Friday, April 19, 2024

The Future of Medical Cannabis in Canada Feels Good

Public attitudes toward cannabis have been shaped by any number of influences, from propaganda films such as 1936’s Reefer Madness (in which it is histrionically labelled a “violent narcotic” capable of driving its users to “incurable insanity”) to the Beatles getting high with a little help from their friends, the stoned hijinks of ’70s potheads Cheech and Chong and the “This is your brain on drugs” ads of the 1980s.

But when Martha Stewart, the 76-year-old grande dame of propriety and sophistication, teams up with noted cannabis proponent Snoop Dogg on a TV show (2016’s winkingly named Martha & Snoop’s Potluck Dinner Party), you get the feeling that recreational cannabis use has “fo shizzle” (that’s Snoop talk for “for sure”) turned a corner toward mainstream acceptance.

Older Canadians who grew up using cannabis in the 1960s and ’70s continue to be a driving force of Canadian cannabis consumption. According to a recent Statistics Canada study, people aged 45 to 64 represent nearly one-quarter (23.15 percent) of Canada’s nearly five million cannabis users, second only to people 25 to 44 (44.64 percent).

According to StatsCan’s Cannabis Stats Hub, 45.7 percent of people 45 to 64, and 13.1 percent of people 65 and older, have used cannabis at some point in their lives. The number of people in the 45 to 64 age group who use cannabis has grown steadily over the past 40 years, from 4.24 percent of cannabis users in 1977 to 4.92 percent in 1987 and 6.72 percent in 1997. Many were among the post-war teens and young adults (aged 18 to 24) who represented an astonishing 90.4 percent of Canada’s cannabis users in 1968.

According to StatsCan, the data is consistent: Boomers who were first exposed to cannabis in high school and university have carried a preference for consumption with them as they’ve aged.

StatsCan has also pegged the value of Canada’s cannabis market at between $5 billion and $6.2 billion, making it between half and two-thirds the size of the beer industry and 70 to 90 percent the size of the wine industry. That’s a lot of green.

But while recreational use of cannabis has steadily gained acceptance – it will be legal in Canada on October 17 – its medical use has been more contentious. Medical cannabis has been legal in Canada since 2001, but the past 17 years have seen contrasting viewpoints and sometimes public spats, all while failing to produce a consensus among medical stakeholders as to its efficacy and, more importantly, its suitability.

As with any debate around healthcare, there are myriad viewpoints among medical professionals about medical cannabis. These views are accompanied by discussions about whether users should be required to pay an excise, or “sin tax,” of 10 percent; whether the expense should be covered by health insurance (some major insurance companies are now offering optional coverage to people with group benefits plans); and which ailments it should be used to treat.

Proponents say that cannabis’s medical applications are broad-based, ranging from pain relief to reducing nausea and loss of appetite stemming from chemotherapy. They say that unlike powerful opioids such as fentanyl, it also carries zero risk for overdose.

Its detractors, meanwhile, argue that today’s cannabis is up to 20 times more potent than it was in the 1960s and can lead to addiction, apathy and a deterioration in intellectual capacity. They say there isn’t enough data to determine its long-term effects on patients.

“I’ve never seen a topic this polarizing in medicine,” says Michael Boivin, a clinical pharmacist and president of healthcare education specialist CommPharm Consulting, who describes himself as “somewhat pro-cannabis.”

While Boivin says there is evidence supporting the use of medical cannabis in treating symptoms such as chronic pain and chemo-induced nausea, he cautions that data supporting more widespread use is incomplete. “For some people some of the time, this is a great option,” he explains. “But it’s not for everybody.”

According to Health Canada statistics, about 270,000 Canadians are registered for a medical cannabis prescription under the country’s Access to Cannabis for Medical Purposes Regulations (ACMPR), although just 11,058 of Canada’s 84,260 doctors and physicians have ever written a prescription. 

Earlier this year, the CBC quoted Dr. Jeff Blackmer, vice president of medical professionalism with the Canadian Medical Association (CMA), as saying that eight out of every nine Canadian physicians are uncomfortable discussing or providing access to medical cannabis. 

“Here to stay” 

But while doctors might still be on the fence, producers seem confident that medical cannabis will continue to emerge as a viable health treatment.

“Unless I’ve misinterpreted thousands of pieces of feedback from our patients on its benefits, medical cannabis is here to stay,” says Vic Neufeld, CEO of Leamington, ON-based Aphria, which has supplied medical cannabis to approximately 50,000 registered patients – including about 30,000 active users. It is currently adding between 600 and 700 new patients each week.

“The Aphria story is resonating with more doctors who a year ago might have been sitting on the fence, but because of a little more comfort, more positive media [coverage] and more patient study evidence, they’re coming on board,” says Neufeld, who joined Aphria from Jamieson Laboratories, where he served as president and CEO in 2014.

In late 2017, Aphria signed what has been reported as a five-year deal to become one of the suppliers of medical cannabis to Shoppers Drug Mart. The deal is contingent on Health Canada’s approving Shoppers’ application to dispense medical cannabis, although the company is publicly confident. 

Neufeld says that Aphria and Shoppers parent Loblaw Corp. signed a deal that will see Aphria provide 12 branded products, including four strains of dried buds in two different sizes and four cannabis oils.

Neufeld says the involvement of the approximately 12,000 to 13,000 pharmacies across the country is key to medical cannabis’s becoming a more widespread form of treatment. “Together with doctors, [the pharmacies] will provide the comfort and confidence that medical cannabis for ailment A, B or C is the right path to consider.” 

Could Boomers lead the medical cannabis charge?

James O’Hara, president and CEO of the patient advocacy group Canadians for Fair Access to Medical Marijuana (CFAMM), believes that Canada’s approximately 9.6 million Boomers – a group that is increasingly driving the healthcare debate – could ultimately become a driving force for the use of medical cannabis.

“They’re beginning to realize there are potential alternatives to some of the medications that have been prescribed over the years,” says O’Hara, adding that the ongoing opioid crisis is contributing to changing attitudes. “They’re living with pain and would like an alternative, and medical cannabis brings that to them today.” 

O’Hara speaks from experience. He has been using medical cannabis for a variety of ailments since his 50s, claiming it has markedly improved his quality of life. “I’d gone through a number of different pharmaceuticals with limited success, and was looking for more relief,” he says. “When I went down the medical cannabis path, I experienced significant benefits, and thought, ‘If I’ve experienced such marked benefits, how come more people don’t know about this, especially folks my age?’”

O’Hara, who took over as CFAMM president and CEO in March, acknowledges that Boomers might have conflicting attitudes toward medical cannabis: Even though they were the first generation to embrace its recreational use en masse, much of that use occurred under a cloud of disapproval from society, the government and lawmakers.

“The Boomers have really gone through the most stigmatized period,” says O’Hara. “While there was widespread use in the 1960s, [in the] post-Nixon period there was the war on drugs and other things that really clamped down.”

Dr. Michael Verbora, chief medical officer with Aleafia Health, which operates medical cannabis clinics across the country, contends that if the two leading medical benefits of cannabis were taken into consideration, between 7 and 10 million Canadians – “at a minimum” – could potentially benefit from a prescription.

And while cautioning that it’s simply an “educated guess,” Dr. Verbora says Boomers could account for anywhere from 60 to 70 percent of that group, since they are increasingly dealing with the types of medical complaints for which medical cannabis is being prescribed.

Boomers could “absolutely” be a driving force for medical cannabis, adds Neufeld. “When you look at inflammation and related pain, Boomers have tried every [prescription] drug possible. But they’re very expensive; you [develop tolerance] after awhile and have to take more to get the same relief, and they come with a whole host of unwanted side effects.”

Timing is everything

The debate around the merits of medical cannabis arrives against a backdrop of rising prescriptions for opioids such as fentanyl and oxycodone. They are generally prescribed for the treatment of moderate to severe acute pain such as that experienced in post-surgery and in the treatment of cancer pain.

A study by the Canadian Institute for Health Information found that 21.5 million prescriptions for opioids were dispensed in 2016, up from 20.2 million in 2012. According to the study, there were 595 opioid prescriptions per 1,000 population as of 2016, making Canada the world’s second largest per-capita consumer of opioids, behind only the United States.

There has also been an attendant rise in opioid-related deaths, which totalled 2,923 in Canada between January and September 2017, 92 percent of which were unintentional.

“There’s a lot of political pressure to reduce opiates, but we need an alternative, because people have genuine pain,” says Dr. Verbora. 

The cannabis conundrum

But medical cannabis doesn’t have unanimous support. The CMA, for instance, is pushing for the government to eliminate the regulatory framework for medical cannabis once its recreational use becomes legal sometime this year.

“With the legalization of cannabis now underway, we believe that a separate regulatory framework for medical use is no longer necessary, and look forward to working with the federal government to eliminate this framework as soon as possible,” said the CMA in a recent statement. 

But experts, including Boivin, worry that taking physicians out of the equation would eliminate a valuable resource for patients, some of whom may be uncertain about how much cannabis to use and how often, as well as other issues.

“If someone is looking at [cannabis] for a legitimate medical use, we need a medical system where providers have to give some guidance about how to use this product,” says Boivin. “If it’s just a recreational system, the patient could walk into the [Ontario Cannabis Store] and say ‘Which one of these should I take?’ and they’ll say, ‘I don’t know.’ It’s a cop-out, to some extent.”

The Canadian Pharmacists Association has publicly stated that there needs to be a “clear differentiation” between the medical and recreational cannabis streams, with incentives for patients to remain in the medical stream. 

The CMA contends that there isn’t enough scientific evidence to advocate for medical cannabis, but proponents continue to amass “thousands and thousands” of stories and case histories and advocate for its efficacy.

Aleafia’s clinics currently treat between 30,000 and 50,000 patients, who range in age from six months (pediatrics is a growing component of the business) to 102 years old, says Dr. Verbora.

No matter where you stand on the issue, there’s no arguing attitudes are shifting and pushing medical cannabis front and centre. 

Cannabis: A Medical History

The first recorded use of medical marijuana dates back to 2700 BC, when Chinese Emperor Shen Nung is said to have discovered its healing properties. The earliest written reference dates back to 1500 BC, when it was referenced in the Chinese pharmacopeia, the Rh-Ya.

Cannabis pops up frequently throughout medical history, with a Roman medical text dating from 70 AD recommending its use for treating everything from earaches to sexual longing. English clergyman Robert Burton’s 1621 textbook, The Anatomy of Melancholy, suggested it as a treatment for depression.

19th Century: Marijuana emerges as a mainstream medicine in the Western world. It is added to the US pharmacopeia, regarded as treatment for a wide range of ailments, from rabies and leprosy to incontinence, gout and insanity. It remains there until 1942.

1938: Canada prohibits cannabis cultivation in an effort to curb its recreational use. Doctors are permitted to prescribe tincture of cannabis (made by dissolving the drug in alcohol), but excessive regulation around its use dissuades many from offering it.

1964: THC (tetrahydrocannabinol), cannabis’s main psychoactive component, is identified by Dr. Raphael Mechoulam, professor of medicinal chemistry at the Hebrew University of Jerusalem. He is also the first to synthesize THC.

1968: The UK Wootton Report determines that long-term consumption of cannabis in “moderate doses” has no adverse effects. The report deems it less dangerous than opiates, amphetamines, barbiturates and alcohol.

1970: The US Controlled Substances Act classifies marijuana as a Schedule 1 drug, meaning it possesses “a high potential for abuse” and “no accepted medical use.”

1976: In a landmark US court case, federal judge James Washington rules that Washington, DC man Robert Randall’s use of cannabis for his glaucoma constitutes a “medical necessity.”

1978: New Mexico becomes the first state to recognize the medical value of cannabis.

1996: California becomes the first US state to legalize medical marijuana.

1999: Federal health minister Allan Rock grants permission to Toronto’s Jim Wakeford and Vanier, ON’s Charles Pariseau, both of whom have AIDS, to cultivate and use cannabis for medical purposes. “This is about showing compassion to people, often dying, suffering from grave debilitating illness,” said Rock.

2000: Ontario Court of Appeal rules that Canadians have a constitutional right to use cannabis for medical purposes.

2001: The Canadian Medical Marijuana Access Regulations grant people with HIV/AIDS and other illnesses access to cannabis for medical purposes.

2013: New regulations shift medical marijuana access away from homegrown to licensed growers. The program gives more than 37,000 people permission to possess marijuana, compared with fewer than 100 in 2001.

Originally published in Issue 02 of YouAreUNLTD Magazine.

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Chris Powell
Chris Powell
Chris Powell is a Toronto-based writer whose career pre-dates the dot-com era. He has interviewed everyone from Mike Babcock to Mike Myers, as well as hundreds of other people not named Mike. His work has appeared in consumer magazines including Reader's Digest, Today's Parent, Maclean's and Canadian Business, as well as Leafs and Raptors magazines.