Patients Weigh in on the Extract Trial
On June 11th 2015, Canada’s Supreme Court ruled in favour of legalizing medical cannabis in all forms. The ruling was unanimous, meaning that all seven judges on the panel agreed with this decision. Previously, laws allowed medical cannabis patients to legally access dried cannabis only, while excluding all other forms such as extracts and derivatives like tinctures and edibles. This ruling was effective immediately, and expanded the definition of “medical marijuana” to include all forms of the substance, rather than limiting it to the dried plant. The SCC found the previous restriction to be arbitrary, potentially harmful to patients’ health, and therefore not in line with the rights to life, liberty, and security of person as outlined in Canada’s charter. This ruling rendered sections 4 and 5 of the Controlled Drug and Substances Acts (which prohibit the possession and selling of non-dried forms of cannabis) to be null and void.
For people who live with chronic and severe nausea, pain, seizures, and other health issues commonly relieved by cannabis, being able to leave the house, run errands, work, socialize, and attend public events is often contingent on being able to consume medication when and where they need to. Using cannabis as a medicine has historically left patients feeling stigmatized, is often associated with criminality, and is not generally practical in enclosed indoor areas such as workplaces, classrooms, and restaurants. Where chronic illness and disability often comes with its own stigma and social isolation, the restriction to consuming cannabis by smoking created further barriers, such as limiting social events and interaction in places where medicating could come with unwanted attention or misunderstanding. These issues also spill into other areas of a medical cannabis patient’s life, such as housing. For people on short-term leases, landlords can use the smell of cannabis smoke as grounds for eviction, even if the tenant has a prescription. If a tenant chooses to appeal the eviction (something which requires substantial time and energy) they may already have lost their lease by the time the case is heard.
According to Sarah,* a long-time cannabis patient and advocate who lives with a severe seizure disorder, smoking also presents a problem because the smell lingers on hair and clothing. “The smell marks me and gives people in a professional setting information that is not their business,” Sarah said. Extracts, in comparison, are discreet. Sarah said that tinctures are her preferred medium, since they are not only portable but also easy to consume at any time and can be made without sugar, calories, or additives.
Many people who use medical cannabis also feel that smoking the dried plant is an inefficient or undesirable way of getting relief from their symptoms. In an interview with CBC, Owen Smith (the case’s appellant) pointed out that it is unheard of for patients to be required to smoke any other medication, since it is generally agreed upon that smoking is a harsh way of consuming any substance. Other ways of consuming cannabis can offer higher bioavailability, and/or produce a more slow-acting result- which, for many patients, can mean the difference between a good night’s sleep and being woken up intermittently by pain or other symptoms.
The ruling may also make a considerable economic difference for many patients. Aside from the fact that medical cannabis does not have a Drug Identification Number, and thus excludes patients from receiving coverage, smoking dried cannabis is very costly compared to other forms of the medicine. For patients like Sarah, who need high doses for effective management of symptoms (her prescription often runs up to half a pound per month, and she can experience frequent seizures if she consumes less) relief can often be unaffordable. In the U.S., there have been efforts at a municipal level to subsidize medical cannabis due to the fact people with disabilities are often low-income, although a similar model has not yet been attempted in Canada, aside from various compassionate pricing programs offered by Licensed Producers which arguably still don’t meet the economic needs of patients.
On some levels, the ruling has created substantial change– patients who chose to place their well being above the irrational previous laws no longer have to fear criminalization for their teas and cookies. In other ways, however, it has not yet had a substantial impact on the day-to-day lives of cannabis patients. According to Ania Bula, a writer and activist who uses cannabis to treat Crohn’s Disease and other health issues, concentrates and other newly-legal cannabis products must now be made accessible through Licensed Producers before many patients can access them. “In practice it hasn’t changed much yet, not until we also allow dispensaries, and other distribution methods to make the concentrates accessible.” Although Health Canada released a statement yesterday issuing a section 56 exemption so Licensed Producers can now provide a legal route of access to oils and fresh cannabis, there are stringent restrictions on the concentration of THC LPs can use, as well as the exclusion of hash and other derivatives important to patients. Many advocates claim that Health Canada is, once again, doing as little as possible to accommodate the court’s decision.
Cannabis is still technically not an approved drug or medicine in Canada, and compassion centers and dispensaries remain illegal. Bula, after a visit to Colorado, has seen what these developments could mean for Canada in the future, including the introduction of THC patches (which are especially valuable for Bula and other people with digestive disorders), and e-juices that make vaporizing cannabis (rather than smoking) easier.
Zurn, a harm reduction advocate who is currently in recovery, stated similar concerns to Bula. “Manufacturing of synthetics and extracts needs a regulation system,” he said “conditions like seizure disorders require exact doses, people shouldn’t really be making these things at home. If companies could actually do what they need to do, it would be easier to get products with exact dosage.” Zurn is currently part of a residential treatment program which took him off his prescription for Cannabidiol (CBD), which was the only medicine he found to effectively treat his Post Traumatic Stress Disorder. “They don’t allow CBD in treatment, but they put me on even more pharmaceuticals,” he said, adding that the pharmaceutical medications he has been prescribed are less effective for him and have more side effects than CBD. In order to achieve full accessibility, it is important to continue dismantling the stigma that surrounds cannabis. Cannabis is still heavily associated with it’s criminal designation, and this means that many doctors are less likely to view it in a neutral light. “Cannabis is a plant that has a lot of potential,” Zurn said. “In Canada, we’re not using healing plants to their full potential, even though other countries are, and the results are clearly positive.”
*interviewee requested anonymity