Medical marijuana in Canada has triggered a classic debate between those favouring its more liberal use to address medical problems, opposite those who believe greater legal access will accelerate the illegal, recreational use of cannabis. That debate appears to have been settled, at least in the courts, with the June 11, 2015 decision of the Supreme Court of Canada in the case of R. v. Smith.
It has been almost 5,000 years since the medical benefits of cannabis were first recorded in a Chinese pharmacology text. In the early 20th century, the drug became illegal in Canada; in the early 21st century, Parliament amended the Criminal Code and other legislation to permit highly-regulated uses of the drug for medical and therapeutic purposes.
Following the passage of the new Medical Marijuana Purposes Regulations (MMPRs) in April 2013, Canadians found themselves under a new regulatory regime for medical cannabis. The new model put a heavy emphasis on controlling distribution of medical cannabis by using approved producers as the de facto regulator of how the drug reaches individual users. Although not strictly a "medication", cannabis is now being prescribed to deal with a number of conditions such as arthritis, cancer treatment symptoms, chronic pain and sleeping disorders.
However, until last week the only legal method of consuming it in Canada for such purposes, was to smoke it. Smoking the drug, however, posed many barriers to effective use: many people don't like to smoke; most other people don't like it when others' smoke; the drug has a well-recognized aroma that is hard to ignore and, most seriously, smoking it is not always the best way to get the medicinal benefits. Indeed, ingested and applied forms of the drug may have better long term therapeutic effects.
Inevitably the law was challenged as a violation of personal security under the Charter of Rights and Freedoms. Freedoms can only be infringed if necessary, and only to the minimum degree possible. Listening to the Government's argument for limiting non-smoking uses versus the demand for freer use of alternative modes of ingesting the drug, the Court was plain:
... the evidence established no connection between the impugned restriction and attempts to curb the diversion of marihuana into the illegal market. We are left with a total disconnect between the limit on liberty and security of the person imposed by the prohibition and its object.
In the absence of any rational reason to prohibit non-smoking uses, the Supreme Court struck down the Criminal Code provisions in question. Thus, as of June 11, 2015, any medically effective form of ingestion is now legal. For employers, the task now is to understand who can use the drug and how workplaces may have to adjust to that reality.
How the System Works: Interview with Chris Murray, of Tweed Inc.
It has been difficult, in the din of competing arguments about medical marijuana, to get simple, straightforward information about the drug and how it is regulated. To cut through the noise, Gowlings went to a source – literally a source: one of the companies which is licensed in Canada to grow and distribute medical marijuana.
Chris Murray is the Director of Business & Medical Development for Tweed,1 a company licensed to grow and distibute medical marijuana. Murray's job is to provide information to the public, patients and medical practitioners about clinical uses of cannabis, approaches to treatment, and guidance on when cannabis is and isn't indicated. Murray is also tasked with providing guidance on how the marijuana regulatory system works. He agreed to answer a barrage of questions on the topic for this article.
Gowlings ("G"): Who can legally grow and sell medical marijuana in Canada today?
Murray ("M"): There are 18 companies licensed to grow and sell the drug. In addition, 7 more are licensed to grow it not to sell it to patients.
G: Where is it grown? Where is it processed into medical use forms?
M: Regulations (section 14 of the MMPR) require it to be grown indoors. Greenhouse or hydroponic. Our company, Tweed, has both.
Nobody can grow it outdoors – that prevents access to the plant and also limits seed migration.
G: How many forms of the drug are there, that can be prescribed?
M: We have over 30 strains to offer in the market. Distinctions: potency.
G: Can any physican prescribe the drug? What qualifies or disqualifies a physician from doing so?
M: In Canada, any doctor with an MD registered with a college can prescribe the drug, except those whose practice is restricted from dispensing narcotics.
G: If prescribed the drug, what legal permission does an individual require to obtain and possess it?
M: The patient gets a document from a doctor; this is akin to a prescription, but cannabis is not recognized as a medication, technically. The patient chooses a licensed producer, sends the prescription to the producer, fills in the paperwork and waits for it to be dispensed.
G: So the producer, the company selected by the patient, gets the prescription and then ships the product to the patient?
M: Yes. The producer acts as both the pharmacy and pharmaceutical company.
G: So what does the patient get?
M: She gets the product, of course. All the pertinent details are on the packaging. And the patient also gets a card with the information necessary to justify posession of the drug. She can provide that card to law enforcement if questioned.
G: Are individuals reporting problems with the police, in terms of possessing it?
M: No, the patients aren't reporting this as an issue.
G: What kind of limits, in terms of volume of the drug dispensed or the time a prescription applies, is common?
M: The prescription determines the number of grams the patient is allowed to get access to, per day. The average is 1 gram a day for a period of 6 months. However, there is a maximum amount we can ship.
G: Which is what?
M: A producer is allowed to ship at one time to one person, the lesser of 30 days' dosage or 150 grams. No shipment can ever exceed 150 grams, regardless of the prescribed dosage.
G: Let's talk about why marijuana is being prescribed.
M: First of all, what most people don't realize is cannabis isn't treatment, in the sense of addressing the cause a person's condition. It's like an Advil – it's a therapy, so it's used to manage the symptoms of conditions.
G: What's in cannabis that gives it any effect?
M: There are two active ingredients in the marijuana grown and distributed by approved companies: cannabinoids (CBD) and tetrahydrocannabinol (THC). The effects of CBD are medically hypothesized; the effects of THC are firmly established. Cannabis has these established effects:
- It's an anti emetic (nausea supression),
- It may suppress nerve inflammation
- It reduces the symptoms of neuropathic pain
- It causes a "euphoric" effect, which can relieve anxiety
- For patients whose illnesses affect appetite, it stimulates appetite
- The sedative effects are key for people with sleep disruption or disorders
- It has also been shown to reduce seizure occurrence in some epileptic patients
G: To whom is it being most typically prescribed?
M: Patients with chronic neuropathic pain, or those whose cancer treatments produce terrible side effects, are among the people most often being directed to use medical marijuana.
G: How does medical marijuana compare to what people buy "on the street" for recreational use?
M: Street product usually contains other compounds. Medical marijuana that is properly grown, also provides patients of with laboratory tested levels of CBD and THC. For the most part illegal product is on the higher end of the THC potency spectrum 25% or more.
There are over 30 different strains of medical marijuana being produced by our company, Tweed. The key difference among the strains is the labeled potency of each active ingredient. Different strains are prescribed for different purposes.
G: A major concern about the drug is what you call its "euphoric" effect. What most people think of as "the high" from marijuana. Does the drug in its medical form, have similar or different effects than when used recreationally?
M: Yes, it has that effect, but it varies depending on the strain, the dosage and the user him or herself. The euphoric effect can be profoundly positive for a patient who has been suffering terrible symptoms due to chemotherapy, for example. There is also a euphoric effect with most products that effect neurotransmitters. It's important to remember the part of a sleeping pill that makes you sleep is considered "psychoactive".
G: But the user of medical marijuana may be impaired – their judgment, senses, etc may be altered by the drug while it is active in them?
M: Yes. But impairment is a subjective thing – people are affected differently by doses of any drug. And like any other drug, the initial impairment or sedative effect of marijuana is typically stronger, but is reduced as the person becomes accustomed to use.
G: What about the workplace implications of this? Does this come up among the patients who order their medical marijuana from your company?
M: Yes. A person comes in asking us to make a case for them to consume cannabis in the workplace. But where there is a requirement to have a sound mind and judgment, where an impairment would pose a risk to the person or others – like in heavy industry - and if a person is demonstrably impaired I would assume continuing to work may pose a risk and it's difficult to support the use of cannabis under normal cirmcumstances.
G: Many employers have policies that say that if someone is using an impairing substance, the person can't be working. What is your advice to employees who have been prescribed the drug, where there is some potential risk?
M: The drug may potentially affect performance. If there's a safety risk, they absolutely should not be at work.
But, we should remember that if someone has a blinding migraine or chronic neuropathic pain, that could be much more impairing than a low dose of any drug. We can't presume that a drug necessarily affects a person more than the medical problem they're suffering from.
G: But clearly we don't want people at work – or even travelling to work – if they're impaired by a drug.
M: That is absolutely right. As with any drug a person uses for medical purposes, that is absolutely true. As with any drug, we shouldn't let people work where the effect could endanger them or anyone else.
Murray recommends that those interested in the topic, visit the Health Canada website.
1. Disclosure: Tweed Inc. has in the past been a client of Gowlings
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