NORTHERN LIGHTS:Medical Cannabis Policy and Practice in Canada
PHILIPPE LUCASVICE PRESIDENT OF PATIENT RESEARCH & SERVICES, TILRAYCENTRE FOR ADDICTIONS RESEARCH OF BRITISH COLUMBIA
MARCH 2015
Universityof Victoria
Centre for AddictionsResearch of BC
MEDICAL CANNABIS IN CANADA
• R. v. Parker (2000) - constitutional right to choose cannabis as medicine without fear of criminal sanction
• In 2001, the Marihuana Medical Access Regulations (MMAR)
• 1 million Canadians used cannabis for self-defined medical conditions (Adlaf, Begin & Sawka, 2005; Belle-Isle & Hathaway, 2007)
• To date, approximately 50,000 Canadians have obtained an authorization to possess cannabis for medical purposes
Universityof Victoria
Centre for AddictionsResearch of BC
CANADIAN MEDICAL MARIHUANA SYSTEM
MMAR
ENDEDMARCH 31, 2014
MMPR
STARTEDAPRIL 1, 2014
Universityof Victoria
Centre for AddictionsResearch of BC
A STEP IN THE RIGHT DIRECTION
THE MARIHUANA FOR MEDICAL PURPOSES REGULATIONS (MMPR)
The most significant change in medical cannabis access since 2001, the MMPR were implemented by Health Canada in December 2012, and went into full effect on April 1st 2014
• Simplified/decentralized application process
• NPs can prescribe (maybe)
• Multiple Licensed Producers
• Increased quality control
• Increased strain/symptom awareness
Universityof Victoria
Centre for AddictionsResearch of BC
CURRENT LICENSED PRODUCERS
Aphria
Bedrocan Canada Inc.
Broken Coast Cannabis Ltd.
Canna Farms Ltd.
CanniMed Ltd.
CannTrust Inc.
Delta 9 Bio-Tech Inc.
In The Zone Produce Ltd.
MariCann Inc.
MedReleaf Corp.
Mettrum Ltd.
OrganiGram Inc.
The Peace Naturals Project Inc
Tilray
Tweed Inc.
Whistler Medical Marijuana Corp.
Universityof Victoria
Centre for AddictionsResearch of BC
MMPR AUTHORIZED ACTIVITIES PERFORMED BY TILRAY
SEED1
PROCESSING5
SHIPPING / DISTRIBUTION8
GROWING / CULTIVATION3
STORING6
TECHNICAL SERVICES /FINANCIAL INSURANCE10
TE
ST
ING
/ R&
D
6
DISPOSAL / WASTE STREAMS9
HARVESTING4
PACKAGING / LABELLING7
PROPOGATION2
Universityof Victoria
Centre for AddictionsResearch of BC
TILRAY SUMMARY
Scale
Investment
Location
Taxes
Product
Technology
Jobs
Nanaimo BC
65,000 SF facility with over 34,000 SF of production space
25+ million invested
over 120 direct jobs
Cutting edge technology & production practices
Dozens of strains, including many high CBD varieties
Significant contribution to local tax base
Universityof Victoria
Centre for AddictionsResearch of BC
TILRAY RESEARCH STRATEGY
Phase 2 placebo-controlled clinical trial agreement with the University of British Columbia to examine the therapeutic potential of medical cannabis on the symptoms of PTSD
• 40 participants; military and police veterans and other survivors of physical violence.
• Study will compare vaporized cannabis of varying cannabinoid concentrations to placebo
• Health Canada and UBC review and approval process in Spring 2015
Pilot studies of cannabis-based preparations in the treatment of paediatric epilepsy
• New York State
• New South Wales, Australia
Patient patterns of use research
• University of Victoria
Universityof Victoria
Centre for AddictionsResearch of BC
CANNABIS ACCESS FOR MEDICAL PURPOSES SURVEY (CAMPS)
The CAMPS questionnaire is a 414 question cross-sectional survey made available to Canadian medical cannabis patients online and by hard copy in 2011 & 2012.
With 628 responses so far, the Cannabis Access for Medical Purposes Survey (CAMPS) is the largest polling of Canadian medical cannabis patients to date.
Universityof Victoria
Centre for AddictionsResearch of BC
CANNABIS ACCESS FOR MEDICAL PURPOSES SURVEY (CAMPS)
DEMOGRAPHICS
Universityof Victoria
Centre for AddictionsResearch of BC
CANNABIS ACCESS FOR MEDICAL PURPOSES SURVEY (CAMPS)
Fig. 1. Primary medical conditions treated with cannabis by authorization. Note: Sleep Disorders, Attention Deficit Disorder, Fibromyalgia, Hepatitis C, Parkinson’s Disease, Wilson’s Disease, Scleroderma, Tourette’s Syndrome, and unspecified Psychotic Disorder Conditions each
comprised less than 2% of the sample and were aggregated into the category ‘Other’. The anxiety and mood disorders category included 35 participants who reported a primary illness/condition of anxiety, 34 who reported depression and 40 who reported both anxiety and depression. Comparisons
of these groups indicated equivalent profiles with regard to demographic characteristics, health, and use of CTP, and were therefore aggregated for statistical analyses; n = 502 * = difference between proportion Health Canada Authorized and Unauthorized p < 01.
25.00
PERC
ENT
REPO
RTIN
G
HIV / A
IDS
ARTH
RITIS
SPINA
L PAIN
AN
XIETY / DEPRESSIO
N*
CAN
CER
EPILEPSY
MU
LTIPLE SCLEROSIS
GA
STRO-IN
TESTINA
L*
CHRO
NIC PA
IN
OTH
ER
20.00
15.00
10.00
5.00
0.00
ALL
HEALTH CANADA AUTHORIZED
NOT HEALTH CANADA AUTHORIZED
PRIMARY MEDICAL CONDITIONS TREATED WITH CANNABIS
Universityof Victoria
Centre for AddictionsResearch of BC
CANNABIS ACCESS FOR MEDICAL PURPOSES SURVEY (CAMPS)
CHARACTERISTICS OF CANNABIS USE BY CONDITION
Universityof Victoria
Centre for AddictionsResearch of BC
SUBSTITUTING CANNABIS FOR PRESCRIPTION DRUGS, ALCOHOL AND OTHER SUBSTANCES
V1.0
80%PRESCRIPTION DRUGS ALCOHOL
52%ILLICIT SUBSTANCES
32%87%
PERCENTAGE OF PATIENTS WHO USE CANNABIS INSTEAD OF OTHER SUBSTANCES
• Reasons cited: “better symptom management” and “less adverse side-effects”. • Patients who listed a greater number of symptoms were more likely to report cannabis substitution.• Younger patients (30 & younger) were far more likely to substitute cannabis for
prescription drugs, alcohol and illicit substances than older patients (50 & older).
MEDICAL CANNABIS PATIENTS’ SUBSTANCE SUBSTITUTION
Universityof Victoria
Centre for AddictionsResearch of BC
DISCUSSION
V1.1V1.0
SUBSTITUTION FOR PRESCRIPTION OPIATES
With the recent rise in pharmaceutical opiate addiction (Dhalla et al, 2009; Fischer et al, 2008; SAMHSA 2007), and an associated increase in opiate-related morbidity and mortality (Moore et al 2007), cannabis may prove to be a safer substitute to address chronic pain issues in patient populations.
Universityof Victoria
Centre for AddictionsResearch of BC
DISCUSSION
V1.1V1.0
SUBSTITUTION FOR ILLICIT SUBSTANCES
Evidence suggesting that cannabis might be an effective substitute for opiates, crack/cocaine, crystal meth and other illicit substances could be part of a public health-centered harm reduction strategy aimed at reducing disease transmission and overdoses stemming from injection drug use.
SUBSTITUTION FOR ALCOHOL
Public policies informed by evidence that cannabis might be a substitute or actual treatment for alcohol addiction (Lucas 2013; Reiman 2009, 2006; Mikuriya 2004) could have a significant impact on overall rates of alcoholism, as well as alcohol-related automobile accidents, violence and property crime.
THANK YOUQUESTIONS?
PHILIPPE LUCASVICE PRESIDENT OF PATIENT RESEARCH & SERVICES, TILRAYCENTRE FOR ADDICTIONS RESEARCH OF BRITISH COLUMBIA