Canada's Medical Marijuana Program Needs Reform

Hon. Tony Clement
Minister of Health
278 Confederation Building
House of Commons
Ottawa, Ontario K1A 0A6

June 19, 2008.

Dear Minister Clement,

Since its inception in 2001, I have followed the federal Medical Marijuana program with interest and concern. I write to you today to urge a public review of the Marijuana Medical Access Regulations (MMAR) Program.

The MMAR program has been found unconstitutional by several courts, and has been criticized by medical professionals, law enforcement agencies, and patients. Considerable evidence points to the fact that the program is ineffective in many ways.

In December of 2004, Senator Pierre Claude Nolin and I called for the Auditor General to conduct an audit of the MMAR program. Since that time, I have written letters to your predecessor and the Auditor General, again requesting that numerous patients’ reports of complications and obstructions to safe, affordable, available, high-quality medicinal marijuana be taken seriously and corrected by Health Canada. These letters have repeatedly highlighted the following points:

-The MMAR program does not meet the needs of the medical cannabis patients in Canada. Studies show that the policies of the program limit benefits to patients. The small number of registrants in the program is attributed in part to the reluctance of many physicians to enroll their patients, and also to the overly bureaucratic nature of the 33-page application form and up to 12-month approval procedure by Health Canada. As you know, a large percentage of the people the MMAR program is intended to benefit suffer from severe chronic pain and/or terminal illnesses. A lengthy registration process is thus inadequate in addressing their immediate treatment needs, and in many cases completely fails to protect their constitutional right to access cannabis without fear of arrest. Why should patients with just a few months to live be forced to break the law if they chose to use cannabis as part of their palliative care, and how is criminalizing these terminal patients in the greater public interest? A simple solution to this problem would be to have legal protection for patients begin with the physician’s recommendation for cannabis, rather than waiting for Health Canada’s already busy staff to process patient applications.

-The MMAR program’s Office of Cannabis Medical Access has been unable to provide adequate access for medical marijuana users. In addition, the Ontario Court of Appeal in the November 2003 Hitzig case found some parts of the program unconstitutional because of a lack of access for those in need. Recent improvements have helped, but have still failed to remedy this situation or to significantly increase access.

-Very few research projects have been approved and those that have are not moving forward or have been cancelled, despite a $7.5 million, 5-year clinical research grant. In fact, as a result of a refusal by the current government to re-instate $4 million in funding in the fall of 2006, there is currently no federal funding earmarked for clinical cannabis research in Canada, despite our nation being one of the first countries in the world to provide legal access.

-Health Canada’s foray into the production of medical marijuana has been a widely publicized disaster. In December of 2000 Health Canada announced that it was issuing a 5-year, $5.7 million contract for the production of a domestic supply of research-grade cannabis to Prairie Plant Systems (PPS), which proposed to grow the material in a mineshaft in Flin Flon Manitoba. Questions regarding the quality and safety of this project have arisen ever since, and to date fewer than 20% of people enrolled in the federal program avail themselves of this cannabis supply. Criticisms range from concerns over low levels of THC, lack of strain selection, and alternatives to smoke ingestion, to the potential dangers of gamma irradiation of the crop. Health Canada’s new regulations introduced this year to allow more producers to be granted licenses under the MMAR program, but these will still leave the great majority of patients underserved.

-Despite recommendations from the Senate Special Committee on Illegal Drugs, the Ontario Court of Appeals, and the Canadian AIDS Society, Health Canada does not yet recognize the work of community-based dispensaries (e.g. compassion clubs). The department needs to find constructive ways to support their important work and research. Without compassion clubs, which exist in communities across the country, many patients would be forced to obtain their medical marijuana in illegal and potentially dangerous situations. It is worth noting that the country of Israel, and the states of Rhode Island, New Mexico and Oregon are all currently moving towards community-based medical access models.

-There has been a consistent lack of consultation with key stakeholders, even though individuals very knowledgeable about the program and its limitations have requested the opportunity to be involved in consultation and policy development. Health Canada must establish immediate dialogue with key stakeholders to better meet the needs of patients.

-Health Canada is profiting financially from the few chronic-pain patients who can afford to participate in this program and it is bankrupting those who cannot. In May 2007, Canadian Press (CP) published records obtained through Access to Information that showed Health Canada’s program charges patients fees for marijuana that are 15 times more than what Health Canada is paying for the product. Additionally, it has recently come to light that as of January 31st, 2007, 434 authorized users owed Health Canada over $554,000 for cannabis, and that 29 of these patients have been cut off from accessing medical cannabis through Health Canada, which is Canada’s only legal supply. This situation is clearly untenable, and the government’s decision to send collection agencies after some of Canada’s most severely ill citizens is indefensible. It is clear from this data that Health Canada should abandon a cost-recovery model for this program (and therefore offer this cannabis for a more affordable fee) and work with provincial health registries to cover the cost of this essential medicine.

In summary, a public review of the Marijuana Medical Access Regulations program is needed for these reasons:

-The MMAR program fails to meet the needs of medical cannabis patients in Canada.
-Access to the MMAR program is impeded by the bureaucratic nature of the application process, delaying or preventing access for many of the most seriously ill patients.
-Clinical cannabis study requires substantial research funding.
-The quality and safety of Health Canada’s cannabis supply has been repeatedly called into question.
-Community-based dispensaries continue to be unrecognized by Health Canada.
-Medicinal cannabis obtained through Health Canada is overpriced and pushes patients into debt.
-Health Canada must work with provincial health registries to cover the cost of medicinal cannabis.
-Immediate dialogue with key stakeholders must be established by Health Canada, to better meet the needs of patients

There are many other ongoing inadequacies with Health Canada’s medical marijuana program. A public review would go a long way in helping those in need of medical marijuana by forcing the department to highlight and fix existing problems, especially the impacts of bureaucratic process, cannabis quality, and product cost for patients. This may lead to better legal protections for critically and chronically ill patients who can benefit from the use of cannabis, and might additionally protect Health Canada from costly legal challenges stemming from the ongoing unconstitutional practices of this program.

I look forward to your considered reply.

Sincerely,

Libby Davies, MP
Vancouver East

cc:
Steven Fletcher, Parliamentary Secretary to the Minister of Health
Judy Wasylycia-Leis, NDP Health Critic
Philippe Lucas
Kirk Tousaw

This Open Letter to Ministers & Public Officials was posted on June 19, 2008