Improving the Current Cannabis Systems in Canada to Better Meet Patients' Need

After a series of public consultations, surveys of our members and the public, as well as feedback from our advisory committee members, EduCanNation has created the following detailed response to Health Canada’s draft guidance document for the personal production of cannabis for medical purposes regulations.

Please review the document below and sign here. We appreciate your support.

In this letter we cover the following issues:

How public cannabis education impacts safety and resolves many issues brought to light in this document.
The need for accountability, transparency, and oversight in all areas of the cannabis industry, including Health Canada and all levels of government.
Utilizing standardized prescribing practices and guidelines based on harm reduction, best practices, and sound, up-to-date science and research.
Harm reduction through patient, public, and healthcare access to cannabis education.
Incorporation of Certified Cannabis Educators into all levels of the cannabis systems and industry in Canada, including healthcare, adult-use/retail, and government.
Growing permits that focus on the needs of the patient first, with well-researched guidance from science, and how this will reduce criminal activity.
That increased knowledge and understanding of the Cannabis Act and the Regulations, for the general public and all levels of government, will reduce the abuse of the medical system.
With improved care of patients who are authorized to produce cannabis for medical purposes and allowing helpers (with guidelines in place), this system will allow more transparency for all parties involved to achieve improved health and overall wellness.
Education will reduce risk for all people involved.

Link to Health Canada document here.

For optimal viewing, download our full response in PDF form:

ECN_HC_Final

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Preamble

Under the Cannabis Act and Cannabis Regulations, patients with a signed medical document from their health care practitioner can access cannabis for medical purposes by:

purchasing quality-controlled cannabis from a wide variety of federally licensed sellers inspected by Health Canada
- producing a limited amount of cannabis for their own medical purposes as authorized by their health care practitioner ("personal production”)
designating someone to produce it for them ("designated production")

As of September 2020, approximately 420,000 Canadians have an authorization from a health care practitioner to use cannabis for medical purposes. While most patients buy their cannabis from federally licensed sellers (approximately 377,000), approximately 10% (approximately 43,000) are registered with Health Canada to produce cannabis for themselves or to have someone produce it on their behalf.

Our issue - The average Canadian is not aware that the medical cannabis system exists, let alone that it includes the potential to grow cannabis for their own medical purposes. As cannabis educators who work with medical patients, we often deal with patients that are completely ignorant to the ACMPR (part 14 of the Cannabis Regulations) and moreover are uninformed of what rights are entitled to them through it. Many that do know the ACMPR exists have misinformed notions that a personal production permit will allow them to sell their cannabis and products they make from it legally.

In Health Canada’s 2020 survey about cannabis we see evidence of this: “The majority (of people who used cannabis for medical purposes in the last 12 months) (76%) did not have a document from a healthcare professional.”

ECN Proposed Solution

Public education campaigns through mail-outs, public broadcasting, in person / virtual talks, health and community associations that include clear descriptions of the ACMPR as well as the penalties for non-compliance.

Potential outcome

Increase in the number of patients registered with Health Canada to produce cannabis for their own medical purposes or designated growers.
Decrease in the number of misinformed patients abusing the system.

Our issue

Many of the cannabis clinics do not inform their patients of their rights to purchase cannabis from the licensed producer of their choice, never mind their right to apply to Health Canada for a personal production permit and the majority charge extra fees if the patient wishes to obtain the original medical document needed to apply (an average of $20/gram.) This is common practice because clinics rely on sales kickbacks from license producers to stay afloat. It is not in the best interest of their businesses to inform their patients of the rights to purchase products from licensed producers other than those they have contracts with, nor is it to inform them of their right to apply to Health Canada for a personal production permit.

ECN Proposed Solution

Standardized prescribing and followup practices that include proper patient education and guidance, clear descriptions of patients’ rights, the ACMPR and the Cannabis Act, transparency about business relationships between the prescribing practitioner/clinic and the license holders they are in business with, and the patient’s right to purchase cannabis from the licensed producer of their choice even if the practitioner / clinic does not receive financial gain from them.

Potential outcome

Increase in the number of patients registered with Health Canada to produce cannabis for their own medical purposes or designated growers.
Decrease in the number of misinformed patients abusing the system.
Increase in the sustainability of licensed producers businesses by spreading the number of patients out to a greater number of producers

Our issue

There are very few healthcare providers who are comfortable with prescribing cannabis to their patients which is understandable considering the complexity of the medical cannabis system and the amount of time it takes to educate a patient on how and where to obtain medical cannabis, registrations and application processes and lack of specific prescribing guidelines.

ECN Proposed Solution

Incorporation of certified cannabis educators into the medical system by establishing a standard of education and training based on harm reduction principles and by creating a certification board to verify that educators have met minimum requirements and regularly update their education as new evidence is made available through research studies. Requiring all cannabis practitioners/clinics to have a certified cannabis educator on staff to provide patient education and guidance.

Potential outcome

Assurance that a standard of practice and education is being provided to the patient and general public.
Decrease in the number of misinformed patients abusing the system.
Decrease in the amount of time a practitioner needs to spend with their patients when prescribing cannabis.
Increase in the number of practitioners willing to provide cannabis authorizations, education and support to their own patients.

Health Canada is committed to protecting patients' rights to reasonable access to cannabis for medical purposes and recognizes that most patients are using the program for its intended purposes.

There has been a progressive increase in the daily amounts being authorized for individuals seeking Health Canada approval to produce cannabis for their own medical purposes or to have someone produce on their behalf. For example, the average daily amount authorized by health care practitioners for individuals who access cannabis from federally licensed sellers has remained relatively constant at 2.0 grams per day, an amount that is consistent with published evidence and guidance about the use of cannabis for medical purposes. The average daily authorized amount for personal and designated production is approximately 36 grams per day.

Our issue - The average daily amount being authorized for purchase from a licensed producer does not necessarily reflect the actual needs of the patient. Many patients are having to fulfill their needs through the recreational market and many still use the black market.

Because our endocannabinoid systems are different and react differently to each product, so much so that a person may have extremely different reactions to products with exactly the same cannabinoid profiles, a patient may need to try many different products before finding one that is right for them.

ECN Proposed Solution - Provide healthcare practitioners with proper education on the endocannabinoid system, how a patient may need to experiment with many different products before finding success, all the different methods of intake, how prescription deductions are calculated, and how to have conversations with their patients to better understand their needs and their actual use of cannabis.

Potential outcome

Slight increase in the average authorized daily amounts for purchase from licensed producers.
Increase in patient success rates.
Reduction of patients turning to the recreational markets and black markets to fulfill their needs.

Our issue

Monthly deductions do not necessarily reflect the actual number of grams needed to produce the final product, especially with extraction based products like oils, edibles and topicals. Many licensed producers claim to use more than the indicated number of grams of flower to produce the final products. So basing authorized amounts for a permit to produce cannabis for your own medical purposes on the amount of product used by an LP will likely mean the patient will fall short.

Patients producing their own cannabis do not generally have access to the same processing equipment, nor are they allowed to use the same extraction methods so they often require more plant material to be able to obtain similar concentrations which explains why the daily amount of cannabis authorized for personal production is often much higher than the daily amount authorized for purchase from a licensed producer.

Patients do not have access to credible, reliable processing education and often waste a lot of their cannabis through improper processing techniques which leads them to needing higher daily amounts.Provide healthcare practitioners with proper education on how to gauge the amount of daily authorization based on the route of administration and potential loss through processing as well as the potential loss during growing due to moulds and pests as well difference between amounts of cannabis needed for processing into oils, edibles and topicals by an LP vs amounts needed for processing by an individual.

ECN Proposed Solution - Provide patients access to credible education on how to process their cannabis safely and effectively.

Potential outcome

Provide patients with access to daily amounts that better meet their needs.
Decrease patients’ waste of plant material thus decreasing their plant material needs.
Increase patients’ abilities to produce safe and effective products.

Our issue

Due to the fact that it is common practice for prescribing practitioners/ clinics to charge on a gram-per-day basis ($20/g average) for personal production permits, they stand to increase their financial gain according to the number of grams they authorize.

ECN Proposed Solution

Some practitioners are unwilling to authorize anything above 2g / day, despite their patents’ needs because they are unaware of the laws and are afraid to lose their licenses to practice. Put a reasonable cap on prescribing cannabis that reflects the current national average of 36g/day.

Require the authorizing practitioner to submit an application form with supporting documentation for any amount prescribed above the standard cap.

Potential outcome

Deter practitioners from authorizing unnecessarily high daily amounts of cannabis for personal financial gain.
Encourage practitioners to authorize suitable daily amounts of cannabis to meet their patients’ needs without threat to their license to practice.
Increase in the number of practitioners willing to provide cannabis authorizations, education and support to their own patients.