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Stench of stigma remains on medical cannabis

Published on October 13, 2023 by David Wylie

Photo: Adobe stock/the oz.

Five years into legalization—and over two decades since medical cannabis became legal in Canada—the stench of stigma still lingers over those who need it the most

A report released this week by the expert panel conducting a review of the federal Cannabis Act says medical patients are sick of “antipathy” from health care professionals.

The expert panel says in its report it heard from many medical cannabis patients about the stigma and systemic racism they regularly face in some sectors of the medical system.

“Patients told us they want cannabis to be properly recognized as a form of medication in order to address issues related to stigma, affordability, and continuity of care,” says the ‘What We Heard Report’ that was released this week.

“Many patients expressed their frustration that access to cannabis for medical purposes has not improved since the (Cannabis) Act came into force. Patients and their caregivers noted challenges with finding knowledgeable and willing health care professionals to authorize, provide counsel, and monitor their use of cannabis for medical purposes, while at the same time providing acceptable health care for other complex conditions.”

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They also found the majority of health care professionals are not knowledgeable about medical cannabis, despite Health Canada’s efforts to publish information and tools about cannabis—that includes publication of a 266-page guide called Information for Health Care Professionals.

“Many health care professionals are uncomfortable with the lack of clinical evidence that is available for many common uses of cannabis,” says the report.

The report says there has been little progress made in research on the benefits and risks of cannabis for medical purposes.

The panel says they heard calls to promote the development and approval of cannabis products with Drug Identification Numbers (DIN). They also found advocacy for safety, efficacy, and quality requirements developed for non-prescription CBD health products, potentially modelled after non-prescription and natural remedy guidelines.

The panel is now in the process of finalizing its recommendations, to be tabled March 2024.

Indigenous rights and social equity

The report covers a number of topics, including Indigenous cannabis jurisdiction—notably the recognition of First Nations authority over a range of cannabis activities.

“There were a number of themes that were raised by almost all First Nations, Inuit, and Metis representatives who participated in our process,” says the executive summary.

“These include frustration about the limited engagement with the federal government during the development of the Act and  its regulations, and emphasis on the need to reflect the principles of the United Nations Declaration on the Rights of Indigenous Peoples (such as that Indigenous Peoples have the right to participate in decision-making matters that affect their rights and that they have the right to be actively involved in developing programs that affect them).”

The panel says it has heard from BIPOC communities who were, and continue to be, disproportionately impacted by the legacy of historical  policies of prohibition.

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Similar to those in some US states, including New York, Washington, and California), some suggested social equity programs such as licensing prioritization, grants or loans, and specialized training to ease some of the challenges with entering and operating in the legal cannabis market.

“Some of these groups also discussed the continued barriers and harms that exist because of the effects of the framework prior to legalization, such as disproportionate involvement with  the criminal justice system and over-policing. There are also gaps in the research to understand the impact  of cannabis legalization on particular groups, and whether there is ongoing racial discrimination in law enforcement, particularly with youth, where cannabis possession remains illegal.”

Affordability is also an issue, with patients noting products from the non-medical market are often less expensive than those from the medical market.

“Due to the varying needs  of patients, stakeholders suggested the need for a greater diversity of cannabis products for medical purposes, including those with higher THC quantities,” says the report.

“They recommended more accessible methods to obtain cannabis for medical purposes, such as pharmacies and retail storefronts, to complement the existing mail delivery system.”

Cannabis industry says it’s hurting

The What We Heard Report covered business and economic impact.

“While the objectives of the Cannabis Act did not include economic, social, and environmental considerations, we heard a great deal about the economic condition of the legal cannabis market,” it says.

It noted the need for public safety needed to be balanced with the necessary environment to foster business, especially with the goal of combatting the illicit market. That was, after all, a core reason for legalization in the first place.

Industry representatives expressed concern that companies in the legal market are struggling to realize profits and maintain financial viability, noting the burden of taxes, mark-ups, fees, and regulatory compliance costs.

“Industry members also discussed the excess supply of cannabis and the challenges of competing with an entrenched illicit market,” says the report.

“They raised issues such as: the need to increase public possession and THC quantity limits for cannabis; restrictive rules on promotion, packaging, and labelling; and the presence of different federal, provincial, and territorial frameworks with which licence holders must comply.”

Industry feedback also broached risks of both a consolidated market dominated by a few large players with significant market power and of micro licence holders turning back to the illicit market.”

More engagement, then expert panel recommendations

The panel says in its report that it is planning to bring together a group of independent economic advisors in the fall for advice.

The next phase will focus on providing advice and recommendations to the Minister of Health and the Minister of Mental Health and Addictions about the legislative framework and its implementation that may benefit from improvement or reform.

The panel is conducting more engagement this fall to help finalize its feedback.

The Minister of Health is responsible for tabling the report in both Houses of Parliament no later than 18 months following the launch of the legislative review (that is, by March 2024).