a specialized nurse practitioner

Isabelle Têtu, IPS, MSc

Ms. Têtu has noted the number of patients asking about medical cannabis in her clinical practice is increasing, but inadequate training for healthcare professionals have left many professionals unable to support their patients with the answers to the questions they have. 

PANEL: Integrating medical cannabis into your clinical practice: From novice to experienced physicians

Dr. Naïla Debache, MD, Dr. Jérôme Lopez, MD and Dr. Viviane Hoduc MD

All three of these inspiring doctors took different paths leading them to integrate medical cannabis to their routine practice. At first, it was a frustrating trial-and-error, learn-as-you-go method to learn about medical cannabis, and we are proud that Santé Cannabis was the resource that helped them overcome this challenge through our clinical experience. 

“Cannabis is illegal in France, and I arrived here with apprehensions […] I started learning about it, thinking that I would maybe have patients using cannabis for recreational purposes. I wanted to be ready to meet problems related to this. So I collected information, in the end mostly about medical cannabis.” (our translation) – Dr Lopez

He expanded about how his training and investigation changed his mind, and he now considers medical cannabis as part of his routine practice.

Cannabinoid Titration and Opioid Tapering in Patients with Chronic Pain – a consensus-based algorithm

Dr. Jordi Perez-Martinez

Dr. Perez’s presentation was very interesting and pertinent for clinical practice, especially considering the current opioid crisis. He presented an algorithm for cannabinoid titration and opioid tapering in patients with chronic pain that has been built as many chronic pain specialists reached a consensus.This algorithm brings hope that more algorithms and clinical guidelines can be developed, even without a conclusive medical cannabis consensus in the general medical community. 

About the important question, “are there age limits with this algorithm?”:

“We always start with the notion that the use of THC in young patients with a developing brain is probably not a good candidate. But we can’t forget that these are patients who are already taking opiates and we know that opiates have a negative effect on cognitive development.” Dr. Perez-Martinez

There remains a need for rigorous research, and a broader consensus must be reached before medical cannabis for pain management will be implemented everywhere. 

Workshop: Should cannabinoid-based treatments be maintained in the medical field?

Dr. Charles Sun

Cannabis is a unique medicine, as there are currently two access points to this substance: for medical purposes through the medical cannabis program, and for non-medical use through the retail points of the SQDC. Dr. Sun asked the audience about their opinions on maintaining two separate programs, and what might be reasons for or against.

 We were pleasantly surprised to see that almost every person who responded said they believe that a seperate medical cannabis program should exist outside of the non-medical program. Dr. Sun asked them to expand on their reasoning and the answers collected from the different questions provided food for thought:

• A large number of responders agreed that some of the disadvantages of the medical cannabis program are related to the complexity of the system and prescription process. Indeed, the medical cannabis program is far from perfect, but hopefully these disadvantages can be minimized in the future as the regulations evolve.
• There was a great consensus on the importance of patient medical assessment by healthcare professionals prior to medical cannabis treatment, in order to limit potential harms: 96% of responders chose this reason concerning the need for a seperate medical cannabis program.

Panel: medical cannabis use and management issues in different healthcare facilities in Quebec: the pharmacist’s perspective

Sarah Girard, pharmD M.Sc., Philippe Arbour, BPharm MSc and Andrée Néron, BPharm DPH FOP

The panel composed of three pharmacists was extremely interesting as they shared their challenges with medical cannabis in their practices. They are trying to work within a system where they are traditionally seen as experts on the medicine, but find themselves at a loss when asked by their patients and colleagues about cannabis treatments. 

A particular friction point they brought forward was how difficult and tedious it is to obtain complete patient drug information, as medical cannabis is not included in the usual drug list that patients bring. Furthermore, patients do not always think of informing their pharmacist that they take cannabis, be it for medical or non-medical purposes – highlighting the need for pharmacists to update their questionnaires to include cannabis as well as recreational substances like alcohol.

Legal Issues and Patient Education

Max Silverman, LL. B and Naomie Parrot, RN, BSc

For medical cannabis patients, not only do they have to concern themselves with the understanding of their medication, but also with understanding complex laws surrounding cannabis. Our nurse Naomie Parrot covered some of the medical side of education, while Mr. Silverman, a lawyer engaged in litigation for human rights, covered some of the current legal consequences for medical cannabis patients, highlighting some of the regulations that are incomplete or missing. 

For example, there are contradicting and unclear laws between federal and provincial levels as to workplace accommodations. An employee cannot be terminated for using medical cannabis, yet the same employee could be terminated because of medical cannabis side-effects impacting their ability to accomplish their work. It is an issue that is especially worrying if the workplace is resistant against medical cannabis use, and patients’ rights are on the line. Mr. Silverman ended the day with a call to action for all of us – some things need to change, and it’s up to each of us to make a difference.

Conclusion

We were thrilled by the attendance of so many Quebec healthcare providers, patient advocates and organizations, and industry representatives who came to learn about the current state and future of medical cannabis in Quebec. Our speakers brought their expertise, passion and new ideas and for that we are very grateful.

We look forward to hosting our next event in May – this one focusing on international research innovations to improve patient care; and to many more years of our Conferences on Cannabinoid Medicines. Will we see you there?

Authors: Charlotte Bastin, Andrée Charbonneau

Join us at our next event

Quebec Cannabis Forum: Moving Towards a Comprehensive Approach to Public Health

8:00-5:00 pm EDT May 18th, 2022
Scena, Montreal
(EVENT IN FRENCH)

Register here

There will be many articles published highlighting the highs and lows of the last two years. We have a healthcare and research  perspective as a dedicated medical cannabis clinic and research leader since 2014, and similarly have seen highs and lows for our patients and practitioners.

Importantly, before legalization, it was common thought that medical cannabis clinics were not long for the world, that  legalization would remove the need for dedicated medical support for patients. Having worked alongside patients for years, we knew that this would not be the case, and in fact, we have seen an increase in referrals from doctors and self-referrals from patients, stimulated by legalization. With better access to cannabis information, people are seeking support from trained healthcare professionals to make informed choices that can improve their health and wellbeing.

Our increased demand for service, and increasing number of appointments year over year indicate that the need for medical support and patient education from a dedicated healthcare team is not going away any time soon.

WHAT HAS GONE WELL

Less stigma Patients report feeling more comfortable speaking with the healthcare teams, their families and friends about medical cannabis. We’ve observed an increase in interest in educational patient events and our training programs from doctors, nurses and pharmacists.

Reduced ethical burden. Cannabis legalization has helped to provide a clearer role for healthcare professionals and reduce the ethical burden we faced in previous years where doctors were the gatekeepers to legal access. Now, within a legal cannabis framework, we can focus specifically on the patient’s eligibility for medical cannabis treatments and can discontinue treatment if the goals or the conditions of our medical program aren’t met without the concern for legal issues if patients continue to consume on their own.

Diversity of product formulations and methods of administration have provided more options for patients and doctors. In the last two years, cannabis extracts, oromucosal sprays, vapourizer pens and topical products, have become available, meaning patients are more likely to find a treatment regime that works for them.

Updated guidelines for prescription of medical cannabis from the Collège des médecins du Québec. The important emphasis on quality of care and documentation remains, however research is no longer mandatory and decisions such as follow-up frequency of stable patients are left to physician discretion. Santé Cannabis is still very committed to medical cannabis research and all patients assessed and followed at the clinic are enrolled in our Real-World Data study upon their consent. However as this is no longer a mandatory requirement, it reduces barriers for patients and physicians.

WHAT CAN BE IMPROVED

More public education required. Publically-funded and developed training for healthcare professionals is essential. There is still a lot of confusion between medical and nonmedical rules, especially in Quebec.

Commitment to healthcare professional training. Our public healthcare system is a pride of Canada, but the government responsibility for training of our doctors, nurses, pharmacists and healthcare support staff seems to be completely overlooked during the first two years of legalization. The fact that pharmacists still don’t have a defined role in Canada’s medical cannabis program is Canada’s most shameful deficiency.

Improved access points for patients Access has not really changed for patients in the last two years, they still cannot fill medical cannabis prescriptions at pharmacies or retail locations. While SQDC locations continue to expand across the province, and same-day home delivery is available in Montreal for non-medical consumers, patients must still order online or by phone directly from the licensed seller and wait 2-3 business days for delivery.

The cost of medical cannabis remains prohibitive to the majority of patients who could benefit. Legalization introduced an additional excise tax, in addition to the sales taxes already applied. Some improvement has been made with private insurance, however it remains limited and universal cost coverage is still far away.

The introduction of the Cannabis Research License, a license that must be obtained from Health Canada for all research that handles onsite cannabis or cannabis products, has delayed research projects and increased burden on clinical researchers. This barrier causes challenges with project planning and funding. Without improvements, Canada is at risk to lose its global leadership position for research and innovation of cannabis products and cannabinoid-based medicines.

Changes to product packaging with the implementation of the Cannabis Act have created unnecessary burden on patients, healthcare professionals and the licensed producers and manufacturers. After twenty years of medical cannabis in Canada, it is frustrating that policy decisions are still being made without putting patients’ needs first.

On the 2nd Anniversary of Legalization

We are proud to be practicing medicine and completing research in a province and country that has made such impressive gains in cannabis, medical and otherwise, over the past two years. Legalization was something we advocated for since we opened our doors in 2014, and we celebrate this anniversary each year, knowing how many strong people worked tirelessly to make it happen. There is still a lot of work to do, and we excitedly look towards the next two years and beyond. 

For more perspectives on the 2nd year anniversary of legalization, read here.