Despite that fact that medical cannabis has been around in Canada in one form, or another since 2000 – almost 20 years now – there seems to be little traction that has been gained in the medical cannabis space. Over the past few years the emphasis has been put almost solely on marketing recreational cannabis, which became legal in Oct. 2018, and was revised to include edibles October of this year. With almost 18 years of a head start, why is it that medical cannabis has taken a back-seat to recreational cannabis? There were a number of theories as to why this is and these were all tabled at the Alpha Women Future of Medical Cannabis conference that took place last week in Toronto.
The theories as to why included;
The stigma that still exists among patients and their perspective on cannabis use.
Doctor’s hesitance to want to prescribe cannabis, especially in view of the lack of understanding as to proper dosage and the uncertainty around the strains that are being prescribed.
There was a wholesale thought that the recreational market was going to be much larger than in fact it has been. More marketing dollars were dedicated to the recreational market, and in retrospect, likely irresponsibly.
“The political promise was not go give cannabis to everybody. The political promise was legalize, regulate, and restrict access to cannabis.” Will Stewart – Harvest One
Perhaps the single biggest reason however is due to government control. There is no differentiation between recreational cannabis and medical cannabis that is for sale right now in Canada. It is taxed the same, it is the same production, governed by the same act, it follows the same format, and the exact same plants that are grown side by side could be medical or recreational.
Will Stewart, Senior Vice President of Harvest One, and one of the two key note speakers at the event further corroborated this theory. “The political promise was not go give cannabis to everybody. The political promise was legalize, regulate, and restrict access to cannabis. That was the mind set of the elected officials when they wrote the platform. The civil servants perspective? Medical and recreational cannabis must be treated the same, taxed the same, packaged the same, so people do not seek medicine as recreation. This is the mind-set of Health Canada. Even they don’t see it (cannabis) as medicine. “ Stewart continued “ I suggest that we have actually stalled on medical cannabis. We got medical cannabis regime through a non-traditional way but not much has changed since then. We are still selling raw flower and oil. We still haven’t got to a place where clinical studies are happening on a large scale. You can still only buy this either directly from a licensed producer, or a cannabis store, so people are self-medicating.”
“Clinicians are working in an environment where this environment was thrust upon them.” Jai Sharma, VP Medical Communications, FUSE Health
According to the results of a recently released Stats Canada report Oct 30 2019, seniors are the fastest growing demographic of cannabis users in Canada. This is not entirely surprising considering that many seniors are using cannabis to treat age related ailments. Additionally, the delivery means for cannabis consumption have evolved to include methods that aren’t solely smoking related, which too explains why there has been a surge in senior use. With more people seeking cannabis related treatments for various medical conditions, physicians are faced with a difficult challenge of how to address these requests. There is little clinical evidence, a lack of understanding of dosages and strains, and few devices designed to monitor and control dosing – leaving many physicians still uncomfortable adopting cannabis as part of their treatment regime. Jai Sharma, VP Medical Communications, FUSE Health, who participated on the four person panel that evening explained it this way, “Clinicians are working in an environment where this environment was thrust upon them. At the out-set, the mindset of the clinician was, I don’t really want to participate in this framework that is being thrust upon me. I don’t have the information to educate the patients on the questions that are being asked.”
What was generally agreed upon by all participants that evening was, if we are going to see an increase in overall prescribed medicinal use of cannabis, physicians have to have the backing of clinical data. In order to do that however, licensed producers would have to have millions of dollars to support these trials. Over the past several months though, what has become abundantly clear, is these LPs simply don’t have the funds to support such an endeavour. Dr. Phillip Olla, one of the panel members, and CEO of Audacia Bio put it this way. “Yes we need that evidence before they prescribe, but there is no process to get that data that they actually need to get that evidence. So, it puts them into a little bit of a conflict of what do we do, how do we get the data in order to prescribe.” Olla went on to say that Audacia Bio has done a number of interviews with Doctors and GPs and asked the question “Would you prescribe cannabis?” Only 6% of GPs and Doctors would prescribe cannabis to their patients. As he puts it, “Most of them (doctors.) when they get a patient in front of them, do you know what they do?”, Olla added “ They kind of shove them away. Go and talk to a cannabis clinic. Go and have a phone call. They push you away because they are just not comfortable with the question. They are not comfortable with what product they need to prescribe, what dosage they need to give or, as simple as “what is sativa, what is indica”. They literally have no data about how to expect cannabis. What can we do about it? There are lots of advocates, there are lots of great companies, there are lots of great technology out there. The point is WE need to generate the data. There is no magic clinical trial fund that’s going to create the data that we need. ”
Recognizing that there is a wholesale problem with the medical cannabis space can also be evidenced by the Stats Can data that was released earlier this year, which showed that medical cannabis licenses rose nationally from Oct 2018 to June of 2019 by just over 18,000. The biggest rise was Ontario which saw an addition of over 20,000 licenses where at the same time, Alberta fell by almost 16,000. It can’t be ignored that the province of Alberta has more than 300 retail outlets, even though its population (4.3 million) is less than one-third the size of Ontario’s which has fewer than 30 stores.
This begs the question, what can be done to get this back on track. Olla has an idea. “One of the things that we have been doing is looking how we crowd source cannabis data using clinical trial models. We are not shortcutting – we are using the same processes, same models, same ethical approval, same random control observations. Everything is the same. The only difference is the price tag. A trial that is crowd sourced using advanced technology like Artificial Intelligence and Block Chain could run a lot cheaper than your traditional clinical trials which are millions to do 1 phase. The idea is can we bring enough people on board who are involved in the cannabis space to cooperate and share data and technology. That is the challenge we have. Can we all get together to figure out how to solve this big data gap by cloud-basing. And, once we can get over that hump, I think we will start to get somewhere”.
Kristina Shea, Director or Marketing at Rapid Dose Therapeutics, had this as an answer. ““It is really about educating the consumers about a product which you are not allowed to advertise, but if we can tick those boxes and we can get out there and talk to people at events like this, it will be an advantage”
Will Stewart of Harvest One had the most concise list of actions that needed to be taken and they were as follows:
“If we can provide differentiated format for consumption, we can actually start to differentiate recreational cannabis from medical cannabis and then we start to get traction and can move forward with creating proper medicines in traditional ways”
“I think we have to talk about our cannabis consumption both recreationally and medically”
“I think we actually have to show other non-cannabis users that it is not the end of the world to actually consume a little cannabis now and again.”
Will Stewart – Harvest One
Stewart may have summed it up best this way. “You use Heroin. You don’t use wine, you consume wine, and you consume cannabis, you don’t use cannabis. We have to change our language”.