Medical Marijuana in an age of Legal Recreational Use

It has been a long time since my last post here, and it isn’t for lack of material – to the contrary, there has been so much lately that is worthy of documenting, I wanted to make sure I was giving each topic its due.

One of the questions I hear the most is: “Why does a medical [prescription] matter if it is legal for everyone to grow at home?” This question actually represents one of my greatest fears about legal recreational use: someday, someone is going to decide we don’t need both programs. However, there are some significant differences between the new recreational allowances and a medical license.

Firstly, let me point out that we currently have two medical programs in effect. The Marihuana for Medical Purposes Regulations (MMPR) that the Conservative government introduced are still in effect, except where contradicted by the new Access to Cannabis for Medical Purposes Regulations (ACMPR). And of course, the new ACMPR are also in effect.

Under MMPR, Canadians could obtain what was essentially a prescrition from their doctor for marijuana. However, unlike a normal prescription, we could only obtain our medicine via mail, from Licensed Producers, whom Health Canada had authorized. The regulations explicitly prohibited storefronts, requiring patients to receive every gram by mail. (Of course, this was met with mirth from a community that had previously used the mail system to mask deliveries.)

MMPR greatly eased access for most patients compared to the previous regulations (Medical Marihuana Access Regulations, MMAR), however, in Allard v Crown, in February 2016, the Supreme Court of Canada deemed even MMPR unconstitutional. The Licensed Producer program was wrought with problems, not least of which were that it created undue financial barriers to health care.

Under MMAR, patients who grew their own marijuana were spending about $3-4/g, whereas under MMPR, the costs were double or more. Even with compassionate pricing, most paid over $7/g from licensed producers. With the average prescription at 3g per day, the average patient’s monthly cost increased from $270 per month to upwards of $630/month. I don’t know about you, but most people on disability cannot afford an extra $360+ each month for health care. (Oh, and by the way, Canadian taxpayers fund this for military veterans suffering from PTSD or service-related injuries – and rightly so.)

Taking effect in August 2016, ACMPR sought to address this constitutional challenge by reinstating patients’ rights to grow their own medicine. They also simplified a number of lesser, artificial constraints that had further increased costs and unnecessary complications, such as allowing edibles and extracts. This was a panacea for patients who were suffering; suffering from pain, from financial hardship, and from the effects of their illnesses on their families. Suddenly, patients could obtain their medicine from a variety of sources, including Licensed Producers, home-grown, or designated growers who supplied no more than two patients each. Or so we were told….

The reality is that the government was not prepared for the administrative load of ACMPR. At last check, the processing time for ACMPR applications was in excess of four months. Adding in time to actually access a health care practitioner for the prescription, and for the mail system to move around the paper as was its job, it was a year or more for patients (from the date the Court rendered its decision) to “legally” exercise their constitutional right to health care. In the cases of cancer patients, a year can make the difference between life and death. The rest of us just continue to suffer, along with our families. Meanwhile, the government claims its kudos in the media for making health care so much more accessible for us.

Now, back to recreational use…
Under the recreational use legislation that the government introduced in April 2017, they included provisions for home-growing (similar to homemade wine or beer). Each household will be able to grow 4 plants of limited height for personal use. In contrast, the allowance for someone with a prescription, is approximately 5 indoor plants for every gram per day that we are permitted to use. A grower who supplies two average patients can have about 30 plants – 7.5 times the recreational amount.

Next there are the rules about possession. Recreational users may carry up to 30g of dried bud. Medical users may carry 30 day’s supply, typically 3 times more and up to 5 times more (otherwise we would need multiple trips to bring our medicine home from the post office). Without the medical system in parallel with the recreational legislation, some patients would need to receive a new shipment through Canada Post at least once every week. Given CP’s charge of $13.50 per shipment from accredited, certified sources, our average patient with 3 g/day would spend another $40+ each month for legal medicine.

Beyond the direct costs and carrying limits, there are also tax implications. Medical users do not pay taxes on our medication, neither sales tax nor income tax, a savings of almost 40% without considering provincial taxes. The government is free to tax recreational users as much as they choose (as with our current liquor and/or smoking laws) and will likely do so: initially as a deterrent and ultimately as a revenue stream.

As a Chemical Engineering student, I performed research at the University of Saskatchewan that required laboratory-grade alcohol. The only difference between the alcohol at the liquor store and what I used for research was purity. Our team paid for the alcohol under a very different pricing structure than the LBS could afford. We need a similar model for recreational vs medicinal marijuana. While the recreational system is a major step forward for Canada in terms of revenue, tourism, and voter preferences, it is not (and can never be) a replacement for the medical programs. The challenge before us today is to respect the needs of medicinal users, while continuing to manage the access that the public has to this incredibly important plant.