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More than two-thirds of Canadians who report using cannabis for therapeutic reasons do not have a medical cannabis prescription, according to survey data published by research firm Vivintel, a subsidiary of Vividata.

These users without a prescription are also more likely than other medical users to obtain marijuana from illicit sources – 32 per cent said they bought cannabis from black-market sources only, while 14 per cent said they got cannabis from both legal and illegal sources.

Statistics like these could provide ammunition to pharmaceutical companies, industry groups and patient advocacy organizations who want to see an overhaul of the medical cannabis system and are pushing to make the distribution of cannabis through pharmacies an election issue.

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“Essentially, a significant proportion of Canadians (approximately 600,000) are using cannabis for their own healing without having any interaction with a medical professional to do so, or a licensed retailer to obtain cannabis products,” says the Vivintel report released Tuesday, which was based on an online survey of 5,000 Canadians, 3,500 of whom were cannabis users.

Since recreational legalization last October, medical cannabis has been in limbo. Recreational users can buy from legal dispensaries as well as online, while patients can only buy medical cannabis online, using the direct-from-LP delivery system that preceded recreational legalization. Medical and recreational cannabis is essentially the same product – at least for now – but it’s easier to get it through recreational channels than through medical ones.

Last year, Shoppers Drug Mart became the first major pharmacy chain to become a licensed cannabis seller under the Cannabis Act, but it can still only sell online.

"We have heard from some people that they're doing their own research or going through recreational access points to see what works for them, and are not really prepared for what could happen if there are contra-indications with other medications they are taking," said Joanne Di Nardo, director of public policy and government affairs with the Arthritis Society.

The Arthritis Society is asking candidates in the upcoming federal election to consider allowing pharmacies to sell medical cannabis, as a way to make it more accessible and in line with regular drug distribution, overseen by medical professionals.

Pharmaceutical distribution will require approval from individual provinces, Ms. Di Nardo said, but the federal government could provide guidance.

"What we want to see from the federal election is to have a party say, ‘we believe we can improve access to the medical cannabis program and we will enable or support provinces as they move ahead with their own regulatory frameworks,'” Ms. Di Nardo said.

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The campaign for pharmaceutical distribution is, unsurprisingly, supported by pharmacy lobby groups like the The Neighbourhood Pharmacy Association, as well as by drug companies such as Sandoz Canada Inc..

It’s also not a new campaign. Sandoz, for instance, began lobbying governments after it signed a co-branding agreement with cannabis grower Tilray Inc. last spring.

"There's been a tremendous amount of [lobbying] activity in the last year. Has it brought any results? The answer is somewhat, depending on the province,” said Vincenzo Ciampi, Sandoz’s executive director of innovation and strategic projects.

“One of the challenges we have is each province has a different view on what the actual rules are.... Some provinces believe it's up to the federal government to change the law to allow distribution in pharmacy, and some provinces know that it actually is up to them, with the agreement of the federal government,” Mr. Ciampi said.

"I can tell you that certain provinces out west appear to have more of an openness to medical cannabis being in pharmacy,” he added. “What we're hoping is to influence [provinces] out west, and then that could create a domino effect.”

Mr. Ciampi said that the B.C. government appears to be most amenable to the idea. However, when asked about this reported interest, a spokesperson for the B.C. Ministry of Public Safety and Solicitor General gave no indication that B.C. was taking proactive steps to introduce pharmacy distribution.

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“While cannabis meets the definition of a drug under the federal Food and Drug Act (FDA), it has not been authorized as a drug or therapeutic product in Canada. We will continue to work with the federal government, the BC College of Pharmacists and the College of Physicians and Surgeons of British Columbia, to ensure registered patients in B.C. have access to safe and secure products for their medical needs,” said ministry spokesman Jason Watson.

The situation is complicated by the fact that most medical cannabis products – GW Pharmaceuticals’ Sativex and Epidiolex products aside – have not undergone rigorous clinical trials or received Drug Identification Numbers (DINs) from Health Canada.

Some professional associations, such as the Alberta College of Pharmacy, have said that pharmacists should not distribute products without a DIN. Other groups, such as L’Ordre des pharmaciens du Québec, believe pharmacists should be involved in dispensing medical cannabis regardless of whether it has a DIN.

The latter view is being promoted by Neighbourhood Pharmacy Association.

"Just because there isn't a drug identification number today, we should still be thinking of the most effective and appropriate distribution model that ensures access to patients," said Sandra Hanna, the association’s interim CEO.

Health Canada has held consultations on the introduction of a new product category called Cannabis Health Products. The government has proposed allowing companies to market CHPs using minor health claims, but the products won’t require a prescription from a doctor. Health Canada’s consultation documents suggest that CHPs will be allowed to be sold in pharmacies, with provincial approval, as well as in recreational dispensaries.

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The new category is a move in the right direction, said Ms. Hanna.

But CHPs, like medical cannabis, should only be sold through pharmacies, she said: “It’s critical to ensure that you’re giving medicinal patients and patients who are seeking cannabis for medicinal use a different stream and a different consumer or retail experience than the adult use market."

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