The 5,744-participant study, titled Medical Cannabis Access Survey (MCAS), is one of the largest ever done from the perspective of Canadians accessing cannabis for medical purpose and was completed in collaboration with patient groups Medical Cannabis Canada and SheCann Cannabis, Santé Cannabis and McGill University.

In Canada, cannabis can be legally accessed recreationally or through a medical cannabis licensed seller with a medical authorization, similar to a prescription. But in this study, over half of those surveyed obtained their cannabis without medical authorization, according to principal investigator Dr. Lynda Balneaves, associate professor at the College of Nursing, Rady Faculty of Health Sciences.

“According to our study findings, those who take cannabis without a medical authorization were less likely to seek information from health-care professionals, less aware of the amount of cannabis they were consuming, and more likely to use the unregulated market than those with one,” Balneaves said. Specifically, those without a medical authorization were:

• 20 per cent less likely to speak to or seek information from a health-care professional;
• 16 per cent more likely to rely on non-evidence-based and unqualified sources of information (i.e., Google, recreational cannabis store, social media);
• 14 per cent more likely to report not knowing about how much medical cannabis they were actually taking;
• 7 per cent more likely to experience side effects; and,
• 27 per cent more likely to obtain cannabis from unregulated sources.

“People who don’t have medical authorization have limited access to medical advice on things like dosage, potency and type of product. It raises concerns about whether people are using medical cannabis safely and effectively, and if there could be potential harms to their health,” Balneaves says, adding they also face financial barriers.

Those with a medical authorization reported spending 25 per cent more on medical cannabis, but less than six per cent of individuals with a medical authorization received any insurance coverage for costs. The study found nearly half of those who stopped taking medical cannabis did so because it was too expensive.

“The Cannabis Act discourages and penalizes safe and accessible use for patients with a medical authorization,” says Max Monahan-Ellison, board chair of Medical Cannabis Canada, a patient research and advocacy group. “The MCAS data clearly highlights that Canadians accessing cannabis for medical purposes deserve more support and that starts with informed, patient-centered changes to the cannabis regulations.”

Based on the study’s findings, six key recommendations are proposed in the report for consideration as part of the federal review of the Cannabis Act and Regulations and to inform future medical cannabis policy in Canada:

1. Design, implement, and maintain a formalized evaluation of the medical cannabis framework in consultation with patients and key experts;
2. Maintain reasonable access to cannabis through a dedicated medical framework embedded within the cannabis regulations;
3. Implement changes to cannabis regulations, tax policy, and insurance formularies to reduce out-of-pocket costs associated with medical cannabis and re-direct use away from the unregulated market;
4. Develop, implement, and evaluate health-care professional education training focused on medical cannabis across the multidisciplinary health-care team;
5. Expand reasonable access to medical cannabis by adding community pharmacy dispensing; and,
6. Maintain and amplify a federal resource hub that provides updated, evidence-based information and resources about medical cannabis.

The Medical Cannabis Access Survey report will be officially launched by the research team on April 4 at 12:00pm CDT at a virtual national panel. Interested individuals can register at: https://MCAS_2023.eventbrite.ca.

Read the full report at: medicalcannabissurvey.ca/report

The Manitoba NDP has added its voice to a handful of critics with concerns about how the province’s proposed new cannabis legislation will affect medical users. 

NDP justice critic Andrew Swan argued on Thursday the proposed legislation ignores the needs of medical cannabis users in the province and requested the province consult with medical users before the bill goes further….

Critics of the legislation have said it needs refining to get at the nuances of cannabis….

University of Manitoba nursing professor Lynda Balneaves echoed [a UBC professor’s] concerns about stigma, saying the legislation was a “good first step,” but fails to acknowledge the complexity of cannabis.

Schedule Two of Canada’s Controlled Drugs and Substances Act refers to “cannabis, its preparations and derivatives.” That includes close relatives like cannabidiol and Nabilone, which Balneaves said can be used to manage conditions ranging from epilepsy to nausea and vomiting in cancer patients.

The proposed legislation would prohibit cannabis from being stored in a vehicle, unless it’s in the trunk or behind a rear seat — not a good idea, Balneaves said, for some medical forms of the drug.

“If you put Nabilone in a trunk in a hot summer day in Manitoba and try to drive for a few hours, it could actually reduce its medicinal properties,” Balneaves said in an interview on CBC Manitoba’s Information Radio on Tuesday.

“I also feel that the legislation applies to cannabis being provided in mental health institutions and other health-care facilities, which, again, could really restrict its use for people that could actually benefit from cannabis as a medical agent.

Balneaves said it’s still unclear how much cannabis drivers can have in their system before it impairs their ability to drive. The drug can stay in the body for up to seven days, she said.

“We really need to tease apart what level would be needed to cause impairment. Do you just have a zero tolerance law or do you have a per se law where you set an arbitrary level that is perceived to cause impairment?” Balneaves said.

It’s the sort of topic that gets a reaction—usually a strong one—but it’s not just cocktail party chatter anymore, with the federal government working to put forward legislation as soon as spring 2017. After that, Canadians will be able to walk into a brightly lit retail outlet, slap cash on the counter, and walk out with whatever strikes their fancy, from edibles and vape products to the musky green weed itself. If you’re of legal age and you’ve got ID to prove it, it won’t be much harder than picking up a six-pack of beer at the local vendor.

Lynda Balneaves says when that time comes, we’d better be ready. As a researcher and associate professor at the College of Nursing, Rady Faculty of Health Sciences, her focus is on medical marijuana, also known as cannabis. She says that whether you’re considering it as a medical treatment or just want to bring a joint or two to your next social gathering, the most important thing is getting informed—just because something’s legal doesn’t mean it’s time to “toke up”.

Education is key and nurses are going to be a big part of helping demystify a previously sticky topic. “We’re very well-positioned to be doing health promotion and prevention around the non-medical use of cannabis,” she says. And if they’re going to use anyway? “Then it’s about harm reduction. We can talk to individuals about potential concerns and how to safely use it.”

But front-line work with the public is only part of the picture. As the country moves towards legalization, there’s a bigger conversation that’s going on right now amongst leading agencies in Ottawa. As one of only a handful of researchers who has worked on federally-funded studies around medical marijuana, Balneaves was called to Ottawa this fall for meetings that set a national agenda for research on the topic of non-medical use of cannabis. She says it’s about time.

She’s been working in the area for nearly 10 years and she says that for much of it, once she tells someone she’s studying marijuana it’s hard to get them to focus on the research. She’d be giving a lecture and before she knew it, “I’d have a packed house of people tittering and giggling,” she said. “And then there are the people who ask if I do pot myself.” She sighs.

On the opposite end of the spectrum, Balneaves says she’s talked to physicians so nervous about marijuana they want to shut the conversation down before it even begins. “They tell me, ‘It’s just too dangerous, we don’t know enough about it,’” she says. “Yet those same physicians will go ahead and write a prescription for opioids.”

At the end of the day, it’s all about the nature of the beast, says Balneaves. The stigma around cannabis is so strong that for many, fear and misinformation outweighs research and hard science. And that’s got to stop. “So often, attitudes are coming from a social and political perspective, rather than a medical perspective. We’re talking about a drug. Why do we treat it differently from any other drug?”

And yet, we do.

Through her research, Balneaves met a patient dying of HIV/AIDS. With painful lesions in his mouth so bad he could hardly eat, he had wasted down to 100 pounds and could no longer sleep. “He said to me, ‘I’m dying of this chronic disease and when I ask for cannabis to help me manage my symptoms I have to fill out a form for addiction services. Are you kidding me? I’m dying!’”

It’s a heartbreaking story, but Balneaves says it’s not unique. At the moment, most of the currently available information comes from studies on addiction, with the research itself sponsored by organizations like the Canadian Centre for Drug Abuse. More often than not, the participants in those studies are heavy recreational users, a completely different population than medical patients. Under the circumstances, she says it’s no wonder that when we talk about marijuana—even as palliative care for a man close to death—the focus is on the likelihood for misuse, not any potential medical value.

“It’s like we’re still back in the time of ‘Reefer Madness’. I don’t see why we’re not keeping an open mind about therapeutic benefits while being realistic about potential side effects, as we would with any pharmaceutical.”

That’s where researchers like Balneaves come in—working to understand dosage and the effects of therapeutic use. “I’d really like to encourage my colleagues to look at this as being an area that is really rich with questions that need to be asked—especially now.”

For more on Balneaves and her work, visit Canadian Nurse magazine.