In 1997 the Ontario Court of Appeals found that a law prohibiting cannabis possession was unconstitutional (R vs. Parker – Section 4 of the Controlled Drug and Substance Act) as it essentially forced Canadians who were using medical marijuana to choose between their liberty and their health. In 2001, Health Canada granted access to marijuana for medical purposes to Canadians who have had the support of their physicians. This system was called the Marihuana Medical Access Regulations (MMAR).
Despite this judgement, very few clinical trials have been conducted since then because cannabis itself has remained a Schedule II Controlled Substance which the Government of Canada categorizes as having a higher than average potential for abuse and/or addiction.
Much of what we know about cannabis’ therapeutic properties is therefore, anecdotal which can present a problem for physicians who are now grappling with how and when to prescribe medical marijuana to their patients.
Currently, MDs have little solid information about efficacy and dosing and the stigma and confusion surrounding cannabis is tough to beat. As we move toward a new legalized market in Canada however, some groups are beginning to fund clinical trials which will help improve resources for MDs and Nurse Practitioners.
Interestingly; Before cannabis prohibition in 1937 the US Pharmacopoeia cited cannabis as a useful drug for the treatment of a long list of ailments. Cannabis tinctures first began to make their appearance around 1840 and were soon very common.
Health Canada’s MMAR program was established in response to the Parker decision. Those who qualified for medical cannabis could apply to grow their own plants at home or they could designate someone to grow on their behalf. A third option allowed patients to buy from a single Health Canada medical marijuana producer, Prairie Plant Systems. Today Prairie Plant Systems is known as CanniMed Ltd. and is a Licensed Producer under the current regulations.
Designated growers could take on multiple patients and grow a variety of strains, often working closely with their patients to identify and produce strains that provided the greatest amount of relief from symptoms.
During the trial proceedings in Allard et al. v. R. Shane Holmquist of the RCMP testified that police could not always accurately distinguish legal grow operations from illegal operations and that “overgrowing” was an issue that had been identified by the RCMP. The concern stemmed from police officers having no way of knowing whether a license holder was growing the amount their license specified or growing more and potentially trafficking.
In April 2014, Health Canada officially changed the MMAR system to a new system called the Marihuana for Medical Purposes Regulations (MMPR) which allows for large scale production of the plant via government licensed commercial growers. This system is still in play today, however in February of 2016 the MMPR in it’s current state was found to be constitutionally invalid as a patient’s right to Life, Liberty and Security of the Person is violated by the undue restriction of access to medical cannabis. Specifically, the aspect of the regulations that force a patient to purchase their medical cannabis from a Licensed Producer was found to be in contravention to a person’s health and safety.
Brief Overview of MMPR
Starting in April 2014 the MMPR changed the way Canadians accessed medical marijuana. Now, someone interested in trying cannabis as a treatment can discuss it with their physician or a nurse practitioner who can then fill out a Medical Document (similar to a prescription but with some additional information as required by Health Canada) which goes to the Licensed Producer (LP) of the patient’s choosing. A list of LPs can be found online at http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/list-eng.php and Lift Resource Centre members can go over each LP’s product catalogue with their Lift Educator.
There are some restrictions under the MMPR and they are as follows:
• Patients are limited to no more than 150 grams per month and can only order up to 30 times the daily prescribed amount at one time.
• Only the patient or a designated caregiver can order and possess marijuana and no more than 150 grams.
• Only a small number LPs are licensed to produce and sell extracts, the rest are licensed only to produce and manufacture dried flowers or “buds”.
• Prescriptions can only be written by a Health Care Practitioner (MD or Nurse Practitioner) licensed to practice in the province or territory that the consultation took place.
• No LP is licensed to operate a storefront, all sales must be conducted online.
• LPs are forbidden from selling to third party distributors such as dispensaries or compassion clubs.
• There are advertising restrictions; Cannabis is subject to the Narcotic Control Regulations which means that the only information that LPs can share with prospective patients is the name of an available strain, the cannabinoid content of that strain, the price per gram and company contact information.
The Canadian Medical Association has recommended that the advancement of scientific knowledge about medical marijuana should be encouraged as there is insufficient scientific evidence available to support the use of marijuana for medical purposes. In time we will start to see the results from several studies that are looking at cannabis and the treatment of osteoarthritis of the Knee (Cannimed) and PTSD (Tilray) to name just a couple. You can find a list of ongoing active studies on The Canadian Consortium for the Investigations of Cannabinoids website.
With full legalization scheduled for spring 2017, there are still many questions surrounding what exactly legalization will look like. While we haven’t got any definite answers yet we can be reasonably assured that research will carry on and expand and we will continue to learn more about the therapeutic benefits of this plant.