Most medical cannabis users aren't going the prescription route, raising safety concerns: Manitoba-led study

A new report led by the University of Manitoba suggests the majority of Canadians who consume medical cannabis aren't being prescribed the drug, but rather are getting it through the recreational market, raising some health and safety concerns.

In Canada, cannabis can be legally accessed recreationally or through a medical cannabis licensed seller with a medical authorization, similar to a prescription. Among people who use cannabis for medical needs, rather than for recreational purposes, two-thirds of people use it for chronic pain, mental health or sleep issues, the report said.

Over half of the 5,744 Canadians surveyed for the study published on Tuesday obtained their cannabis without medical authorization.

"This raises real concerns around safety," said principal investigator Lynda Balneaves, a professor in the College of Nursing at the University of Manitoba, who says she intends to publish the report in peer-reviewed journals.

The people who consumed cannabis without a medical authorization were 20 per cent less likely to speak to or seek information from a health-care professional and 16 per cent more likely to rely on unqualified sources of information, including social media and staff at the recreational cannabis store, the study found.

These people without a prescription were also 14 per cent more likely to report not knowing how much cannabis they were taking and seven per cent more likely to experience side-effects.

Balneaves says some survey respondents got their cannabis products from family or friends or from unregulated sellers online.

"It raises concerns in terms of has that product gone through good manufacturing processes? Could there be a potential for contamination? Is the labelling on that product accurate in terms of the amount of THC, the cannabinoid that makes people feel high? It may not be accurate, and then that potentially could lead to people experiencing more side-effects," she said.

Most survey respondents reported minor side-effects like a cough and feeling tired, but some reported very severe nausea and vomiting, dizziness and even experiencing falls because they had taken more THC than expected, Balneaves added.

Dr. Paul Daeninck, a palliative care physician out of Cancer Care Manitoba, wasn't involved in the study, but has been prescribing cannabis for 20 years. Daeninck wonders whether people rely on the expertise of salespeople at recreational pot shops, who aren't medical professionals.

"That's a little scary," he said.

Financial burden of medical cannabis

There's also a financial barrier for people who have gotten an authorization from their doctor to buy medical cannabis, the study found.

Less than six per cent of people with a medical authorization said they received insurance coverage for the cost of their medical cannabis, and they reported spending 25 per cent more for cannabis than those without medical authorization, the study found.

Nearly half of those who stopped taking medical cannabis did so because it was too expensive, the report said.

"People are telling us that they're either stopping using medical cannabis or they're walking away from the legal market because they just can't afford it," Balneaves said.

When non-medical cannabis was legalized, she thought the underground market would disappear, but cracks in the regulated system has left room for people to access the drug that way.

"I was kind of shocked that the market hasn't stabilized in a way that's supported people to use a safe supply of medical cannabis."

Recommendations to improve access

The report, developed with McGill University and in consultation with the patient groups Medical Cannabis Canada, SheCann Cannabis and Santé Cannabis, made a number of recommendations to improve the medical cannabis system and its users during the federal government's current review of the Cannabis Act and regulations.

The report's recommendations include:

• A formal evaluation of the medical cannabis framework in consultation with patients.
• Changes to reduce out-of-pocket costs associated with medical cannabis.
• To add community pharmacy dispensing.
• To maintain reasonable access to cannabis through a dedicated medical framework.
• To maintain a federally-run hub that provides updated information and resources about medical cannabis.
• To create healthcare professional education training focused on medical cannabis.

Daeninck believes training for health-care professionals will help reduce stigma about the drug, which he thinks is part of the issue with people not going to their health-care providers for medical marijuana.

He also thinks health-care professionals are unfamiliar with prescribing it because they aren't taught to do so in their training.

"Because they don't have that knowledge, they don't have that experience. I think that's where some of the biggest barriers are happening," Daeninck said.

The physician hopes the study will help highlight the deficiencies in the medical cannabis system for those in power.