Medical Cannabis will be lost amid the gummies and suds

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The next phase of legal cannabis – the arrival of edibles – is unlikely to do any good for one area of the legal market: medical cannabis. Once they arrive in 2020 edibles will largely be a distraction for medical cannabis. This is one likely outcome we see as we reflect on the completion of the first year of cannabis legalization for recreational use and look ahead.

Edibles, extracts and topicals offer a brand new market for cannabis suppliers, and beer companies, tobacco companies, beverage makers, skincare developers and pet care companies have all shown interest in moving into this market. Estimates suggest the broader edible and topical market could be worth an additional 30 percent. But these companies are typically connected to the recreational side of the market, and the advance of more whimsical products such as gummies and brownies is likely to temper at least some of the clinical respect that cannabis as a medicine receives. 

Originally, the main reason for introducing recreational cannabis was to remove as much of the black market as possible, with a focus on keeping prices low enough to do so. The black market has rarely provided edibles, so the motivation for their legalization is surely different. Edibles are aimed at the adult entertainment market, and there are limitations on the amount of the psychotropic chemical tetrahydrocannabinol (THC) present. (The amount of cannabidiol [CBD] is not legislated.) According to the regulations, the maximum allowed dose of THC is 10 mg per package item, which might be too low for some medical patients and is not at all relevant for patients taking only CBD. The medical benefit from legalizing the sale of edibles might be the convenience for patients seeking THC, since liquid extracts (oil) are already available. Medical patients are likely going to choose an amount and a response time that is tailored to their health care needs. Allowing for a low dose of THC is understandable, given concern over the unintended consequences of the more potent and lasting effects of edibles (the duration of the effect can be 4 to 10 hours).

Medical cannabis must find a home in the Canadian medical environment, and edible products have the potential to devalue its opportunity to do this. We think there must be ways for cannabis to enter into the conventional health care stream, where Canadians obtain their health advice and products.

A potential medical entrant for the dispensing of medical cannabis is pharmacists. At present, they can offer advice and counselling for patients taking cannabis but cannot dispense it. The Canadian Pharmacists Association is asking that pharmacist be permitted to dispense medical cannabis. There is a strong case to be made for medical cannabis prescribed by physicians to be dispensed from a medical facility by a person the patient already trusts, a pharmacist. As well, allowing pharmacists to prescribe could also improve access and coordinate the exchange of information with the family physician. This separate and monitored medical cannabis outlet might also be the mechanism through which to remove GST.

There has been no fundamental change in the health care profession on the merits of the wide-spread use of medical cannabis. The Government of Canada has a frighteningly long list of potential problems arising from the medical use of cannabis. The Canadian Medical Association has warned of the risk associated with it, but it does also recognize that some patients with “terminal illness or chronic disease may obtain relief with cannabis.” Many in the health care community have called for clinical studies of this drug, but conducting such worthwhile work is hampered because private laboratories are not able to get compensated for their findings (via patent protection) on a so readily available product. It is likely that only governments are capable of financing such research.

To obtain a prescription for medical cannabis a patient simply has to find a physician with a valid licence in Canada. The form asks for information about grams per day, but apparently Health Canada is not required to check that the dose is respected. There are no stipulations about the relative THC/CBD content. Physicians may give their own advice and follow up with their patients, but apart from signing-off, this is not required.

Around the country, some licensed producers have physicians connected to them or on staff who offer clinical advice on treatment paths and dosage. Some charge for this service.

No best practices are in place, because medical testing of cannabis is largely absent. From a patient’s perspective, it might be intimidating to venture into this kind of care, which seems so unfamiliar.

To appreciate how far Canada has moved on cannabis production and consumption, there is now a separate entry for cannabis in Statistics Canada’s National Income Accounts (figure 1). As expected, the cannabis industry began to boom when its recreational use was legalized. Cannabis production is worth around $7.7 billion in chained 2012 dollars, representing less than 0.4 percent of the economy, but production grew dramatically in 2019. Of course, the black market is still important, as Statistics Canada has pointed out. In comparison, alcohol sales are around $21 billion in 2012 dollars.

We are astounded that there has been no comprehensive study on the implementation effects of legalizing cannabis. Such a study would include everything from health and safety to employment and wages. Statistics Canada is the only agency with all the information to conduct such a review, and we would encourage it to do so and release as much of its data as possible. A question that should be asked is, have there been any cost savings from reduced policing or court cases? There is also likely value in having provincial entities conduct their own reviews, but we doubt there is much energy or the funds to do so.

Given that two staples in policy debates are reflection and prediction, moving on with the legal market for edibles without this review is problematic.

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