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Canadian HIV/AIDS Policy & Law Review

Minister Reaffirms Commitment to Provide Medical Marijuana, but Delays Continue

Amid ongoing doubts about the federal government’s commitment to provide marijuana for medical use, the first Canadian clinical trial of smoked cannabis has been launched, and a Senate committee has released its controversial and much-anticipated report.

Health Canada has been criticized for appearing to backpedal on a commitment to distribute Canadian-grown cannabis for therapeutic purposes. Health Minister Anne McLellan has responded to these criticisms, claiming that the government’s position has not changed, and that the delays are due to unanticipated quality-control issues with the crop produced by Prairie Plant Systems Inc in Flin Flon, Manitoba.

In a letter to the press dated 28 August 2002, the Minister reaffirms the government’s commitment to the two “parallel tracks” of the medical marijuana program: research to provide scientific evidence of marijuana’s risks and benefits, and the Marihuana Medical Access Regulations, which allow authorized people to possess and cultivate marijuana for medical purposes.[1][[1]1[1]] However, uncertainty still surrounds the question whether Health Canada intends to make the Flin Flon crop available for distribution to people authorized to use marijuana under the regulations (or whether the crop will be used solely for research).

Due to the unsuitability of the Canadian crop, the first Canadian clinical trial of smoked cannabis for people with HIV/AIDS, announced in October 2002 by the Community Research Initiative of Toronto and St. Michael’s Hospital, is using material from the US National Institutes of Drug Abuse. The study is investigating the safety and efficacy of smoked cannabis for appetite stimulation and weight gain in people with HIV. The 32-patient pilot study should conclude within six to 12 months and should provide data that will help design a larger and more conclusive clinical trial.

The Nolin Report

The paradox of Health Canada’s insistence on further clinical research, while failing to provide Canadian-grown research-grade marijuana, is only one of many issues raised by the report of the Senate Special Committee on Illegal Drugs, released in September 2002.[1][[1]2[1]] The committee, chaired by Senator Pierre Claude Nolin, was mandated to examine the social and health impacts of cannabis use, as well as Canadian and international policies and approaches toward cannabis. The committee’s report, which fundamentally challenges the federal government’s approach to cannabis use and to cannabis users (both therapeutic and recreational), has surprised many people and sparked considerable debate. Criticized by some as being too radical, the report’s recommendations have been applauded by many others.

Noting that billions of dollars in spending have failed to significantly affect the level of cannabis use in Canada, the Nolin report asserts that “it is time to recognize what is patently obvious: our policies have been ineffective, because they are poor policies.”[1][[1]3[1]] In 11 sweeping recommendations, the report proposes replacing Canada’s current prohibitionist stance with policies and practices that recognize that “used in moderation, cannabis in itself poses very little danger to users and to society as a whole.”[1][[1]4[1]] The report says that Canada should focus on preventing and treating risky and excessive use, and on more comprehensive and integrated research. Particularly relevant for people with HIV/AIDS is the Nolin report’s critique of the regulations governing therapeutic cannabis use.

The Marihuana Medical Access Regulations

The Marihuana Medical Access Regulations (MMAR), in effect since July 2001, define the process by which Canadians may apply for the legal right to possess and use marijuana to treat HIV or other medical conditions. These regulations have been widely criticized as unwieldy and overly restrictive – notably in a civil suit currently before the courts.[1][[1]5[1]] Applicants are required to obtain a detailed recommendation from a medical practitioner – something most physicians are unwilling to provide. Applicants must either grow their own plants or designate another individual to do so for them. Cultivation on rented property requires the landlord’s permission as well. Buyers’ clubs that provide marijuana to people with medical conditions remain illegal under the regulations.

The Nolin report’s analysis of the MMAR concludes that “the refusal of the medical community to act as gatekeepers and the lack of access to legal sources of cannabis appear to make the current regulatory scheme an ‘illusory’ legislative exemption and raise serious Charter implications.” The report states that “the MMAR are not providing a compassionate framework for access to marijuana for therapeutic purposes and are unduly restricting the availability of marijuana to patients who may receive health benefits from its use.” According to the report, “changes are urgently needed.”[1][[1]6[1]]

While the legal and political debates continue, patients and caregivers continue to be vulnerable to legal action. In August 2002, the Toronto Compassion Centre (a cannabis buyers’ club in operation since 1997) was raided and shut down by police. Four of the Centre’s personnel face criminal charges. Meanwhile, a group of individuals in Vancouver has opened what it calls Canada’s first marijuana factory. The facility intends to process marijuana plants into “THC balls” – concentrated pellets of tetrahydrocannabinol, the active ingredient in marijuana – that can be incorporated into food. Besides distributing its product to individuals with MMAR exemptions, the factory may also provide it to others who require it for medical reasons but have not received the exemption.

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