More than 50 per cent of people recently surveyed by the research firm Leger on behalf of Sandoz Canada Inc. didn’t know whether Canada still has a medical cannabis system following recreational legalization.
That perception is a problem for Sandoz. The generic drug producer, a subsidiary of pharma giant Novartis International AG, partnered with Tilray Inc. to co-brand and market medical cannabis oils and capsules. Recreational legalization, however, has sowed confusion around the medical cannabis system, creating concerns that ACMPR patients will simply self-medicate in the recreational system. That would mean fewer customers for Sandoz, which is keenly interested in cannabis but won’t touch the recreational market.
“Unfortunately the situation now is very hectic,” said Michel Robidoux, president of Sandoz Canada, pointing to shortages on both the recreational and medical side, along with the lack of information about the medical cannabis system.
The best way to stave off attrition of patients into the recreation system, is to allow pharmacies to sell medical cannabis in brick-and-mortar stores, Mr. Robidoux said. It’s an argument that Sandoz and other pharmaceutical interests such as Shoppers Drug Mart have been making for months. Pharmacies can be licensed to handle cannabis – as Shoppers proved in September when it received a cannabis production license (“for labelling and associated product testing”) from Health Canada. But pharmacies still aren’t allowed to sell cannabis in-store, having, instead, to send it patients via the mail.
“Enabling cannabis for medical purposes to be sold in pharmacies would require support from the provinces and territories, their regulatory authorities responsible for pharmacists, and pharmacists themselves,” said Health Canada spokesperson Tammy Jarbeau in an e-mail. “Health Canada has previously indicated that it is open to discussing other models of distributing cannabis for medical purposes, including pharmacy distribution, if support exists.”
Both Sandoz and Loblaws (owner of Shoppers) are lobbying provincial and federal governments on the issue, but Mr. Robidoux says neither level of government wants to make the first move.
"Ottawa thinks the provinces now have the freedom to regulate distribution, and the provinces are saying no, no, no, I need Ottawa, because ACMPR is in Ottawa, it's a federal rule. So I think they're all throwing the ball at each other," he said.
Even if Health Canada does greenlight in-store pharmacy sales, the system would likely roll out province-by-province depending on each provincial college of pharmacists, said Mr. Robidoux. And views vary widely.
On one end of the spectrum Quebec’s Ordre des pharmaciens is actively advocating for in-store pharmacy sales, even for cannabis-based drugs that don’t have formal Health Canada approval.
“We are afraid that some patients might try cannabis when they shouldn’t, they will be using it for indications that they shouldn’t, they’re going to stop other drugs that they shouldn’t, so it’s a matter of protection of the public,” said Bertrand Bolduc, president of the Ordre des pharmaciens . “At the present time there’s enough literature for some indications, not all, but some. And we will work within the state of the literature on those indications.”
In Alberta, by contrast, the college of pharmacists is taking a more cautious approach.
“The reality is Health Canada has not evaluated the cannabis plant for safety and efficacy,” said Greg Eberhart, registrar of the college. “Should research demonstrate efficacy around those products for particular conditions, we would expect that Health Canada would move through the appropriate processes for licensing. And if they're licensed as drugs, and they address quality, safety and efficacy, we think the only place it should be provided is through a pharmacy.”
Ontario is somewhere in the middle on the issue, neither opposing nor advocating for in-store pharmacy sales. In a policy statement released in June, the Ontario College of Pharmacists said that it “would not oppose legal dispensing for medical use within pharmacies regardless of whether cannabis is approved as a drug by Health Canada or whether it receives an assigned Drug Identification Number provided that sufficient quality control measures are put in place by Health Canada.”
Mr. Robidoux is betting that Quebec will be the first province to move forward on the issue. In the meantime, Sandoz has partnered with the Canadian Pharmacists Association and the University of Waterloo to develop training courses to introduce pharmacists to cannabis. The program is financed in part by Loblaws.