Across Canada, numerous stakeholders are becoming more active in the medical cannabis sector. The pan-Canadian group “Common Initiative for medial cannabis distribution in pharmacies,” made up of more than 25 organizations (pharmacist associations, patient groups, cannabis producers, pharmaceutical companies, chains and banners) has given itself the objective of convincing governmental decision makers to authorize the distribution of cannabis for medical use in pharmacies as quickly as possible. In Quebec, the Association québecois des pharmaciens propriétaires (AQPP) has also been holding discussions on this topic with different levels of government. The recent legalization of cannabis for recreational use has increased the urgency of resolving the issue of cannabis for medical use. In this context, is there is a window of opportunity to find a solution for distribution of medical cannabis following the legalization of its recreational use on October 17, 2018?

Since the adoption of legislation on medical cannabis in 2010, Quebec has been one of the most hostile Canadian provinces towards the prescription of cannabis, notably because of the obligation for patients to be registered on the Registre Cannabis Québec in order to obtain a prescription for medical cannabis use from a doctor. Producers and patients have pointed to the Registre as one of the reasons explaining why Quebec is behind in terms of prescription of medical cannabis. Last September, the Collège des Médecins du Québec (CMQ) updated its guidelines for the prescription of medical cannabis and ended the obligation to register patients on the Registre. In addition, the CMQ underlined that from now on, doctors can prescribe cannabis for medical use outside of the context of a research project, by respecting the new guidelines. Lastly, the CMQ recognized the emergence of new scientific data supporting the use of cannabis for medical reasons. All these elements will now favour the use of medical cannabis and will allow the number of prescriptions in Quebec to catch up with the rest of Canada.

Patient safety is at the heart of the issue for groups advocating for the distribution of medical cannabis in pharmacies. In their October 17 press release, the AQPP described the concerns of different actors: “Medical cannabis, as a product prescribed medically, should be treated like any other medication and be distributed in pharmacies, under the supervision of a health professional. With the arrival of the stores run by the Société québécoise du cannabis (SQDC), there is a real risk that patients under medical cannabis treatment decide to obtain cannabis at these stores, due to their proximity and ease of access.” In addition to the reasons presented by the AQPP, there is a clear price difference between recreational cannabis sold at the SQDC and the cannabis sold directly by producers, who are the only ones who presently have the right to provide medical cannabis to patients. The price of medical cannabis can be between 20 per cent to 73 per cent more expensive than recreational cannabis, depending on the product type and THC levels. In a context where a small percentage of insurances and third-party payers currently reimburse medical cannabis, it is quite possible that some people, for example those with low incomes, will be tempted to obtain a product similar to their prescription from the SQDC at a lower cost.
It is legitimate to question the reasons why the distribution of medical cannabis is still not allowed in pharmacies. On this question, the federal government and the provincial governments pass the buck to each other. Provincial governments argue that medical cannabis is under federal jurisdiction and Health Canada, and therefore cannot act on the subject. However according to the federal government, the provinces can act as without restriction on the ways medical cannabis is distributed in their territory. So, who should act? The update of the Access to Cannabis for Medical Purposes Regulations, which Health Canada published last August 24, does not specifically address the question of distribution. In the short term, one of the two government levels must initiate the process.

This is where the window of opportunity lies. Indeed, the new François Legault government has clearly indicated its intention to modify the existing legislation. The CAQ wants to increase the age at which cannabis can be consumed from 18 to 21 years old as well as restrict the places where it can be smoked. These legislative changes will force the government to submit a new bill, creating an opportunity to address the question of distribution of medical cannabis. Dr. Carmant, Minister responsible for this file, is familiar with the question of medical cannabis and it will be interesting to find out how open the CAQ will be on this sensitive subject.