map of countries with legal medical cannabis

Global Medical Cannabis Landscape

image via Cannabisser

The long-held perception of cannabis and reefer madness is slowly fading into the background as advances in medical research pertaining to the drug have increased. Many countries have now begun to adopt legislation to legalize cannabis medicinally and other countries have even looked at decriminalizing and legalizing the plant completely. The following article will examine some of the changes in medical cannabis legislation that has been occurring in the western world.

Medical Cannabis in Canada

The government of Canada has committed to introducing legislation on the legalization and strict regulation of cannabis for the spring of 2017. The new legislation would come into force after being passed by Parliament. Currently, the legal status of cannabis in Canada dictates that possession, production, and trafficking of cannabis, is still prohibited, except where authorized by exemptions such as those for medical purposes. Cannabis has been legal for medical purposes in Canada since 2001 when the first medical cannabis legislation, Medical Marihuana Access Regulations (MMAR), was introduced. This system has evolved greatly as the legislation has been challenged and changed over time. Today the Access to Cannabis for Medical Purposes Regulation, more simply ACMPR, is the current legislation that dictates how cannabis can be prescribed and accessed legally in Canada.

One of the key concerns surrounding medical cannabis in Canada has been the importance of ensuring patients have fair and reasonable access to the medication. The first revamp of the Canadian medical cannabis system which occurred in 2013, resulted in a drastic change in the distribution model of how patients access this medication. This new legislation was referred to as the Marijuana for Medical Purposes Regulations (MMPR) and was the Canadian Government’s attempt at establishing a regulated medical cannabis industry. Under the MMPR access to medical cannabis could only be secured through an authorization from a physician; this authorization would then be provided to a Licensed Producer which is a company that can legally sell cannabis. Licensed Producers are given the green light to operate by Health Canada after passing strict regulations. Distribution under this system is mail order only and patients purchase products online or over the phone before the product is shipped. No storefront distribution existed under the MMPR.

Dispensaries in Canadian Cities

Although the system had established itself in such a manner, many of the major Canadian municipalities (Toronto, Vancouver, and Montreal) began to see a proliferation of storefront dispensaries that operated in an illegal gray- area to provide cannabis to patients. These dispensaries have had much appeal with patients as they offer brick and mortar locations for patients to access cannabis medication and products some of which is currently not accessible through Licensed Producers (ie, edibles, tinctures, capsules, and topicals).The Government of Canada supports federal, provincial and municipal enforcement actions to address illegal storefront distribution and sale of cannabis. This has resulted in upsetting patients and challenging the distribution and access models of the MMPR. Canadian courts have also found that Canadians have a constitutional right to reasonable access to a legal supply of cannabis for medical purposes. As a result of the current cannabis legislation, ACMPR has re-introduced personal production of medical cannabis as a means to address some of the challenges of access and distribution which arose under the MMPR. This now enables patients to grow their own medication which can help with easing the accessibility of medical cannabis. However, storefront distribution still remains illegal and the Government of Canada still upholds the enforcement of illegal dispensary operations.

The United States of America and Medical Marijuana

America has a unique history with the cannabis plant. In the early history of the United States of America, hemp was considered legal and was grown as a crop utilized for many purposes. Around the 1850s, cannabis was introduced into American pharmacies and entered the American pharmacopeia. As pharmaceutical regulations began to be increased, an emphasis was placed on labeling medications correctly especially medications that contained some form of a narcotic. Prior to the strict stance on labeling regulations, most medication makers were mislabeling certain ingredients such as narcotics as “secret ingredients” and were patenting these products. These laws would be referred to as the “Poison Laws,” and was the American government’s attempt at reducing the easy sale of narcotics.

The Marijuana Tax Act

These laws would eventually develop to restrict narcotic sales greatly by limiting their sale to pharmacies and only with a physician’s prescription. Eventually, cannabis was criminalized and banned in the United States in 1937 with the Marijuana Tax Act, thus beginning the prohibition era of the cannabis plant. Subsequent legislation would further criminalize the cannabis plant and cannabis users, until the current Controlled Substances Act which was implemented in 1970. Under the Controlled Substances Act, cannabis was designated as a Schedule 1 drug which means that the United States government does not feel it possesses any acceptable medical use and has a high potential for abuse; cannabis remains classified as a Schedule 1 drug.

As cannabis has begun to gain more recognition for its medical benefits, through research and through anecdotal evidence, the social perception of cannabis has begun to greatly change. This changing attitude has resulted in the American government easing their policies towards cannabis use. Though cannabis is still illegal on a Federal level in the United States, various individual states have begun to legalize cannabis use for both medical and recreational purposes.  The following states have legalized cannabis for both medical and recreational purposes: Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, and Washington. 

Medical Cannabis in Europe

Numerous nations have introduced specific laws and programs to allow patients to use cannabis preparations in various forms to relieve the symptoms for a wide array of severe and disabling conditions. The general consensus, however, remains that it is the physicians who should decide under which circumstances cannabis should be prescribed and which patients could benefit from the treatment. Members of the European Union are free to set their own national drug laws, although all of them are parties to the UN single convention.

Medical Cannabis for Special Cases

The Netherlands has the longest experience of cannabis use, both medicinal and recreational, where physicians have been able to prescribe cannabis preparations for patients for more than 10 years. In Germany, the federal institute for drugs and medical devices has authorized the medicinal use of cannabis for special cases. In Italy, the therapeutic use of cannabis was authorized first in 2007, this system was revamped in 2014 with the implementation of new legislation which abolished the previously long process required to obtain a cannabis prescription; this new legislation made cannabis freely available to patients with a prescription from a primary care physician.  Spain is lagging behind Italy and Germany in terms of legalizing medicinal cannabis use, though it has made more progress than the UK. In Spain, cannabis consumption and cultivation is legal in private spaces but not in a public setting; if cannabis plants being cultivated privately are visible from the street or from a public place then the offense is considered an administrative offense which has a fine as a punishment. Public consumption, possession and the purchase of cannabis is still illegal, but it is a misdemeanor punishable by a fine and confiscation of the product.

Medical cannabis has also been legalized in other EU member states, most recently in France, Romanian and the Czech Republic.  Although European laws have not gone as far as legalizing cannabis, the current changes assist in acknowledging that there are justified medicinal uses of cannabis.

Medical Cannabis in Australia 

Medicinal cannabis will soon be legal in Queensland after state parliament passed the Public Health Bill 2016. This new law came into effect March 2017.

Medicinal cannabis is already legal in both Victoria and New South Wales, but Queensland’s new legislation has a very different framework – establishing two different pathways for medicinal cannabis treatment. First, giving specialist doctors the ability to prescribe medicinal cannabis to patients with certain conditions without state approval. The second concerns non-specialist doctors who are able to apply for permission from a government body to prescribe cannabis for patients suffering from certain conditions.

The Victorian Access to Medicinal Cannabis Act 2016

The Victorian Access to Medicinal Cannabis Act 2016 gives patients access to medicinal cannabis products, but use is restricted to children suffering from severe epilepsy. In New South Wales, the state’s Poison and Therapeutic Goods Amendment Regulations require every patient to be considered by an expert panel before getting access to medicinal cannabis treatment.

Cultivating medicinal marijuana was made legal across Australia earlier this year, so long as you have a license. So far, only New South Wales and Victoria have taken advantage of the new law, it remains to be seen whether Queensland will follow. The new medicinal cannabis laws came into effect in April 2017.

References

https://www.researchgate.net/profile/Greg_Swensen/publication/228483115_Reforms_to_Minor_Cannabis_Offences_in_the_United_Kingdom_Western_Australia/links/564d2a2408aeafc2aaafc3f4.pdf

http://www.justice.gc.ca/eng/cj-jp/marijuana/faq.html

http://embor.embopress.org/content/early/2015/01/09/embr.201439742

https://www.tni.org/en/publication/the-rise-and-decline-of-cannabis-prohibition

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