Health

How To Navigate Canada’s Medical Cannabis Maze

The confusion is understandable—but there are several good reasons to cut through it.

A image of a marijuana leaf.

(Getty Images)

Every day, dozens of women across Canada visit the Facebook group SheCann: Empowering Canadian Women to chat about medical cannabis. Its almost 5,000 members spill the cannabis-infused tea on everything from the most effective products for period pain and migraines to how to bake the best bud brownies. They also share tips on the basics, like how to access medical cannabis in the first place and how to write it off on your taxes.

“Medical cannabis can be complicated and overwhelming,” says Ashleigh Brown, who founded the group. “Women can feel very alone and ashamed. SheCann is a safe space that allows them to get resources, information and support.”

Brown, who lives in Winnipeg, created SheCann in 2017 after stumbling her way through the medical cannabis system in an attempt to reduce the number of seizures she has due to an unknown condition. Thanks to the drug, she’s down to between 15 and 30 seizures a month, from a high of 150 to 180. “This medicine gave me back my life, so I felt an obligation to help others,” she says.

Medical cannabis has been legal in Canada for about two decades, and there are more than 350,000 registered patients. Despite that, it’s still difficult to find information and guidance on using it. Confusion is understandable: Cannabis comes in several forms, including oils, edibles, topicals and classic dried flower, and there are thousands of cultivated varieties (cultivars for short) with hipster names like Penelope, Zula and Nollia.

And while cannabis has been touted as a treatment for a wide range of ailments, including pain, nausea, insomnia, anxiety and even low libido, there’s a lack of high-quality research to support some of these claims.

“You can find people proposing cannabis as an effective therapy for all kinds of things,” says Jason Busse, who researches medical cannabis at McMaster University in Hamilton, Ont.

“We have increasing demand, enormous variability in products and tons of advertising making all kinds of claims, many of which we don’t have the evidence to know if they’re true or not,” he says.

The dirt on plant medicine

Researchers think there’s potential for cannabis to treat a wide range of conditions because it acts on the endocannabinoid system, which has receptors throughout the body and helps regulate a variety of processes, including pain, mood, movement, appetite and sleep. Reliable studies lag in part because the endocannabinoid system was only discovered in the 1990s and, until very recently, cannabis was illegal.

“It’s hard to do research on illegal products,” says Busse. And it’s still not easy to get Health Canada approval for clinical trials: “We have to play catch-up now.”

Type cannabis into PubMed (Google for medical research) and you’ll get more than 23,000 hits for studies on the drug, including research into whether it can treat conditions ranging from ADHD to COVID-19. But there haven’t been many placebo-controlled studies, which are necessary to accurately determine the benefits and harms of any drug.

About two-thirds of medical cannabis patients use it to manage chronic pain, so much respectable research has focused on this area. Busse and his colleagues
recently completed a systematic review of relevant placebo-controlled studies and found that 10 percent of people who used cannabis for chronic pain had reduced pain, six percent had improved sleep and four percent had improved physical functioning. A small percentage also reported side effects, like drowsiness and nausea.

“There is evidence for a small but significant effect on pain reduction,” says Busse. He says some women with chronic pain are trying to reduce or eliminate their opioid use by consuming cannabis instead: Early research indicates that opioids and cannabis are similarly effective in treating chronic pain, but cannabis is much safer.

Dr. Carolina Landolt, founder of Summertree Medical Clinic, a cannabis chronic-pain clinic in Toronto, says the drug isn’t a cure but can help alleviate symptoms. “It’s one more thing to try in a limited list of options,” says Landolt, a rheumatologist. Even a small reduction in pain can mean better sleep and mental health: “All of that is going to greatly improve quality of life.”

People are also exploring whether they can trade in antidepressants for cannabis. A 2019 McMaster University study found that 30 percent of medical patients were trying to treat a mental health issue. More than 90 percent said cannabis improved their symptoms, and nearly half said it replaced their other medication. Again, more research is necessary, as the authors noted the possibility of a placebo effect.

It’s important to note that cannabis can have negative short- and long-term health effects. The risks vary depending on how and how often you consume the drug. Vaping cannabis concentrates—particularly from unlicensed sources—has been linked to serious lung illness and even death.

The DL on getting an Rx

Family doctors should be the first stop for people interested in treating a medical issue with cannabis. But in a qualitative study of family physicians in Ontario, Busse found that many lack the training and information needed to counsel their patients. A lot prefer to not get involved at all. Those who do usually refer patients to specialized clinics, though some worry that the bar to get a prescription can be very low.

Cannabis clinics are different from dispensaries. Clinics are staffed by doctors and don’t sell cannabis directly, while dispensaries—both the ones authorized by provincial governments and the ones that aren’t—sell cannabis to recreational customers.

There are hundreds of cannabis clinics across the country, but they aren’t all created equal. Some require a doctor’s referral; others don’t. Some do appointments exclusively online or over the phone; others have appointments in person (COVID-19 notwithstanding). Some charge fees, while others are free.

If a clinic doctor determines that cannabis could help, they will write you a prescription that allows you to grow your own, designate someone to grow it for you or, as most patients do, purchase it from one of Health Canada’s 200-plus licensed producers (LPs). Your prescription will detail how much cannabis you can consume daily and for how long.

Patients planning to buy from an LP need to register before being able to order online—most people register with one LP, but it is possible to split your prescription between two or more, or register with an LP aggregator, such as Shoppers Drug Mart, that sells products from several. Clinic counsellors often help with LP registration and advise on what products to try, but it’s important to note that many clinics are paid by LPs to funnel patients their way.

“A lot of medical cannabis clinics are business enterprises, and patients are the commodity,” says Landolt, who doesn’t accept kickbacks because she says it’s “dishonest to my patients.”

She recommends new patients start with a big LP that’s been around for a while. “You don’t need a producer selling cannabis that’s highly curated, artisanal, grown in the foothills of wherever and carefully tended by monks,” she says. “You need your [big-box store] experience: big, bland, reliable.”

But why bother going the medical route when you can just saunter into a dispensary, chat with a budtender and access a wider variety of products? There are a few good reasons. For one thing, some medical cannabis products, such as high-potency CBD oil, are only available through LPs. As well, Health Canada requires all legal products to be laboratory tested to ensure they’re free of pesticides and other harmful contaminants, and to determine the concentration of cannabis’ two main active compounds, tetrahydrocannabinol (THC) and cannabidiol (CBD). What’s more, there are no guarantees that products from illegal dispensaries are safe or labelled accurately.

You can also save some money by going the medical route. Medical cannabis is generally less expensive than recreational, can be claimed as a medical expense on your taxes and is covered by some insurance companies. Several LPs even have compassionate pricing for people with low income. As well, the budtender at your local dispensary isn’t legally permitted to give you medical advice. That said, Brown found her sessions with doctors and counsellors at cannabis clinics were woefully inadequate.

“I was left adrift,” she says. The people she consulted weren’t able to advise her on dosage amounts or offer information on taking cannabis alongside other medications, even though there are almost 400 known drug interactions.

Landolt says clinics need to do more than simply fill out paperwork and send patients on their way. She says a medical assessment should include a history, a physical, an evaluation of other medications and drug interactions, a prescription and an eventual re-evaluation.

New patients should be taken through a logical, gradual, stepwise approach to testing the various products, she says. This can take a lot of time, which is at odds with most clinics’ volume-driven revenue model. “If you are doing that, you’re not making money in this industry,” says Landolt.

Cannabinoids, cultivars and terpenes—oh my!

In the absence of adequate information, education and guidance, a new profession has cropped up: the cannabis coach. She might have gone to “cannabis college” (there are now several institutes offering programs) and can teach you the ABCs of cannabinoids: the differences between THC and CBD; cultivars (plant varieties); and terpenes (organic compounds that produce unique tastes and smells).

Andrea Meharg became a coach after a long, frustrating process of figuring out what products, ingestion methods and doses would work best for managing her depression and anxiety. “The cannabis world is enormous,” says Meharg, who runs Reveal Cannabis, a coaching company in Parkhill, Ont. “Having someone who can hold your hand and answer your million questions is really important.”

That’s what she does via one-on-one consultations, online and (pre-pandemic) in-person workshops and retreats. A consultation—which includes a 30-minute phone conversation, a personalized cannabis guide and a month of email support—costs about $150.

Meharg walks newbies through a simple three-step process: determine your goal, choose your consumption method and, if you’re going to inhale, look at the terpenes. She also helps clients navigate the medical cannabis system, often referring them to a clinic she trusts (the clinic gives her kickbacks and is associated with an LP, which she always discloses to clients).

For potential medical users, determining your goal involves identifying what symptoms you’re trying to manage, and understanding how THC and/or CBD might help. THC gets you high, while CBD doesn’t, and they have different and overlapping potential therapeutic benefits. Meharg points out that THC is an appetite stimulant, CBD is an anti-inflammatory, and both are muscle relaxants.

All cultivars have various amounts of these two components, with products offering higher THC, higher CBD or a more balanced experience. Meharg’s top tip for beginners is to “start low and go slow” with THC. Some doctors put a THC cap on prescriptions to ensure patients don’t get too high.

Next is choosing how to consume the drug. The two most popular options are inhaling—smoking a joint or using a vape—or ingesting orally, through an oil, capsule or edible. There are also synthetic prescription cannabinoids, such as Sativex, for pain associated with multiple sclerosis, and Cesamet, for nausea and vomiting associated with chemotherapy. Other options include topicals, such as lotions or salves, for aches and pains.

The effects of the drug differ depending on the method. Inhaled cannabis typically takes effect within minutes, and the results last for two to four hours. Ingested cannabis can take 30 minutes to four hours to take effect, and results can last for eight hours or longer. It’s important to match the mode of consumption to the problem: For instant relief of a migraine, inhaling would be the way to go; to ease chronic pain throughout the day, a capsule might be your best bet.

If you decide to smoke or vape dried flower, the next step is exploring the terpenes, which influence your experience. “For example, strains that smell like lemon and pine are very likely to make you feel bright and uplifted. Strains that smell skunky and earthy are very likely to make you feel sleepy,” says Meharg.

Even after going through this three-step process, there can still be a lot of trial and error, and Meharg advises clients to play around with methods, products and doses for a couple of weeks.

“It’s always my biggest fear that somebody will try cannabis once, have a bad experience or not have any experience and then say, ‘Oh, cannabis didn’t work for me’ and move on,” she says.

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