Opinion

Phasing out medical cannabis would leave pediatric patients in the lurch

If cannabis is phased out of the medical stream, and access for children and youth is prohibited under the recreational stream, how will these young patients get access to the cannabis treatments they need?

The Canadian Medical Association has floated the idea of eliminating the medical cannabis access system

If cannabis is phased out of the medical stream, and access for children and youth is prohibited under the recreational stream, how will these young patients get access to the cannabis treatments they need? (CBC)

Physicians in Canada are prescribing cannabis. They have been doing so for years, and will likely continue to do so after recreational cannabis is legalized this fall. But the Canadian Medical Association (CMA) says that doctors in Canada want to see the phasing out of the medical cannabis access program once pot is legalized. And no doubt, some do.

But this position is shortsighted, for all sorts of reasons. First off, over 13,000 of the CMA's own members are currently prescribing cannabis in their practices, and over 296,000 Canadians across the country regularly use cannabis for a medical condition.

The CMA's position on cannabis for medical purposes is that there is "insufficient evidence on risks and benefits, the proper dosage and potential interactions with other medication." However, this view ignores thousands of peer-reviewed journal articles and studies that provide evidence of the efficacy of cannabis use for some medical conditions — chronic pain, as one example. While we do not deny that more clinical studies are needed, surely the publishing of over 10,000 peer reviewed articles signals that the use of cannabis in medical treatment is not some fringe endeavour.

There are numerous risks in eliminating a medical stream of cannabis access — risks that include things like the loss of guidance around dosing and administration, contraindications to cannabis use, screening for dependency risk and potential drug interactions. Essentially, it ignores the realities physicians are facing on the ground.  

Cannabis for pediatric patients

But there's one critical topic that has been left completely out of consideration regarding the issue of narrowing cannabis access to just the recreational stream: youth under the legal age of access.

Currently, pediatric populations can access cannabis legally through the Access to Cannabis Medical Purposes Regulations (ACMPR), which does not specify a minimum age of access. While most provincial physician colleges recommend not prescribing to young people under the age of 25, it is up to physician discretion.

But if we were to dissolve the ACMPR, there would be no mechanism for physicians to prescribe cannabis for pediatric patients. The Cannabis Act, which will legalize recreational marijuana in October, makes it a criminal offence to give cannabis to minors and includes a maximum penalty of up to 14 years in prison. So if cannabis is phased out of the medical stream, and access for children and youth is prohibited under the recreational stream, how will these young patients get access to the cannabis treatments they need? The CMA, to our knowledge, has yet to acknowledge this quagmire.

The cost for many children (and adults) using cannabis daily or near-daily can exceed $1,000 per month.

Many families currently rely on cannabis to treat a variety of issues affecting their children, such as epilepsy, autoimmune diseases and cancer. There are also families that turn to cannabis for conditions that lack therapeutic options and are not understood — rare genetic conditions such as Dravet syndrome, for which a recent randomized controlled trial showed positive results.

Parents have rightly expressed concern and frustration with the CMA's position. Some worry that particular cannabis products available from licensed producers — products that appeal to medical consumers — will be eliminated under a single stream of non-medical access.

And while cost continues to be a significant barrier for medical cannabis patients, without a medical cannabis access stream, it is unlikely cannabis will ever be covered by health insurance plans. The cost for many children (and adults) using cannabis daily or near-daily can exceed  $1,000 per month. 

Studying medical cannabis

Finally, while we have been seeing research interest grow in pediatric uses of medical cannabis, there's a risk that this interest in this area will dry up with added regulatory and legal barriers to studying medical cannabis. That is, unless a new legal pathway is drawn for medical access for minors. 

Other professional health care bodies, such as the Canadian Nurses Association and the Canadian Pharmacists Association, continue to support a separate medical stream for cannabis. The Canadian Pharmacists Association, in fact, launched a foundational cannabis course in 2017, a program that has since expanded to keep its members up to date with the changing regulatory landscape and evidence around cannabis as medicine.

The CMA, however, continues to lag behind. The therapeutic use of cannabis is not taught in medical schools, and many physicians simply do not feel equipped to authorize medical cannabis for their patients due to their lack of education on the subject. Eliminating the medical access stream will likely make this worse.

And pediatric patients — and their parents — will be the ones who struggle most. While we continue to advocate for, participate in and lead the development of ongoing research around the medical and instrumental uses of cannabis, when it comes to the CMA's position on the medical cannabis program in Canada – please consider the children.

Jenna Valleriani, PhD, is a postdoctoral fellow in Vancouver who studies cannabis and vulnerable populations, and a strategic advisor for Canadian Students for Sensible Drug Policy.

Dr. Caroline Maccallum is an internal medicine specialist with expertise in complex pain and cannabis. She is also a clinical instructor in the Department of Medicine at UBC and medical director at Greenleaf Medical Clinic. 

This column is part of CBC's Opinion section. For more information about this section, please read this editor's blog and our FAQ.