The Times They Are A Changin’: Canada’s Legal Cannabis Will Change Everything

Forbes/October 16, 2018/Nick Kovacevich

As cannabis sales become legal in Canada, the country will move ahead of the U.S. in reaping the benefits.

On October 17, everything changes. That’s the day the manufacture, distribution, possession and use of cannabis in Canada becomes legal nationwide. But the repercussions will be felt here in the United States from Portal, North Dakota, to Brownsville, Texas, and from sea to shining sea.

We’re already seeing the impact. Last week, a Canadian company listed on the New York Stock Exchange legally sent cannabis products across the US border to be used for medical research. Products, keep in mind, that are illegal in the US at the federal level. It is just another example of how backwards we are about cannabis. Not only are US companies losing market share to foreign competitors, the public companies we do have are barred from the bigger exchanges. Remarkably, however, we are allowing Canadian firms on the granddaddy of them all, the NYSE.

The first impact of Canada’s big move will be financial. Recreational sales are projected to be as high as $6.5 billion by 2020, with the government collecting an excise tax of 10% or $1 per gram, whichever is higher. Each Canadian province also will collect a sales tax.

But we should expect other, more subtle changes that ultimately will impact how cannabis is manufactured and used — and further isolate the U.S. as it continues to classify cannabis in the same category as heroin and methamphetamine. In the meantime, here’s what to expect.

Research

As an illegal substance, cannabis is hard to come by, which has long stymied anyone interested in finding out more about the plant. (Hence the hoopla around Canopy Growth sending cannabis to the US.) But once cannabis is legal, Canadian scientists – unlike their American counterparts – will find it easy to buy or produce cannabis for research purposes. They’ll also be able to conduct clinical trials on humans to determine cannabis’ biological, sensory, clinical and societal effects. New research will bring a better understanding of the chemical attributes of particular strains, explaining why some induce yawns and others are energizing. More and better research also will allow us to produce cannabis that better meets specific medical needs.

Meanwhile, the U.S. will continue to fall behind, since our federal drug laws hinder research. Although the Drug Enforcement Administration since 2016 has received dozens of applications from scientists wanting to produce cannabis for research purposes, it’s only approved one institution, the University of Mississippi. And the DEA doesn’t appear eager to approve any others, despite the fact that the Pew Research Center says 61% of Americans support nationwide cannabis legalization.

Employers

Each of Canada’s 10 provinces will set up its own system to regulate the sale of cannabis. But nationwide, employers will have to consider how to deal with the plant’s change in status. Although recreational cannabis will no longer be illegal, employers may or may not allow it in the workplace. Experts predict most employers will expand existing alcohol policies to include cannabis, and generally prohibit any sort of impairment. Of course, there’s no consensus about what “impairment” means in regard to cannabis use, so that may be tricky. Employers also will have to examine existing policies to determine if they need updating. For example, consuming edibles will no longer be prohibited under a rule against “illegal drugs” at work. They’ll also have to decide whether to — or even if they can — apply any restrictions to employees who work remotely or from their own homes. Whatever they do, employers must design policies and procedures to ensure a safe work environment where employees want to work.

Opioid Use

Several studies have shown states with legal medical marijuana dispensaries have fewer opioid addicts and overdose deaths. In fact, a February 2018 study found opioid prescriptions fell significantly in states with medical cannabis laws. Patients with chronic pain said their opioid use decreased by more than 60% in those states. In the U.S. alone, the economic cost of the opioid epidemic is expected to reach $500 billion from 2018 to 2020. That doesn’t even count the personal cost to families and communities of lives lost to opioid addiction and overdose. Canada can expect to reap the benefits of those reductions across the board.

Retail experience

The retail experience will differ across the country, because each province is making its own rules. The Canadian government gave provinces the right to determine how cannabis can be sold, where stores may be located and how they must be operated.

Most provinces will allow online sales, but in some places they will be run by the government. Some provinces will allow private, for-profit dispensaries. Nova Scotia, instead, will allow cannabis sales only at stores now run by the Nova Scotia Liquor Corp., the sole distributor of alcohol in the province. Ontario, the most populous province, set up a monopoly called the Ontario Cannabis Retail Corp., to act as the only wholesale distributor of cannabis in the province. Canada has just 10 provinces. Fifty different sets of rules and regulations in the U.S. would be confusing and could inhibit development of the industry as companies struggled to meet the various qualifications in each state. Of course, that’s where we’re headed now, unless and until the federal government legalizes cannabis.

How Many Prescriptions Are Replaced by Cannabis? Canada Study Explores an Answer

Leafly/May 19, 2017/Bailey Rahn

In the US, we’ve seen a marked drop in opioid overdoses in legal states, prodding the question of whether patients are replacing their prescription medicines with cannabis. Recent survey data collected from patients enrolled in Canada’s MMPR program indicates this may be more than just a correlation.

Led by researchers Philippe Lucas and Zach Walsh, this investigation surveyed 271 patients purchasing medical cannabis from Canadian LP Tilray (which, like Leafly, is owned by Privateer Holdings). Seeking to understand who is using medical marijuana and why, they discovered some staggering statistics pertaining to substitution–63% of respondents reported using cannabis in place of prescription medications.

Breaking down the results by drug classes, Lucas and Walsh found that:

  • 30% of respondents replaced opioids with cannabis
  • 16% replaced benzodiazepines
  • 12% replaced antidepressants

The reason? “Less adverse side effects,” said 39% of patients. Others responded that cannabis was safer (27%) and more effective in treating symptoms (16%).

“In light of the growing rate of morbidity and mortality associated with these prescription medications, cannabis could play a significant role in reducing the health burden of problematic prescription drug use,” the authors wrote.

Putting to rest concerns of cannabis dependence, the survey also established a strong tendency for recreational use to precede medicinal use, not the other way around as we see with many pharmaceutical medications. A transition from medical to recreational use was only reported by less than 3% of respondents, indicating a low risk potential.

The substitution effect reaches beyond just the medicine cabinet; cannabis also helped patients curb other types of substance use:

  • 25% of respondents replaced alcohol with cannabis
  • 12% of respondents replaced cigarettes/tobacco with cannabis
  • 3% of respondents replaced illicit drugs with cannabis

Though widely supported by anecdotal evidence, this study is one of hopefully many to substantiate what patients have been experiencing for themselves when it comes to replacing other drugs and habits with cannabis. How might these statistics look in the US, where prescription medication use and abuse runs rampant? That’s a question for future research.

 

Number of Canadians with prescriptions for medical pot soaring, now almost 130K

Number of Canadians with prescriptions for medical pot soaring, now almost 130K

Edmonton Journal/February 24, 2017/Cheryl Ubelacker

TORONTO – The number of Canadians registered to purchase medical marijuana from licensed producers has exploded since the federal commercial-access program was introduced almost four years ago, reaching nearly 130,000 by the end of last year, the most recent Heath Canada figures show.

As of Dec. 31, 129,876 Canadians had signed up with the country’s cannabis producers, a 32 per cent jump from the 98,460 registered at the end of September and a whopping 1,544 per cent increase from the 7,900 granted access to medicinal cannabis in mid-2014.

But the surge in demand has many wondering if all these patients have a legitimate medical need for the drug. Or are some people using the system to acquire recreational pot before it is legalized, as the Liberal government has promised to do this spring?

Dr. John Goodhew, a family practitioner in downtown Toronto who supports the use of therapeutic cannabis for specific conditions, said he’s seen a definite uptick in patients seeking prescriptions.

Because Goodhew has become known as one of a minority of doctors who will prescribe medical marijuana, he has patients from all over Ontario contacting him.

“So patients will frequently call me and I’m not able to help them because I only consider marijuana as a therapeutic agent for people in my practice, people that I know, people whose medical histories I’m familiar with,” he said Thursday.

“And this is really the only responsible way to do it. Unfortunately it leaves other people kind of in the lurch.”

Goodhew said he prescribes cannabis for such ailments as pain, weight loss from conditions like inflammatory bowel disease, nausea and hepatitis C.

But increasingly patients are asking for it because of osteoarthritis, a painful condition that’s on the rise as the population ages.

“Things like anxiety and depression where there really isn’t good data that it works … I won’t prescribe it,” he said.

“And other people will come in and just ask (for a prescription) and I’ll say ‘What is the medical condition?’ and they’ll say ‘Can’t you just make something up?’ And I’m like, ‘No, it doesn’t work that way.'”

Goodhew attributes such behaviour to the “Trudeau effect,” a slackening of concern as people anticipate that Ottawa will soon decriminalize recreational marijuana. But he acknowledges it can be difficult for physicians to determine which patients have a genuine need for the drug and which ones want it just to get high.

“I think there are probably a minority that are strictly medical and there’s a minority that are strictly recreational and with most people it’s probably a combination.

“Because part of pain relief is if it relieves pain and it also makes you feel good, it’s kind of a mixed blessing that way.”

Dr. Jeff Blackmer, vice-president of medical professionalism for the Canadian Medical Association, said the spike in the number of people registered to purchase medical cannabis could be a reflection of doctors becoming more comfortable with prescribing the drug, coupled with growing patient demand.

And he agreed that while some people seek a prescription for authentic health reasons, others likely simply want it for its euphoric effects.

“When I talk to doctors about this, there’s no question people will say, ‘Some of my patients I feel really would not be here asking for it if they did not have these medical conditions,'” he said from Ottawa.

“But I also hear from colleagues that they do suspect some of the patients are there asking for the approval to use it recreationally,” said Blackmer, adding there’s no standard test “to tease that out.”

While doctors aren’t prohibited from prescribing cannabis, the CMA opposes its use medicinally because of a lack of scientific evidence proving the drug is effective in treating specific conditions.

Dr. Mark Ware, a pain specialist and medical cannabis researcher at McGill University in Montreal, said there are several pharmaceutical cannabinoids approved for use in Canada, including a spray containing a cannabis extract used to treat pain and spasticity due to multiple sclerosis or for advanced cancer pain.

But herbal cannabis in the form of dried flowers or oils is not “approved” as medicine in Canada. But they are legal under federal Access to Cannabis for Medical Purposes Regulations, he said, noting that the best available clinical trials support their use for pain caused by nerve damage, after standard treatments have failed.

“There is a very long list of conditions for which people have claimed benefit from cannabis use,” Ware said by email. “Most of these conditions have not been formally studied in clinical trials, but intriguingly, for many such ‘claims,’ there is a body of scientific literature that provides a rationale for why cannabis might work for those conditions.”

Some of those trials are either planned or underway in Canada and elsewhere.

In the meantime, Blackmer said doctors are waiting to see if and when Prime Minister Justin Trudeau’s government will legalize and regulate the sale of recreational pot.

“We would like to see just one system,” he said. “So if marijuana is legalized for recreational use, we feel very strongly that that makes the ‘question’ around use of medical marijuana essentially moot, because it would be something that’s available to everyone for any reason, and you wouldn’t need to go through physicians and you wouldn’t need to get special dispensation.”

Goodhew is anxious for that day.

“I’m supportive of the role that marijuana has in medicine. But I’m really tired of being the gatekeeper for it. And all my colleagues are,” he said.

“Not only are we the gatekeepers and have to fill out forms constantly for people with legitimate use, we’re now getting inundated with people who want a prescription so they can get the good-quality stuff at a decent price from the licensed growers … (and) we’re constantly having to turn people down.

“So the day that it becomes legal will be a day when we’re all going to breathe a sigh of relief.”