Chapter 13 - Regulating Therapeutic Use of Cannabis

Access to cannabis

Concerns regarding patients’ ability to grow marijuana on their own or to find a person willing and able to do it for them were often raised. This problem is compounded by the condition in the MMAR that a person cannot be the holder of more than one licence to produce. Problems associated with the present scheme include  a lack of experience in cultivation; products of unknown potency and quality; security risks related to cultivation of marijuana; etc.

Undoubtedly, patients must have access to safe and high-quality cannabis products. The current option of self-cultivation should remain open for those who prefer this avenue. In such cases, the patient would register directly with Health Canada. In cases where self-cultivation is not appropriate or feasible, access should be permitted through properly regulated Dedicated Cannabis Distribution Centres. These centres would be staffed by personnel with knowledge of the therapeutic use of cannabis, who could advise patients on the dosage, strain and potency best suited for their particular conditions. The failure to obtain a domestic source of research-grade marijuana, as had been planned, provides further justification for allowing distribution centres to dispense high-quality cannabis to eligible patients. In addition, we are convinced that the government should not be the only distributor of cannabis intended for therapeutic purposes. Currently, Compassion Clubs play a very important role in distributing cannabis to those who need it for therapeutic purposes. For example, the B.C. Compassion Club Society is a registered non-profit society that has been distributing cannabis for medical use since 1997.  It employs  a  staff of 28 and serves a membership of approximately 1,600 people. Before registering a member, the club requires a confirmation of diagnosis and a recommendation for cannabis from a physician, naturopathic doctor or a psychiatrist. If a doctor will not sign a recommendation solely because he or she is uncomfortable with the legal status of cannabis, or has concerns about professional retribution, the club may register the patient without a doctor’s recommendation, depending on the severity of the diagnosis. Similar Compassion Clubs exist elsewhere in Canada.[1][36]  

Access to a variety of strains of cannabis with varying levels of potency is crucial. For example, the B.C. Compassion Club Society currently stocks many varieties of cannabis products.

 

Our daily menu usually has seven to ten varieties of cannabis, one or two varieties of hashish, cannabis tincture and baked goods. It is important that medicinal users have access to a variety of strains, as the effect of cannabis varies depending on which strain is being used and the method of ingestion. Our members are made aware of the differences and can then select the best strain of cannabis to most effectively treat their symptoms. [2][37]

 

High-quality products would be ensured through proper testing. The importance of testing was raised as a key issue.  

 

It is absolutely crucial in the developments on which we are working – and that we would like to continue – to have strict guidelines in terms of moulds and mildews, pesticides, fungicides, heavy metals and the kinds of things – which can be very dangerous – that you find in non-organic cannabis. Even in organic cannabis, some of those elements of microbiology can be very harmful to people, especially for people with depleted immune systems. We can only develop such standards when the medical marijuana community has access to laboratories. I think that there are all kinds of standards that can be developed in terms of safety and cleanliness in growing and distribution. [3][38]   

 

Despite what most would view as laudable motives–distributing cannabis to patients in order to alleviate their suffering–most of the existing clubs have faced or are facing difficulties with the justice system. Because they are operating in a grey area, those involved in these clubs are subject to prosecution and have in fact been prosecuted. For example, we heard from Philippe Lucas, director of the Vancouver Island Compassion Society (VICS), who indicated that he had been arrested and charged with possession for the purposes of trafficking because of his work with VICS. Mr. Lucas pleaded guilty to the charge but was recently granted an absolute discharge. Some of the comments made by the judge at sentencing are certainly relevant to this chapter. On the question of eligibility, the judge stated the following:  

 

This case must be viewed in a broad context, in which to date, the combination of federal regulations and College of Physicians trepidation has made it extremely difficult for applicants to obtain approval to use marijuana. [4][39]

 

He added the following with respect to access to marijuana:

 

Further, the federal government has so far been unable to ensure any legal supply of marijuana to those whom Health Canada thinks need it as a therapy. This is a particular hardship for those who cannot grow it.

 

…the Crown cannot rely upon the argument that there is a lawful option for those in need of the drug when the evidence establishes that the drug is only theoretically available through legitimate sources. [5][40]

 

In conclusion the judge stated the following.

 

I find that while there is no doubt that Mr. Lucas offended against the law by providing marijuana to others, his actions were intended to ameliorate the suffering of others. His conduct did ameliorate the suffering of others. By this Court’s analysis, Mr. Lucas enhanced other peoples’ lives at minimal or no risk to society, although he did it outside any legal framework. He provided that which the Government was unable to provide a safe and high quality supply of marijuana to those needing it for medicinal purposes. He did this openly, and with reasonable safeguards. The fact that he has stated he will continue this activity points to the sincerity of his principles, and points to our need as a society to get this thorny issue resolved quickly by either Parliament or the Supreme Court of Canada. If he re-offends, he will have to argue his case again, and may find a discharge difficult to obtain in the future. This court hopes that cooler heads will prevail pending the final resolution of issues regarding the medical and non‑medical use of marijuana. [6][41]

 

In Montreal, we heard how two volunteers of the Club Compassion de Montréal had been arrested only three months after they started operations. A decision is expected by the end of August 2002. Encouragingly, Hilary Black, founder and director of the B.C. Compassion Club Society, stated that the local police had generally been “wonderfully supportive of their work.” However, her next statement reveals readily apparent contradictions.

 

Police who have come to the Compassion Club Society have told me what great work we are doing, and have, on one occasion, protected a safe full of cannabis on our behalf. However, I have had a police gun held to my head for being at a growing facility. While I met with the federal health minister, Alan Rock, to give recommendations and information Health Canada had requested from us, the RCMP raided a greenhouse that was growing low cost, organic cannabis for the Compassion Club Society. While I am here before you, sharing our information as experts in the distribution of medicinal cannabis, my colleagues risk arrest, imprisonment, their ability to travel, to be employed, and their freedom to distribute cannabis to those in need. Prohibition is not protecting Canadians from the evils of cannabis; prohibition is destroying Canadians’ lives. [7][42]

 

Because these organizations are presently operating in a grey area we would hope that those in charge of enforcement would use their discretion powers liberally and that cooler heads will prevail. Some of the statements made by Hilary Black led us to be optimistic in this area. Clearly, in other areas of the country, the political climate will have to change.

In order to create a transparent therapeutic distribution system, these centres should be licensed and properly regulated. The conditions of their operation should include a requirement that they be authorized only to distribute cannabis for therapeutic purposes to those who have been diagnosed as having an enumerated condition or symptom. In addition, the distribution centres would be required to keep suitable records and make periodic reports. The purpose of such information would be to keep Health Canada informed of the centres’ members for registration purposes and also to provide valuable information for scientific research. Thus, the records would include information on a patient’s medical condition and its evolution, the amounts consumed and the observed effects on the patient. The centres would also be required to ensure that security measures are in place and would be subject to inspections to ensure compliance with the regulations.  

While added regulation will increase the costs of these distribution centres, this is essential to ensure proper controls over therapeutic use of medicinal cannabis. We insist that the costs of this regulatory scheme be kept to a minimum so as not to impede access to cannabis through inflated prices.

With respect to obtaining products, centres would agree to be supplied only by licensed producers. Such producers would be able to cultivate cannabis only for therapeutic purposes–since the separation of the therapeutic system from the recreational system is crucial. Licensed producers would be properly regulated–in particular, to ensure adequate safety measures are in place–and would be required to produce safe, high-quality products.

 

Products

Currently, the MMAR authorize possession of only dried marijuana, and not other cannabis products. We do not feel that this is justified and would recommend that the scheme be expanded to cover other cannabis derivatives .

 

Costs

We heard on several occasions that patients using cannabis for therapeutic purposes were often suffering from serious debilitating diseases, which negatively affected their financial situations. We recognize that drug coverage by insurance plans is generally a provincial responsibility. However, we believe that the purchase of marijuana for therapeutic purposes, and the purchase of equipment necessary for its cultivation, should be considered a medical expense for the purposes of the Income Tax Act.

 

Marihuana Medical Access Regulations	Committee Proposals
Eligibility The medical practitioner must not only confirm the applicant’s medical condition and the symptom that is associated with that condition or its treatment, but also confirm that the recommended use of marijuana would mitigate the symptom and that the benefits from the applicant’s recommended use of marijuana would outweigh any risks associated with that use   Requirement to consult one (category 2) or two (category 3) specialists for symptoms associated with medical conditions set out in category 2 and category 3   Generally requires that all conventional treatments have been tried or considered     Three categories of eligibility	Eligibility The diagnosis of a medical doctor or other medical practitioner regulated by a provincial colleges of physicians and surgeons would suffice for the purpose of authorizing therapeutic use           Eliminate the requirement to consult one or two specialists       Eliminate the requirement that all conventional treatments have been tried or at least considered before cannabis may be used   Eliminate the three categories and enumerate the medical conditions or symptoms for which cannabis use would be permitted – updating the list on a continual basis based on commissioned research
Access ··         Patients are limited to growing their own supply or designating someone to grow it for them	Access ··         Patients would be allowed to grow cannabis themselves or obtain it from dedicated distribution centres supplied by licensed producers
Products Limited to cannabis (marijuana)	Products Include all cannabis-derived related products
Dosage ··         Set by medical practitioner	Dosage ··         Would be determined by patient in association with the dedicated distribution centre