Barriers forcing patients to self-medicate with pot

by Leo Almazora19 Oct 2020

Systemic barriers in the legal medical cannabis system are forcing patients into unregulated and recreational markets without support from a health care professional, according to national non-profit group Medical Cannabis Canada (MCC).

In its inaugural Medical Cannabis Patient Survey (MCPS), the organization found that only 37% of Canadians who use cannabis medically have a “medical document,” which is similar to a prescription from a health care practitioner.

That creates a catch-22 for many patients, MCC said. The medical system requires patients to have a medical document, but patients without a medical document report substantially less engagement with health care practitioners. Against that backdrop, a greater number of patients without the document report going to unregulated markets to access their treatment.

Based on the MCPS findings, 74% of marijuana patients who have a medical document go to a health care practitioner or pharmacist to guide their use of medical marijuana. In contrast, just 24% of those who’ve never gotten a medical document said the same.

“Unfortunately, there is little incentive to access a medical document or use the legal medical channel and many are being left to manage their treatment alone,” said Max Monahan-Ellison, Medical Cannabis Canada Board Member and MCPS Project Lead.

Among patients who’ve never received a medical document, the majority said they turn to friends and family, websites, and retail salespeople at recreational cannabis stores – so-called “budtenders” – for medical guidance. Just a small minority of these patients have talked to a health care practitioner about potential drug interactions with cannabis that might be of concern.

A large majority (83%) of patients said they felt the use of medical cannabis comes with a stigma among traditional medical practitioners, and 57% said they struggled to find a health care practitioner who they can to about obtaining a medical document. For 60% of respondents, the unregulated market is their only option to access medical cannabis because of the challenges in the regulated side, including costs, barriers to getting a medical document, and difficulty navigating the structure.

The biggest perceived barrier dissuading patients from using the medical cannabis system was cost, which was cited as the top reason why patients who’ve switched sources have done so. Over the past year, 24% said they’ve accessed their treatment from an unregulated dispensary, and 33% said they’ve used informal sources like friends, family, acquaintances, or dealers.

Those staying away from or abandoning the legal medical cannabis system also stand to suffer even direr consequences. One in four respondents said that increased use of medical cannabis lowered their reliance on opioid pain relievers; 36% of these patients reported that hurdles to accessing medical cannabis pushed them to go back to opioid medications.

“As the Cannabis Act comes up for review in 2021, collaborative efforts are needed by the industry, non-profits and regulators to ensure patients can access their treatment and health care professional support,” Monahan-Ellison said.

To improve patient access to pot, MCC pointed to two key areas to be addressed:

  • In addition to current mail delivery options, access to medical cannabis should be expanded to include pharmacy distribution, as a 90% majority were supportive of empowering pharmacists to issue medical documents, dispense medical cannabis, and provide guidance on cannabis use and risk; and
  • Improving affordability of legal medical cannabis by eliminating excise duty, HST/GST, and PST, as well as pushing for the expansion of benefits coverage that includes medical marijuana.