Harm reduction on the frontlines: The need for policy reform regarding accessibility and affordability of medical cannabis

It has never been more evident that we have more work to do as it relates to education about medical cannabis, as well as its potential as a tool to reduce harm in communities. As research trickles in, funding dollars are beginning to be directed towards novel research in cannabinoid therapy. Our focus must first be to our most vulnerable populations. Those living with addiction remain the most stigmatized population challenged by a chronic illness. Can you believe that, in Canada, one person overdoses on opiates every two hours? Let me repeat that: ONE person EVERY TWO HOURS in Canada dies of an overdose.

I am a physician who has worked in the area of addiction medicine providing opioid replacement therapy (ORT), and the adjuvants or “helper “medicines, for patients to access a clean supply of medication dispensed by a trained pharmacist. Patients are able to stabilize their day-to-day lives and maintain their health. The challenge with these programs and protocols is that patients often have a difficult time tapering off or reducing these medicines and, dependent on geography, they are not easily accessible. Ironically, the “helper” medicines can also be misused, or can be potentially fatal, if mixed with alcohol or other sedating medications. Most patients I see are taking more than four medications.

During patient assessments, which may take upwards of one hour to complete, I have found that many were using cannabis from the illicit/legacy market. In reality, many were using it to reduce their withdrawal effects and anxiety, to help with sleep, or to reduce pain. How was this working for them? Was it really working? And in the back of my mind I remember a patient telling me 10 years ago, “Hey, Doc, there’s weed out there that doesn’t make you high”, and I, with head hanging down, admit at the time, didn’t believe her. What I now know is that given that the overdose profile for cannabis is non-existent, I feel it is a safe option for my patients living with opioid addiction, and the science and evidence-informed data is proving this. After much reading of research, and with a few of my patients stable on opioid replacement therapy (methadone/suboxone), I began providing access to legal medical cannabis for these patients with surprising success. The result? Patients were able to reduce opioids and feel like they had more control of their health and of their lives.

Fast-forward to today, with data collected on almost 6,000 of my patients who have been prescribed medical cannabis, more than 80% are able to reduce opiates and other pain and sleep medications. Patients who have drug coverage and/or are able to cover the cost of cannabis do better and are able to maintain their care plan with medical cannabis. However, for those patients living with addiction who do not have insurance, including many of our Indigenous/Status patients and/or those on low or fixed incomes, financial challenge limits their ability to continue to receive the benefits that legal medical cannabis provides .

Professionally, it has proven to be an eye-opening and humbling experience to assist patients in navigating this legal cannabis system, warts and all. It has changed how I practice. It makes me question every single pill I prescribe and has helped me become a better physician. Additionally, it has turned my patients, for the most part, into willing scientists. I tell each patient as they trial cannabis, “We are doing science!” as they sigh and fill out their umpteenth questionnaire. For those patients accessing medical cannabis, a sharp line between the recreational and medical market is required to address accessibility and affordability. Could you imagine someone with diabetes having to get their drugs illegally? If the supply of insulin was not clean? In an environment where our national physician’s governing body does not actively support medical cannabis, and where those of us working on the frontlines see the benefit and possibilities of this plant, there must be more communication and bridge-building regarding its medicinal properties. Our pharmacy partners, who understand the complexities of medicines, must be involved in the care of our patients.

In a system where physicians are now encouraged to de-prescribe opiates and benzodiazepines (BZD’s), but are left with little else to offer the patient, the disconnect is evident. Current drug policy has yet to catch up with the science that supports safe-use sites, access to clean sources of opiates, and the reduction of deaths in communities in Canada. When building resilience amounts to little more than lip service as the resources supporting substance use and mental health services are limited and finite, it becomes challenging to offer and address the underpinnings of addiction. As a result, our efforts are not enough, and we must challenge the status quo. The advocacy work of all those on the frontlines, actively giving care, must be supported through research, and provincial and federal funding. Let us, on the frontlines, continue to do this work. On a broader scale, we all must focus our efforts and work together to drive the accessibility and affordability of medical cannabis for patients – it is promising as a medicine, for many, many patient populations and, most certainly, for those living with addiction.


Will be a featured Speaker at the national Indigenous Cannabis & Hemp Conference, being held in Kelowna at the Delta Grand Okanagan Hotel. November 26-28, 2019
For more information and registration: https://www.nichc.ca