Study exposes barriers, safety concerns for medical cannabis use in Canada

A majority of Canadians who require medical cannabis are obtaining their products through the recreational market rather than the medical system, raising health and safety concerns, according to a massive new study led by a UM researcher.

The 5,744-participant study, titled Medical Cannabis Access Survey (MCAS), is one of the largest ever done from the perspective of Canadians accessing cannabis for medical purpose and was completed in collaboration with patient groups Medical Cannabis Canada and SheCann Cannabis, Santé Cannabis and McGill University.

In Canada, cannabis can be legally accessed recreationally or through a medical cannabis licensed seller with a medical authorization, similar to a prescription. But in this study, over half of those surveyed obtained their cannabis without medical authorization, according to principal investigator Dr. Lynda Balneaves, associate professor at the College of Nursing, Rady Faculty of Health Sciences.

"According to our study findings, those who take cannabis without a medical authorization were less likely to seek information from health-care professionals, less aware of the amount of cannabis they were consuming, and more likely to use the unregulated market than those with one," Balneaves said. Specifically, those without a medical authorization were:

• 20% less likely to speak to or seek information from a health-care professional;
• 16% more likely to rely on non-evidence-based and unqualified sources of information (i.e., Google, recreational cannabis store, social media);
• 14% more likely to report not knowing about how much medical cannabis they were actually taking;
• 7% more likely to experience side effects; and,
• 27% more likely to obtain cannabis from unregulated sources.

"People who don't have medical authorization have limited access to medical advice on things like dosage, potency and type of product. It raises concerns about whether people are using medical cannabis safely and effectively, and if there could be potential harms to their health," Balneaves says, adding they also face financial barriers.

Those with a medical authorization reported spending 25% more on medical cannabis, but less than 6% of individuals with a medical authorization received any insurance coverage for costs. The study found nearly half of those who stopped taking medical cannabis did so because it was too expensive.

"The Cannabis Act discourages and penalizes safe and accessible use for patients with a medical authorization," says Max Monahan-Ellison, board chair of Medical Cannabis Canada, a patient research and advocacy group. "The MCAS data clearly highlights that Canadians accessing cannabis for medical purposes deserve more support and that starts with informed, patient-centered changes to the cannabis regulations."

Based on the study's findings, six key recommendations are proposed in the report for consideration as part of the federal review of the Cannabis Act and Regulations and to inform future medical cannabis policy in Canada:

1. Design, implement, and maintain a formalized evaluation of the medical cannabis framework in consultation with patients and key experts;
2. Maintain reasonable access to cannabis through a dedicated medical framework embedded within the cannabis regulations;
3. Implement changes to cannabis regulations, tax policy, and insurance formularies to reduce out-of-pocket costs associated with medical cannabis and re-direct use away from the unregulated market;
4. Develop, implement, and evaluate health-care professional education training focused on medical cannabis across the multidisciplinary health-care team;
5. Expand reasonable access to medical cannabis by adding community pharmacy dispensing; and,
6. Maintain and amplify a federal resource hub that provides updated, evidence-based information and resources about medical cannabis.