Medical Cannabis vs. Recreational Cannabis…. Why we need them both

By Chelsea Cox

The recent legalization of cannabis in Canada has captured headlines across the world, but Canadians have had access to legal cannabis for almost two decades – as long as they had a physician’s note.  

A Supreme Court decision in 2000 (R v Parker) lifted the complete prohibition on cannabis. The Court found that Canadians had a right to possess cannabis for medical purposes. In the years since the Parker decision, the country has experienced a slow lifting of prohibitive cannabis laws and the rapid development of a multi-billion-dollar industry.

Right now there are two Federal frameworks that govern cannabis in Canada, one for medical users and one for recreational consumers. Questions are arising as to whether we need two streams. Is access to recreational cannabis enough to meet medical user’s needs? The Canadian Medical Association 's formal position is that one stream is enough: 

“with legalization of cannabis now underway, we believe that a separate regulatory framework for medical use if no longer necessary, and look forward to working with the federal government to eliminate this framework as soon as possible.” (CMA, 2018)

This statement was met with instant pushback, with patients, medical professionals, researchers, and others questioning the CMA’s position. In short, many argued that the CMA’s position resulted in grouping medical cannabis users with recreational cannabis users, which both reinforced stereotypes and stigma’s that medical users had fought for decades to unravel, as well as ignoring a growing body of evidence.

Merging the two markets into one does have the clear benefits of reducing the administrative burden and streamlining the process for access and distribution. And indeed, someone smoking a Purple Kush strain when they get home from work can look almost identical to a medical user smoking a Purple Kush strain when they get home from work. But there are fundamental differences that need to be considered.  Medical patients using a drug to treat a condition is not the same as someone consuming a drug for pleasure.

The following five considerations help tease out why we need to keep two distinct frameworks:

1. Access

There are already shortages across Canada for accessing recreational cannabis. With many of the same producers now supplying the medical and recreational markets, medical users are already experiencing difficulty in accessing their medicine. These are individuals who are reliant on the drug to alleviate their chronic pain or minimize the occurrence of seizures (among other conditions). Maintaining a separate medical market is necessary to ensure access for those who rely of cannabis for medical reasons.

2. Market Incentives & Product Diversification

At the end of the day, cannabis producers are motivated by their bottom line – how can profits be maximized and value increased for shareholders? Recreational cannabis consumers and medical cannabis consumers buy different products for different purposes and in different quantities. If the market is pushed into one, there is no assurance that the products that medical users need will be available. There are far more recreational users than medical users in Canada and producers will naturally cultivate products that match this. Currently licensed producers can sell to both, but should the market be recreational only, producers have no incentive to create and sell products that medical users consume.

3. Insurance and Taxes

Medical cannabis can be claimed as a medical expense on an income tax return, and five major unions and employers cover medical cannabis for employees - including Veterans Affairs. Sunlife and Medavie Blue Cross have included medical cannabis coverage as part of their plans, with more insurance companies considering adding cannabis to their coverage list. Should markets be merged and medical cannabis eliminated, then the burden of the cost of cannabis which is necessary for a medical condition would likely fall on the individual.

4. Research

The legalization of recreational cannabis has opened the door to scientific research that can finally begin to uncover objective and current information about cannabis and its impact on the body. While research will continue regardless of whether there is a medical market or not, having a standalone market can incentivize research that looks at the potential therapeutic impact of cannabis. Researching cannabis’ potential medical application is fundamentally different than researching recreational cannabis interactions, and the former should continue to be supported, encouraged, and prioritized.

5. Stigma & Classification of User

A final consideration is the stigma of grouping those who use cannabis medically with those who use it recreationally. Smoking for pleasure is not the same as consuming to medicate. A separate medical framework validates the utilization of cannabis for medical purposes. Merging the market into one de-legitimizes medical users of cannabis’ reasons for using, and discredits thousands of anecdotal reports (and emerging scientific literature) of the positive benefits of cannabis as a therapeutic agent.

This is not a closed list. There are further considerations around travel exemptions, employee rights as a medical user, emerging research on cannabis’ potential as an alternative to opioids, monitoring drug interactions for medical users, the optimization of education served by the physician-patient relationship, and others. The Federal Government has only agreed to maintain the integrity of the medical cannabis market for the next five years, and will reconsider in 2023 whether its needed, Medical users fought hard to have their rights to address their medical needs recognized. Without their advocacy and decades long legal battles, the liberalization of cannabis in today’s world would be starkly different. Recognizing this, and recognizing the potential harms that would arise if the medical market is eliminated needs to have a place in conversations both current and future. Jurisdictions across the world are looking to, or have already created, medical markets that mirror Canada’s. To continue to be a leader we need to maintain our medical market integrity.