Legalization of Medical Cannabis in Canada

The MMAR regime allowed patients to obtain cannabis through personal or delegated production. This was replaced in 2014 with the MMPR and later ACMPR regimes that eliminated personal cultivation and rely exclusively on Licensed Producer shipments to authorized patients.

Concerned about illicit diversion, the government removed physicians from the responsibility of authorizing access to cannabis and instead imposed prescribing restrictions through the provincial Colleges that regulate physician licensure. These regulations vary across provinces.

Legalization

The Canadian government regulated medical cannabis use in the 1990s by permitting access to those who have physician-documented evidence of a severe health problem that cannot be managed by conventional therapies. Despite this regulation, most authorized users access the drug via illicit storefront dispensaries and unregulated growers.

The resulting illegal supply industry is lucrative, but it is also highly variable in quality and potency. In response to this, a number of stakeholders have challenged the legality of storefront dispensaries and unauthorized suppliers. These challenges have not resulted in the removal of these products from the market, but they have led to a number of reforms to provincial policy.

In 2016, Health Canada published the Marihuana Medical Access Regulations (MMAR), which replaced the previous regime. Under the new regulations, physicians could sign a medical document allowing their patients to purchase cannabis from a licensed producer, or alternatively, to cultivate the drug themselves or have a designated person do so on their behalf.

This paper analyzes data on the MMAR and its successor, the MMPR/ACMPR, to examine how these changes impacted rates of physician and patient participation in the program, as well as the prices and potency of medical marijuana sold by Licensed Producers. The authors also evaluate the fraction of the population using cannabis on a regular basis and how this has varied over time by province.

Regulations

The Canadian federal government has established a series of legislative and regulatory restrictions to safeguard public health. These include limiting the potency and daily consumption of cannabis, requiring cannabis to be in plain packaging, and preventing the sale of any product with an appearance, shape or another sensory attribute that appeals to youth. Additionally, the act requires all cannabis and accessories to be sold in child-resistant containers.

However, these measures have not reduced the number of people who use cannabis for medical purposes. In fact, the rate of cannabis use in Canada increased after the passage of the Act. This was mainly due to the increase in recreational use, but also because many people who previously used medical cannabis have now switched to the new legal market.

We estimated rates of daily cannabis use in each province and compared them to the fraction of people using medical cannabis. We found that rates of medical cannabis use tended to be higher in provinces with less stringent prescribing restrictions. This suggests that physician prescribing restrictions affect rates of participation in the medical cannabis access program.

Moreover, the volume of cannabis sales from Licensed Producers to registered patients has varied greatly across provinces. The highest volume was reported in Alberta, where per capita shipments were over ten times higher than those in British Columbia. We attributed this variation to differences in the willingness of physicians in each province to authorize cannabis use.

Taxes

In Canada, the federal government collects cannabis taxes and shares them with provincial governments. The federal tax rate is 5%, which includes the Goods and Services Tax (GST). In addition to this ad valorem tax, some provinces add an excise tax on cannabis. This varies from zero in Alberta and the Northwest Territories to 10% in some Atlantic provinces.

The first Canadian medical cannabis framework was promulgated in 2001 by Health Canada as the Marihuana Medical Access Regulations (MMAR). It granted access to people with physician-documented evidence of severe medical conditions that could not be adequately managed by conventional medications. Most patients accessed marijuana via personal or delegated production.

This program was replaced by the Marihuana for Medical Purposes Regulations (MMPR) in late 2013 and fully enacted in April 2014. The new regime allowed registered patients to purchase cannabis in dried form from Licensed Producers, which were regulated commercial vendors approved by Health Canada. It also revoked personal and delegated production.

Despite this, some physicians continue to authorize cannabis use, and the number of patients per prescriber rose from about five under MMAR to over 150 under the MMPR regime. This increase may be due to a higher willingness of physicians in certain provinces to authorize the use of cannabis, or to changes in regulatory rules by the provincial Colleges.

Access

Prior to legalization, medical cannabis in Canada was largely accessible through physician authorization. Most physicians who supported their patients’ use of cannabis used a standardized medical form. In response to concerns about illegal diversion, the government replaced this system in late 2013 with a new set of rules known as the Marihuana for Medical Purposes Regulations (MMPR) and the Access to Cannabis for Medical Purposes Regulations (ACMPR). This regime revoked the licenses that permitted cannabis production in the home and required authorized users to obtain their cannabis through mail-order from a licensed commercial vendor called a Licensed Producer.

A recent study of a random sample of approved users in Canada found that the rate of participation in the medical cannabis program increased after recreational legalization, but this increase was not the result of more people enrolling. Instead, the increase was due to more people getting their cannabis through routes that were outside the official medical access program.

The study used repeated cross-sectional surveys to examine the effects of legalization on medical cannabis use and perceptions. It also compared the rates of participants in the medical cannabis program to estimates from provincial population-based surveys on daily cannabis use. This allowed the researchers to estimate the percentage of the Canadian population that had ever tried cannabis. In addition, they compared the use of different delivery methods to determine which ones were preferred by approved users.