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Part of Cannabis and your health

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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.Graeme Roy

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 (supplemented 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 budkeepers 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.

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