Medical access to cannabis has been legal in Canada since 2001. However, since its inception, the federal medical cannabis program has gone through several iterations, and the road towards seeing more than 120,000 Health Canada registered medical cannabis patients today has been bumpy, to say the least.
Prior to the summer of 2015, Mandy McKnight broke the law every day when she administered cannabis oil to her son, Liam, in order to manage his treatment-resistant seizures. Like countless other parents of paediatric cannabis patients, McKnight was baffled by the federal regulations at the time, which prohibited the use of cannabis oils and edibles by patients.
“How are you supposed to administer to a child through dried marijuana? They’re not going to smoke pot,” says McKnight when describing her experience with Canada’s early medical cannabis programs.
In 2015, a medical cannabis patient and baker named Owen Smith successfully appealed a possession charge for cannabis-infused edibles, which led to a ruling by the Supreme Court of Canada that said federal restriction of legal access to only dried cannabis flower was violating constitutional rights of medical patients.
As a result, patients were granted legal access to cannabis derivatives, including oils, under the Marihuana for Medical Purposes Regulations (MMPR). McKnight could finally let go of the fear that her and her family had been living with for years.
But, how did a devoted mother like McKnight end up in a position where she risked arrest by taking care of her son, within a world-leading healthcare system where access to cannabis had been legal for over a decade?
McKnight ended up in such a position because cannabis is unlike any other medication that we encounter in our healthcare system. Unlike opioids, side-effect ridden and highly addictive benzodiazepines and anti-depressants, cannabis is not an approved medication in Canada.
Although cannabis is one of the oldest medicines used by humanity, dating as far back as 2737 B.C., its prohibition in Canada came into effect in 1923 with the passing of the Narcotics Drug Act Amendment Bill. Unlike other medications in Canada, legal access to cannabis for medical purposes did not come about as a result of hundreds of double-blind randomized trials, but rather as a result of years of legal and advocacy work.
“In Canada, medical cannabis has been a movement for a lot longer than it’s been an industry” says Hilary Black, founder of the BC Compassion Club Society (BCCS), Canada’s first compassion club which opened its doors in 1997 and continues to service thousands of patients in Vancouver, despite its illegal status under federal law.
Black has long believed in the healing power of cannabis, and it has led her to become the first “out the closet pot dealer” in the country. Due to popular demand, Black, along with a handful of other inspired women, provided cannabis to patients in Vancouver through an act of compassionate civil disobedience.
Hilary’s actions inspired countless others to participate in acts of civil disobedience, acts which, alongside multiple legal triumphs, paved the way for both medical and recreational legalization of cannabis in Canada today.
According to Dana Larsen, one of Canada’s most prominent advocates for cannabis reform and the end of the war on drugs, today’s medical cannabis program owes much of its success to the Charter of Rights and Freedoms, the legal foundation which has “protected activists and forced the government to regulate cannabis”.
Complete prohibition of the cannabis plant persisted until 2000, when Terrance Parker became the first person in Canada to legally use medical cannabis to treat his epileptic seizures. Parker was granted this right as a result of a ruling by the Ontario Court of Appeal which deemed cannabis prohibition unconstitutional.
This ruling was instrumental in nudging authorities towards creating the first legal program for access to medical cannabis in 2001, known as the Medical Marijuana Access Regulations (MMAR). Under this regime, patients were given the right to apply to Health Canada to cultivate cannabis for personal medical use, or designate a grower to do so on their behalf.
Although a step in the right direction, the MMAR was “doomed to failure”, according to Alan Young, associate professor at Osgoode Hall Law School at York University and a respected lawyer who has spent much of his career working with the federal government to recognize cannabis in the medical drug schedule and has led constitutional challenges on drug and morality laws. The MMAR’s highly restrictive nature required a patient’s application to be signed off on by two specialists, which seriously limited access to the plant.
“When we were MMAR, it was really hard to find a doctor for Liam [McKnight]. We ended up having to fly out west to find a doctor there, because we couldn’t find a doctor in Ontario, or anywhere,” says McKnight.
Additionally, lack of oversight and regulation saw an abuse of the legal regime, with patients requesting upwards of 50-150g/day prescriptions, according to Young.
As a response to the inadequate regulation of the MMAR, the federal government introduced the MMPR system in 2013 which allowed patients to purchase dried cannabis product from a Health Canada regulated licensed producer wherein all medical cannabis product was required to be grown in high security facilities and undergo extensive laboratory testing prior to sale.
The current Access to Cannabis for Medical Purposes Regulations (ACMPR) came into effect in 2016 as a result of a four-plaintiff challenge of the MMPR regime, which had suspended personal production and forced patients to purchase their medicine from only a few federally regulated licensed producers.
The Federal Court of Canada ruled in the plaintiffs’ favour, which required yet another revision of the law, and gave birth to the ACMPR, which allows for both personal production, as seen in the original MMAR regime, as well as regulated production and sale through Health Canada-approved growers.
Today, the future of Canada’s medical system is uncertain. As Canada prepares to legalize cannabis for recreational, adult-use this summer, patients, advocates and industry leaders fear that not enough attention is being paid to the medical cannabis community.
“I am worried about patients just accessing cannabis in the recreational market and not getting adequate access to education,” says Black, who now works as the Director of Patient Education and Advocacy at Canopy Growth, Canada’s largest licensed producer of medical cannabis.
Black and others are concerned with the lack of funding being dedicated to research and education around medical cannabis across the board.
“As the recently proposed Cannabis Act recommends keeping the ACMPR as a distinct medical cannabis system, it is important the federal government also explores medical cannabis specific measures including zero-rated taxation and increased research funding,” says Jonathan Zaid, founder and Executive Director of Canadians for Fair Access to Medical Marijuana, a patient advocacy group.
The concern also lies in the current cost of this medicine to patients, which has been and continues to be a significant barrier to access. Despite numerous legal advancements, medical cannabis remains an unapproved medicine, still not covered by most drug plans. According to Young “unless you subsidize medical use, you don’t have a medical program”. Additionally, the federal government has proposed an excise tax on cannabis sales, a decision that is being protested by certain political parties, cannabis advocates and patients.
As we move towards recreational legalization, it’s important to remember that “patients who use cannabis medically are not doing so out of choice, but out of a medical need and require constant access to affordable medicine” according to Zaid.
Only through insurance coverage, access to education, and significant efforts to focus in on the potential of this plant through research, can we begin to move cannabis to be treated as a true medicine in the 21st century. The hope of many is that with recreational legalization, the stigma around consumption will fall away and Canada will lead the world by developing a world class medical cannabis system.
Story by Ljubica Kostovic
The preceding is for informational purposes only. It is not meant to condone the use or consumption of cannabis. For more information, please refer to our disclaimer.