CCSN Submission to the Task Force on Marijuana Legalization and Regulation

On August 29, 2016, the Canadian Cancer Survivor Network made a submission to the Task Force on Marijuana Legalization and Regulation. The text of our submission follows.

The Canadian Cancer Survivor Network (CCSN) is a charitable organization of cancer patients, survivors, caregivers, families, friends, community partners and sponsors who work together to take action to promote the very best standard of care, support follow up and quality of life for patients and survivors.

CCSN works to ensure that patients and survivors can easily access tools to understand decision-making processes for positive change on issues critical to optimal patient care; that they are supported to make a difference through working with others to take action on those issues; that they are able to obtain current knowledge about cancer diagnosis, treatment, options and outcomes and are able to work together to end disparities in patient care and treatment.

CCSN and medical marijuana

When the Mahihuana for Medical Purposes Regulations (MMPR) was introduced, CCSN became concerned about patients’ access to marijuana. From that time, CCSN has created resources to provide patients with up-to-date information and educational tools to enable them to understand the swiftly shifting environment.

Currently, CCSN provides information and educational activities on access to medical marijuana through a Medical Cannabis section on its website (http://survivornet.ca/en/cancer_basics) as well as providing updates on medical marijuana as part of its Promoting Cancer Patient Engagement through Educational Webinars series.

Medical users of marijuana

There are several issues related to the medical use of marijuana that are unique and that are of concern to CCSN.

Stigma as an illegal drug

The illegality and subsequent stigma attached to marijuana has influenced how Canadians think about medical marijuana, including those people who may benefit from medical cannabis products. This poses an access impediment to individuals who may benefit from medical cannabis products but who are reluctant to raise the issue with their health care provider (HCP), ask for a prescription from their family doctor or other HCP, or fear recriminations from family members.

An additional stigma can occur if patients are required to smoke marijuana, given that smoking itself has rightfully acquired strong stigmatization of its own. CCSN believes that medical marijuana should be available in many forms so that patients can choose the format that best fits them and to which their illness responds.

Lack of research and clinical trials

Medical cannabis is unique in Canada in that it has not gone through the rigorous health technology assessment (HTA) that all other drugs do through the pan-Canadian Oncology Review (pCODR) for oncology drugs or the Canadian Agency for Drugs and Technologies in Health (CADTH) followed by provincial/territory consideration and approval. The result is that there is a lack of research not only on the effects of medical marijuana but also on the quite different products, given that marijuana itself contains “…hundreds of chemical substances, among which are over 100 known as ‘cannabinoids’.”[i]

Although research on the safety and efficacy of medical marijuana is being conducted, there are still many unanswered questions which often make it difficult for HCPs to prescribe medical cannabis and for patients to be certain that they are deriving therapeutic benefits from it.

Healthcare professionals lack of knowledge about medical marijuana

As mentioned above, the lack of evidence of therapeutic benefits from medical cannabis and their lack of knowledge about appropriate strains and doses has inhibited many HCPs from prescribing medical cannabis, and patients themselves lack knowledge of the different types of medical cannabis being produced in Canada today. HCPs are neither informed nor educated about medical marijuana strains being developed to treat various medical conditions.

CCSN is concerned that many patients who may benefit from medical marijuana are not able to find doctors or other HCPs willing or able to prescribe it, even those HCPs working in areas where there is strong anecdotal evidence and some clinical evidence that medical cannabis has therapeutic value, like oncologists, rheumatologists, orthopedists and HCPs who treat epilepsy as well as family doctors and general practitioners.

Patients lack of knowledge about medical marijuana and continuing access issues

Since there has been a lot of media attention paid to both medical and recreational marijuana in recent years, CCSN is concerned that many individuals who might benefit from medical marijuana are not able to access it legally, and will therefore attempt to access marijuana illegally and use it for medical purposes. This possibility is enhanced when patients are not able to obtain prescriptions from their HCPs. In this situation, patients are in a hit-and-miss situation, given that they have no knowledge of or control over the THC level in the illegal marijuana they have access and the impurities that it may contain.

In addition, medical marijuana users who were growing their own may still have difficulties with the cost of buying from licenced producers and therefore turn to the illegal market. As mentioned above, this leads to lack of control of the THC level in illegal marijuana and the dangers of impurities it may contain. A medical cannabis production and distribution system must be able to offer not only quality but a pricing system that enables and encourages medical marijuana users to buy the product legally. Canadians who choose to grow their own medical cannabis must have a clear path to inexpensive, regular testing of their product so that they know that it is safe and effective to use. CCSN believes that patients should have access to medical marijuana through a variety of distribution sources.

Medical cannabis in a legalized marijuana landscape

The Canadian Cancer Survivor Network strongly supports a separate regime for users of medical marijuana.

The reasons for this recommendation include:

·         The mandates and uses for recreational cannabis and medical cannabis are quite different. 

o   The legalization of recreational cannabis will provide legal access to cannabis while safeguarding product quality and control over distribution, ensuring the safety of youth by limiting access, and establishing pricing to discourage illegal use.

o   Access to medical cannabis is already a constitutional right. Establishing a separate regime for medical marijuana will recognize and validate that the reasons for medical access are indeed different:

§  Medical marijuana access is dependent on a prescription from a healthcare professional for treatment of a specific illness or symptoms.
§  A separate system would bolster the argument that medical marijuana sales should be zero-rated as are other medical devices and treatments.
§  It would leave the door open for third party coverage of medical marijuana through government formularies and insurance benefits.  
§  It would encourage research on medical uses.
§  It would recognize that in some cases, minors benefit from medical marijuana (e.g., treatment-resistant epilepsy in children).
§  It would encourage pricing that would provide access to all patients without anyone utilizing the illegal market.

For additional information, please contact:

Jackie Manthorne

President & CEO
Canadian Cancer Survivor Network
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2X 2B5
613-898-1871

jmanthorne@survivornet.ca

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[i] Toward the Legalization, Regulation and Restriction of Access to Marijuana Discussion Paper, 2016.

Why medical marijuana should be exempt from sales tax

The authors are members of the Canadian Medical Cannabis Council patient advisory committee: Lynne Belle-Isle (Canadian AIDS Society), Joanne Simons (Arthritis Society), Cody Lindsay (The Wellness Soldier), Jonathan Zaid (Canadians for Fair Access to Medical Marijuana), Sharon Baxter (Canadian Hospice Palliative Care Association), Sandy Smeenk (Improving the Lives of Children) and Jackie Manthorne (Canadian Cancer Survivor Network).

While Canada engages in complex dialogue about how best to regulate the sale of cannabis for adult use, tens of thousands of Canadians are currently authorized to use cannabis to treat a variety of symptoms and medical conditions. They have obtained this authorization from a physician or nurse practitioner, the only way they can use it legally under current regulations.

Research funded by the University of British Columbia’s Institute for Healthy Living and Chronic Disease Prevention has shown that for many Canadians with chronic medical conditions, a lack of affordability can be a barrier to using cannabis for medical purposes. Sales tax on medical cannabis only adds to the financial burden.

Among research participants who reported buying cannabis for medical purposes, the median amount spent was $200 a month. Likewise, more than half of respondents who currently use cannabis for medical purposes report that they can never or only sometimes afford to buy enough cannabis to relieve their symptoms. The proportion was higher – approximately two-thirds – among those who reported fair to poor general health. Perhaps more importantly, a third of respondents stated that they often or always have to choose between medical cannabis and other necessities, such as food, rent and other medicines.

Health Canada has reiterated that cannabis should be treated like other prescription drugs. Canada’s Excise Tax Act specifies that drugs prescribed by a health-care practitioner that are not available over the counter are zero-rated and not subject to federal and provincial tax. Under the Marihuana for Medical Purposes Regulations, medical cannabis can only be purchased with a medical document obtained from a health-care practitioner. This medical document has been acknowledged as being akin to a prescription by the Colleges of Physicians and Surgeons in Ontario, British Columbia, New Brunswick, Nova Scotia, Quebec and Saskatchewan.

While Canada will likely benefit greatly from the sales tax revenue from the legal adult recreational cannabis market, this should not come at the expense of people who need it for medical purposes. With sales tax unfairly applied and few cost-coverage options available, patients who cannot afford their medicine are suffering.

The removal of sales tax from medical cannabis is a simple and effective first step to increase affordability.

The Canadian Medical Cannabis Council has taken an active leadership role in advocating for this straightforward but critical change. Interim executive director Philippe Lucas has already met with the Ministry of Finance, making the case that removing this financial barrier for those who rely on legal medical cannabis is a low cost, non-controversial investment in the well-being of Canadian patients with a high level of public support, as demonstrated by the 8,000-plus signatures gathered so far in a petition to that end.

As members of CMCC’s patient advisory committee, we represent the interests of people who use cannabis for medical purposes. Together, we join the growing number of voices calling for the minister to treat medical cannabis like other medical necessities and exempt it from sales tax.

Medical cannabis is not just another commodity. For many people, it’s a medical necessity. It should receive the same zero-rating as other prescription medications.

A New Patient Assistance Program For Medical Cannabis Use in Canada

One of our partners, CannTrust, a licensed producer and distributor of medical cannabis in Canada, has introduced a comprehensive patient assistance program for medical cannabis compassionate use in Canada.

Known as the CannTrust Access program, it’s available immediately to eligible Canadians whose health plans do not reimburse medical cannabis.

Qualified patients will be eligible for up to 30 grams of medical marijuana per month.  Three levels of financial assistance are available through the program depending on the patient’s income status, which will be reassessed every six months.  CannTrust anticipates that a number of patients’ financial status will qualify them to receive their monthly order at no cost. 

CannTrust Chairman Norman Paul said in a news release: “As a company founded on the principles of patient access, CannTrust took the bold step of creating the innovative CannTrust Access program with a goal of offering broad access to medical cannabis for patients in need.”

As we know patient assistance programs are common among the pharmaceutical industry as a financial support tool for cancer patients in need to treat and manage their disease.  It’s good news to learn that CannTrust believes having a limited income shouldn’t marginalize a person’s access to medicines they need. In fact, CannTrust is committed to helping make its medical cannabis available where and when it is needed most.  

Details to register are available at CannTrust.ca