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The Final Frontier

Canada’s legalisation of medical cannabis paved the way for recreational cannabis

Well, we did it. On 17 October, Canada became only the second country in the world to fully legalise recreational cannabis through legislation. And I have no doubt that our country will be different from where we were before legalisation.

How, I don’t know. But certainly different. However, let’s not forget that it was medical cannabis that led the way. And here are a few facts, points of view and perspectives around medical cannabis in Canada that may interest you and that you may be forced to consider in your own country in the near future.

We tend to think of medical cannabis as a recent phenomenon, but we’ve had legal medical cannabis in Canada since 2001. A lot has happened since then: George Bush was president of the United States, we had the 9/11 terrorist attacks and the iPod (not the iPhone) was invented. And if none of that blows your mind, the earth’s population was 6.2 billion and today it’s 7.6 billion. Which means that the entire population of China has been born since Canada legalised medical cannabis.

Here’s another thing about the use of medical cannabis in Canada. Using Health Canada’s Access to Cannabis for Medical Purposes Regulations (ACMPR) database, there are about 350,000 medical cannabis patients in Canada or ~1% of the population (see Figure 1). Not the millions of people and crazy percentages that sometimes get thrown around. And, yes, the numbers continue to grow. This is a good thing because it shows that clinicians are getting comfortable with medical cannabis as a treatment option and it shows that patients are asking for and demanding it.

Fig 1

The mind is a funny thing. When we hear a number like 350,000 and we know that Canada has ten provinces and three territories, we tend to think that there is an even distribution of medical cannabis users across the land. Wrong. More than 80% of the usage is driven by two provinces (see Figure 2). This is due to many factors and will certainly change over time but suffice it to say that medical cannabis is not a national trend in Canada.

Fig 2

Often, people say that there’s no evidence for the use of medical cannabis. What they really mean is that there’s no evidence for the use of medical cannabis in the way they would like to see the evidence: randomised- controlled trials, double-blind and placebo- controlled. That is true. But it’s hard to conduct clinical trials on a therapeutic agent that has been considered illegal for the better part of the last century. But we do have real-world evidence. We have millions of patient-years of data in various countries. We have emerging academic data that is published every year. And we have observational reports and case studies that can easily guide and inform our approach to the use of medical cannabis in the right patients for the right illnesses.

Something else we’ve learned in Canada is that people believe that the therapies we have for the conditions that medical cannabis can treat are good enough. Maybe. The Canadian Pain Society recently moved cannabinoid therapy up from a fourth-line treatment option to a third-line treatment option for neuropathic pain. Right behind opioids and gabapentin. We don’t need to talk about opioids – everyone knows the destruction they have caused. But let’s talk about gabapentin. In Canada and the US, gabapentin is indicated as an adjunctive therapy for patients with epilepsy, who are not adequately controlled with conventional therapy. So, when we talk about ‘good enough’ and whether we need medical cannabis as a treatment option, maybe we need to start thinking about our current treatment approach and whether that is ‘good enough’.

Prevalence is important too. Understanding how many people are affected by a disease at any given point in time helps us make better decisions. Some Canadian researchers attempted to answer this question about ten years ago. They sent questionnaires to households asking about self-reported pain frequency, intensity and persistency. Depending on how you interpret the results, anywhere from 19-44% of Canadians self-report as being afflicted with chronic pain. That, folks, is a lot of people. And we owe it to these people to make therapies available that have the potential to help them.

I don’t know exactly how this grand experiment with recreational cannabis is going to work in Canada. I suspect that things are largely going to be fine, with perhaps a few bumps along the way. But what I do know is that the legalisation of medical cannabis in Canada has been a tremendous achievement for the country’s patients and physicians. And if that is any indication of how well things are going to go with recreational cannabis, then we’ll be just fine.

Rohit Khanna is the Managing Director of Catalytic Health, a healthcare communication, advertising & strategy agency. He can be reached at:

7th November 2018

From: Healthcare


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