Since its inception in 2001, I have written various Health Ministers on a number of occasions with concerns about the execution of Health Canada’s Marijuana Medical Access Program (MMAP). MMAP has been found unconstitutional by several courts, and has been criticized by medical professionals, law enforcement agencies, advocacy groups, and patients.
Most recently, in August 2011, I wrote to you with specific concerns regarding proposed changes to MMAP. Considerable evidence pointed to the fact that the Program was ineffective in many ways. In 2011, I posed several questions that needed to be addressed in the new regulations:
1. Health Canada has not demonstrated its plan for providing documentation of lawful possession of medical cannabis within the new Program. Many patients have already experienced anxiety over their lawfulness while waiting for delayed renewal licenses to arrive. How will Health Canada support medical marijuana patients to demonstrate their legal possession of this medication and avoid the precarious legal situations that have arisen with the current application system?
2. How will Health Canada ensure that the granting of licenses will be done in a timely manner? Access to the current Program has been impeded by the bureaucratic nature of the application process, delaying or preventing access for many of the most seriously ill patients. Any revisions to the Program must increase access to this medical treatment and Health Canada must adopt a system to enforce timely distribution goals for licensed suppliers.
3. The new regulations place greater responsibility on doctors to utilize and prescribe medical marijuana as a treatment and their approval of applications will become more critical than ever. With this additional change to the licensing system, how will Health Canada work to better educate doctors about their responsibilities under the new Program? The proposed Program changes are very vague.
4. Finally, my greatest concern lies in the “commercial” production of medical marijuana proposed within the new Program. Why has Health Canada selected out commercial producers in its new Program proposal? Health Canada’s previous contracts with commercial producers have been highly problematic. If Health Canada plans to license commercial producers within the new Program, how will it work to avoid these same problems previously experienced by patients regarding the quality and variety of government commercially produced cannabis?
After reviewing the latest proposed regulatory changes within Marijuana for Medical Purposes Regulations (MMPR) that were released in December 2012, I am very concerned that the issues I raised in my letter of 2011 have not been addressed.
As a result of the newly released proposals, I have spoken to and heard from many MMPR patients and advocates who have shared many concerns about the new proposals.
The new regulations will place greater responsibility on doctors to prescribe medical marijuana as a treatment and their approval of patients’ applications is a key element of the new MMPR process. The Canadian Medical Association has stated that doctors who are worried about the effectiveness of cannabis should not prescribe medical marijuana. Many doctors have chosen not to be involved in the Program. The MMPR regulations state that an expert advisory committee has been established to assist health professionals in accessing comprehensive and up-to-date information on the use of medical marijuana. I would like assurances as to when this advisory committee will be set up to provide guidance to doctors and how the members of this committee be selected.
The Medical Cannabis Patients’ Alliance of Canada has expressed its concerns that if many doctors refuse to write medical marijuana prescriptions, access to medical marijuana will be extremely difficult.
In addition, I have the following concerns:
• How will Health Canada ensure that patients receive their medical marijuana supply in a timely manner once the production and distribution of medical marijuana is turned over to private industry? Will Health Canada provide any oversight into the timely distribution of what is for many patients an essential component of their health and well-being?
• I remain skeptical of the effectiveness and rationale of the commercial production of medical marijuana proposed within the MMPR. Why is Health Canada only allowing patients to order medical marijuana from commercial producers in its new Program proposal? Health Canada states that only a small minority (13%) of current Program participants access Health Canada’s supply of medical marijuana. The vast majority of current Program participants prefer either to grow their own supply of medical marijuana (64%) or to have the product grown specifically for them (16%). Why would Health Canada insist on taking away the option that most participants of the Program choose?
• Given the limited number of producers in Canada who meet the security and organic farming standards necessary to produce medical marijuana, how will Health Canada deal with the increased production demand under the new Program if individual growers are no longer able to grow their own supply? Also, many patients note the lack of strain selection currently available by commercial growers. While the new MMPR suggests strain selection will be enhanced under the proposed MMPR, the regulations make no mention of how this will be achieved. How can patients be assured of enhanced strain selection if this is not clearly stated in the new regulations?
• There are also serious concerns issues about pricing. How will Health Canada ensure commercial producers are selling medical marijuana at a fair price? The MMPR states that it would not regulate the price of medical marijuana, rather, licensed producers would price set. Under the proposed MMPR, analysis predicts a significant cost burden to consumers of medical marijuana due to increased production costs of the product. Health Canada has projected that the cost of medical marijuana will rise to as much as $8.80 cents a gram— it presently ranges from $1.80 to $5.00 a gram. Currently, many medical marijuana patients grow their own supply or buy medical marijuana from their local compassion club because commercially produced options are too expensive. Yet Health Canada appears to be moving towards a commercial distribution system, rather than not-for-profit community-based producers.
• In 2011, I noted that an increasing number of advocates and concerned citizens are suggesting that the Program be a provincial responsibility. Has Health Canada considered the feasibility of transferring the Program to provincial authorities? This would allow medical marijuana to be produced and distributed via a regional system that meets the needs of patients in the community, by utilizing the current system maintained by compassion clubs. As noted, these dispensaries already serve the needs of more medical marijuana patients than Health Canada’s current Program, and therefore it would be a logical next step for provinces to utilize them as licensed growers and distributors in their region. A provincial approach would also allow provinces to offer community programs around patient, physician, and distributor education and support. Why was the option of provincial responsibility not included in the proposed changes?
• Under the proposed MMPR, how would the proposed commercial distribution system provide better benefits offered by community producers? Compassion clubs offer specialized education, care and support around the provision of medical cannabis, yet this viable option appears not to be under consideration. Why is this? Further, start-up costs (or costs associated with meeting the proposed regulations) may be prohibitive to most compassion clubs who run on a not-for-profit model. The proposed MMPR suggests that most potential licensed producers of medical marijuana would have heavy start-up costs but would realize strong profits within a few short years. This model appears to heavily disadvantage many compassion clubs that may want to enter this “new industry”.
The new Program must be functional, accessible and fulfill its original purpose: ensuring that medical marijuana patients get timely access to high quality medical marijuana.
The proposed MMPR, I believe, does not fulfill this original purpose.
It will: further restrict access; will be more expensive for many patients who are already on low income and facing additional health costs; and the options for access for patients are severely restricted.
I urge you to act in good faith and respond to the many recommendations submitted about the Program and work with your officials to improve the proposed MMPR.
Libby Davies, MP
This Open Letter to Ministers & Public Officials was posted on February 19, 2013