How will Cannabis Legislation Impact Medical Cannabis?

How will Cannabis Legislation Impact Medical Cannabis?

The upcoming legalization of cannabis has been a hot topic this year. We all know people who use cannabis for medical purposes whether they have suffered head, spinal cord or other injuries, or whether they use it to manage spasticity and pain. I wondered what the impact of legalizing cannabis would be on those who don’t use it recreationally, but rather for medical purposes. Here is what I discovered.

 

Some background information

Cannabis was outlawed in Canada in 1923. Access to dried marijuana for medical usage was granted for the first time in 1999(1) which lead to the Access to Cannabis for Medical Purposes Regulations (ACMPR) in 2001. At this time, the only ways to access cannabis were to grow it oneself or to designate another individual to grow it for you. Permission from a granting physician was required(1), as is still the case today.
Several court decisions have lead to changes in the original legislation. In 2013, major changes brought about new regulation: Marijuana for Medical Purposes Regulations (MMPR). It was at this time that production was shifted to a more commercialized industry to assure quality control, safety and security. People could no longer produce their own dry marijuana(1).

In 2015, the Supreme Court of Canada ruled it unconstitutional to limit access to marijuana in its dry state only. Exemptions allowed producers to provide cannabis oil, green leaves, fresh shoots as well as dried marijuana to their clients. Users could also make their own cannabis-based products(1).

It was in 2016 that the Marijuana for Medical Purposes Regulations (MMPR) was established further to a decision made by the Federal Court of Canada. These regulations stipulated that it was a violation of a person’s Charter rights to require them to obtain their medical marijuana from authorized producers only since these rights were protected under Article 7 of the Canadian Charter of Rights and Freedoms. It was ruled that this did not constitute “reasonable access”. This regulation changed nothing in how producers worked. Simply put, consumers of medical cannabis could continue to grow their own product (either themselves or through a designated third-party) as long as they were registered with Health Canada(1).

In April of 2016, the Government of Canada announced that it would introduce a Bill to legalize medical cannabis in the spring of 2017(2).

 

Evidence / Cannabis Research

Is cannabis really helpful in treating pain? In 2017, a scientific literature review was completed on the subject(3). Few studies were available and those that were proved to be quite varied. Marijuana appeared to relieve pain, but the data was lacking. Ingestion by inhaling seemed more effective than when taken orally. As well, fewer side effects were felt in the gastrointestinal tract when marijuana was inhaled. The review concluded that further research is needed to better understand its effects.
How quality of life was impacted is still unsure. Improvement was found with certain medical conditions (ex. Multiple Sclerosis), but it was not so with others (ex. HIV+ patients) where quality of life decreased. This also requires further research(4). So are the (positive) effects actually disease dependent?
When it comes to spasticity, research on a molecule from cannabis (cannabidiol) showed a significant decrease in spasticity for Multiple Sclerosis patients(5). Few in-depth studies have been done on how cannabis affects spasticity, and those that were targeted the MS population. For those with spinal cord, head or other types of injuries, the few studies done had limited patients, and questionable methodology. We are therefore left with many questions and are unable to make clear recommendations.

So, is cannabis beneficial? That’s what patients are telling us; therefore, it must be! But the science behind it is still does not allow us to understand the specific benefits. We remain uncertain. Which conditions will be helped? What is the correct dosage? Also, which molecule from the cannabis plant has an effect, and what exactly is affected? Finally, what are the possible interactions with other medications(6)?
Why are there so few studies done on this topic? Maybe because it is still illegal to be in possession of cannabis, even for researchers! Legalization is interesting in a framework where we want to describe the possible benefits this plant has on the human body through scientific study.

The Impact of Legalizing Marijuana for Medical Usage
“On June 30, 2016, the Minister of Justice and Attorney General of Canada, the Minister of Public Safety and Emergency Preparedness, and the Minister of Health announced the creation of a nine-member Task Force on Cannabis Legalization and Regulation (“the Task Force”)(7)”. Its mandate was to consult and provide advice on the design of a new legislative and regulatory framework for legal access to cannabis, consistent with the Government’s commitment to “legalize, regulate, and restrict access.” The final report is available online at : https://healthycanadians.gc.ca/task-force-marijuana-groupe-etude/framework-cadre/alt/framework-cadre-eng.pdf. I was particularly interested in the chapter on access to medical cannabis.
The users concerned by the legislation were questioned as well as doctors and pharmacists.
I was surprised when I realized that many users seemed troubled by the current legislation allowing cannabis for medical purposes. I understand their point of view.
Obtaining a prescription for medical cannabis when there are few medical retailers available is hardly enticing. People don’t want to be forced to share their personal medical information in a context like this. Also, since it will be available to the general public as a recreational drug, cannabis will be taxed (and twice taxed if you live in Québec!). Most medication in Canada is tax exempt. Will prices increase for current users? Several people have recommended that medical cannabis be available in local pharmacies. However, before this can happen, cannabis has to undergo approval as an accepted medication by Health Canada (which is currently not the case). As I mentioned previously, more studies will be necessary to understand possible interactions with current medications, to establish possible side-effects, and to set dosage levels, etc. Also, pharmacists feel ill-equipped to help patients with their cannabis prescriptions. Doctors also feel uncomfortable since there is still a lack of information and conclusive data(7),
This working group has recommended maintaining the ACMPR (Access to Cannabis for Medical Purposes Regulations) for at least five years following adoption of the legislation. In this way users can keep their current supply, and scientific studies can continue. At this point, the current rules can be newly revised allowing cannabis, or one of its molecules, to be recognized as a medication under Health Canada guidelines.

And what about self-medicating?
If you purchase a bottle of tylenol at the pharmacy, you can follow the directions and warnings on the label and take it yourself. Any substance that you ingest comes with risks – certain medications carry more risks than others. As you already know, cannabis can be addictive. It also affects brain function. The Canadian Psychological Association has published a document detailing the possible effects of using cannabis. https://www.cpa.ca/docs/File/Position/Position_Paper_Recommendations_for_the_Legalization_of_Cannabis_in_Canada-September_2017.pdf
Attention and memory deficits….and others that can become permanent with prolonged and regular usage. Risk of motor vehicle accidents, psychoses, and minor correlation between consuming cannabis and bi-polar and manic-depressive disorders…(7).
If you wish to use cannabis on a regular basis to manage pain, depression or spasticity, you should seek professional advice.
It appears that the current legislation on cannabis is acceptable to the Canadian Psychological Association: “The legalization of cannabis in Canada has the potential to enhance the safety and quality control of the substance. It could also remove the criminal element from the cannabis market and the negative consequences that illegal or black-markets entail. CPA has long been concerned about the inaccessibility of evidence-based psychological treatments for mental and substance use disorders because these interventions are inadequately resourced through our public and private health insurance plans. The legalization of cannabis will bring about increased tax revenue for governments, revenue which could be allocated to the prevention and treatment of mental health and substance use disorders(7).”

To find out more….

A question and answer page has been made available by the Government of Northwest Territories. A small section at the end of the document is specific to this region, but the rest of the document is very interesting.

https://www.eia.gov.nt.ca/sites/eia/files/cannabis_-_qas_for_public_engagement_final.pdf
You will find answers to questions such as:
Q.: Is the Government of Canada also legalizing edible products that contain cannabis or its derivatives (e.g. THC)?
A.: It is anticipated that the regulation of edible cannabis products will follow approximately six months after the proposed Cannabis Act comes into force.

 

Bibliography
1- https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/understanding-new-access-to-cannabis-for-medical-purposes-regulations.html
2- https://www.inspq.qc.ca/dossiers/cannabis/contexte-legal-du-cannabis-au-canada
3 – Aviram, J., & Samuelly-Leichtag, G. (2017). Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Physician, 20(6), E755-E796.
4 – Goldenberg, M., Reid, M. W., IsHak, W. W., & Danovitch, I. (2017). The impact of cannabis and cannabinoids for medical conditions on health-related quality of life: A systematic review and meta-analysis. Drug & Alcohol Dependence, 17280-90. doi:10.1016/j.drugalcdep.2016.12.030
5 – Syed, Y., McKeage, K., & Scott, L. (2014). Delta-9-Tetrahydrocannabinol/Cannabidiol (Sativex): A Review of Its Use in Patients with Moderate to Severe Spasticity Due to Multiple Sclerosis. Drugs, 74(5), 563-578. doi:10.1007/s40265-014-0197-5
6 (FRENCH VERSION) – https://canadiensensante.gc.ca/task-force-marijuana-groupe-etude/framework-cadre/alt/framework-cadre-fra.pdf
(ENGLISH VERSION) https://healthycanadians.gc.ca/task-force-marijuana-groupe-etude/framework-cadre/alt/framework-cadre-eng.pdf
7-(FRENCH VERSION)
https://www.cpa.ca/docs/File/Position/Position_Paper_Recommendations_for_the_Legalization_of_Cannabis_in_Canada-September_2017-FRENCH.pdf
(ENGLISH VERSION)
https://www.cpa.ca/docs/File/Position/Position_Paper_Recommendations_for_the_Legalization_of_Cannabis_in_Canada-September_2017.pdf[/vc_column_text][/vc_column][/vc_row]