BC Compassion Club Society

Transcription

1 BRITISH COLUMBIA COMPASSION CLUB SOCIETY S SUBMISSION TO THE PROVINCIAL GOVERNMENT S BC CANNABIS REGULATION ENGAGEMENT October 31st, 2017 BC Compassion Club Society 2995 Commercial Drive, Vancouver, BC V5N 4C8

2 Introduction The BC Compassion Club Society ( BCCCS ) is a non-profit society that has been responsibly and openly providing cannabis therapies to critically and chronically ill patients for 20 years. We are the first cannabis dispensary in Canada, founded in 1997, and our model is unique. Last year, we provided 3400 non cannabis-related holistic healthcare appointments to some of Vancouver s most marginalized people, with little or no cost to our members. We have developed the gold standard for medical cannabis education and patient support. We are on the front lines of safe access, harm-reduction and communitybased healthcare. The BCCCS is offering 7 recommendations to assist the Government of BC in prioritizing and addressing patient needs. Cannabis legalization will affect some of the most vulnerable members of Canadian Society, particularly critically and chronically ill patients. The needs of patients must be prioritized in the process of legalizing cannabis for recreational consumption. Respect, Acknowledge and Protect Historical Canadian Cannabis Institutions Regulating the retailing and distribution of cannabis is the purview of the provincial government, it is therefore this government s responsibility to ensure the health care of Canadians is not unjustly and harmfully interrupted. The BCCCS has been catching marginalized patients falling through the cracks of the healthcare system for two decades. Many of our clients report they feel the Compassion Club has saved their life, without it they would be seriously suffering, or dead. Recommendation #1: The Government should give special consideration to Canada s historical medical cannabis institution, the BCCCS. Protect our subsidized wellness centre and standardsetting education services and dedicated suppliers. It is imperative that the health care services provided to the BCCCS s 11,833 members is not interrupted, and our unique knowledge is not lost. Colorado and Washington are examples of jurisdictions which prioritized transitioning long standing medical cannabis institutions into the new regulatory framework. a) Previous Acknowledgment and Recognition from Many Levels of Government The BCCCS has been supported and recognized by all levels of government and should be given special considerations and protection. The Vancouver Police Department has refrained from enforcement action on the BCCCS for over 20 years due to our commitment to patients, responsible and industry-leading operating practises, and overwhelming community support. The courts have repeatedly commended our work. The Senate Committee on Illegal Drugs (2002) recommended the BCCCS s unique model should be the standard for medical cannabis access and patient care across Canada. Libby Davies, former MP for Vancouver East granted us a certificate of congratulations on our 10th anniversary, May 1st 2007, for serving our community. Our model was enshrined into municipal by-laws by the City Of Vancouver (2015) to encourage the replication of our model. The founder and an early employee were selected by Senator Nolin to receive the Governor General s Diamond Jubilee Medal, acknowledging their significant contribution to Canada for their work with the Compassion Club. Members of the Task Force on Cannabis Legalization and Regulation, including Chair Anne McLellan, visited the BC Compassion Club Society. In the press conference releasing their report, McLellan said: What we learned there, putting aside certain issues of illegality; is that there can be a holistic, wellnessbased approach, street-level approach, that serves generally, highly marginalized populations and that this is a model that the report references and suggests the governments should take a look at going forward. The BCCCS worked with The Arthritis Society and Canadians for Fair Access to organize and host a special meeting of patients for the Task Force, September We are the sole cannabis related organization that has been invited to participate in the Health Canada s Partnership Symposium on Cannabis Public Education and Awareness We continue to offer our experience and expertise to all levels of government and would like to extend a formal invitation to visit the BC Compassion Club Society to all members of the BC government. b) Additional Healthcare Services Last year alone, the BCCCS subsidized 3400 holistic treatments including: acupuncture, clinical counselling, clinical herbal therapies, craniosacral therapy, nutritional counselling and massage. We catch many patients falling through the cracks in the healthcare system. Patients across the country deserve the level of care provided by the BCCCS. Waitlists are up to 4 years long to see range of our practitioners as we are inundated with

3 referrals from physicians and patient service providers. Patients given access to affordable holistic healthcare are often able to manage their conditions more effectively, and as a result, require less cannabis to manage their symptoms. c) Education Patients, especially those new to using cannabis as a therapy, require significant and ongoing education in order to maximize benefits and minimize risks. Each new patient at the BCCCS receives an individualized minute intake and education session. This standard of care should be available for all patients exploring medical cannabis as an option. d) Community Support The BCCCS is supported by its community, including neighbours, businesses, government officials, law enforcement, healthcare professionals and patient service organizations. The two local elementary schools support us remaining in our long-standing location. Our model has evolved carefully over the years to ensure any concerns our community may have are addressed, and our policies could offer valuable guidance to the development of distribution regulations. e) Cultivators When long standing cultivators for the BCCCS apply for production licenses, they should be given special consideration and be fast tracked in order to prevent interruption of our members cannabis therapies and to protect the genetics and specialized knowledge they have developed. Affordability - Status, Tax and Insurance Although the status and taxation of cannabis are in the federal jurisdiction, the BC government should be aware of the affordability crisis facing patients. The current status of medical cannabis causes it to be in a category of one and not treated in a similar manner to other medicines although patients access it through an authorization from their physician, without the benefits of it being considered a prescription. According to the Supreme Court of Canada, cannabis is a medical necessity and must be treated as such. Medical cannabis is unjustly taxed and cost coverage via public and private insurers remains extremely difficult to obtain. Patients are often still choosing between an procuring an adequate quantity of their medication and other necessities. Recommendation #2 - Status: Since cannabis was made accessible through the courts, it s in a unique situation not shared by any other prescribed medication. The province should advocate for a fasttracked regulatory pathway for medical cannabis to be approved as a drug or medicine. Treat medical cannabis like other medical necessities to by: Changing the language in the ACMPR to call the medical document a prescription Giving it a Drug Identification Number, or something akin to it An approved drug status would facilitate both fair taxation and cost coverage through insurance. Recommendation #3 - Tax : Support patients by encouraging the federal government to amend the Excise Tax Act to that clarify the medical cannabis obtained through a physician is GST exempt to relieve the unjust financial burden carried by critically and chronically ill patients. Medical cannabis should be zero-rated like other medical necessities and prescription medicines. The Excise Tax Act proclaims drugs that are authorized by a healthcare practitioner and which are not available over the counter, are zero-rated. In fact, both the judges in the Federal Tax Court and the Federal Court of Appeal recently interpreted the Excise Tax Act to apply to sales of medical cannabis outside of the process set out by Health Canada s medical marijuana access program. In its decision, the Courts noted that the legislation imposing sales tax on medical cannabis resulted in uncertainty and confusion and that the legislation needs work. Hedges v. The Queen, 2014 TCC 270, Hedges v. Canada, 2016 FCA 19 Canadian patients are looking to their elected officials to address this unjust tax. Recommendation #4 - Insurance: Medical cannabis needs a Drug Identification Number (DIN) or something akin to it, to facilitate insurance coverage. This is a complicated process. An alternative route to facilitating and encouraging insurance coverage for medical cannabis is for the government of BC to lead the country and the world by including coverage in the plan for employees of the provincial government. Based on average current pricing and dosage, medical cannabis patients, many of whom are on a fixed income, bear costs upwards of $250/month for their medicine. This constitutes an unreasonable financial burden and it is the responsibility of this committee to remedy this unacceptable and unjust situation. More than half [of patients] reported that they were sometimes or never able to afford to buy sufficient quantity to relieve their symptoms, and approximately one third reported that they often or always choose between cannabis and other necessities such as food, rent, other medicines because of lack of money. (Belle-Isle, L. et al., International Journal of Drug Policy 2014)

4 While more research is needed, our experience suggests a potential for cost savings on other medications, as patients often report reducing or replacing other medications entirely with cannabis. Access - Range of Products Patients must be able to purchase cannabis medicines in all of its forms and potencies from a legal source that has been tested for safety and potency. Restrictions on the forms and potency of edible medical cannabis products allowed. The impact on patients is significant, unacceptable and incongruent with the Supreme Court ruling on the issue. Furthermore, such restrictions will only encourage the future illicit market to meet the demand. Recommendation #5 - Range of Products: Advocate to ensure legal access to cannabis products in all of its various forms and potencies, including but not limited to: herbal cannabis, capsules, tinctures, topicals, resins, suppositories and finished edible products. Otherwise patients will continue to access them in the unregulated market. This move would bring federal policy in line with the recent Supreme Court ruling, R vs. Smith a) Impacts of Arbitrary Limitations Current restrictions on potency of liquid cannabis oils and capsules is a major barrier to reasonable access to medical cannabis. Patients at the BCCCS safely use cannabis products in many forms and potencies to manage their symptoms. This range of products must be legally available. Patients who find effective symptom management from inhaled extracts that will continue to be prohibited under Bill C-45 as proposed will continue to procure them from unregulated markets or produce them at home. It is unreasonable for these products to be prohibited from being retailed in a regulated environment. b) Following the Spirit of the Supreme Court Rulings The R. vs. Smith 2015 ruling determined that limitations on cannabis products in its various forms are arbitrary. Future regulations must follow the spirit of the Supreme Court ruling. The trial judge concluded that for some patients, alternate forms of administration using cannabis derivatives are more effective than inhaling dried cannabis. He also concluded that the prohibition forces people with a legitimate, legally recognized need to use cannabis to accept the risk of harm to health that may arise from chronic smoking. It follows from these findings that the prohibition on non-dried medical cannabis undermines the health and safety of medical marihuana users by diminishing the quality of their medical care. (R vs. Smith 2015 SCC 34) c) Mitigating Risk Some cannabis extracts can be risky to produce and consume due to the use of volatile, highly flammable and carcinogenic solvents and should therefore be a priority to regulate. Advertising - Education Restrictions It is essential to ensure patients have access to all of the necessary information they need to make informed choices about their sources of medical cannabis. Currently the BCCCS does not advertise its services in compliance with the ACMPR ( Access to Cannabis for Medical Purposes Regulations ) or the NCR (Narcotic Control Regulations, which govern advertising). Prohibitions on advertising will create confusion and distrust in a new regulatory environment in which consumer confidence and buy-in is paramount to success. Recommendation #6 - Advertising: Ensure advertising restrictions to not unduly limit the capacity for service providers to provide education and convey product characteristics, in order to help instil consumer confidence in this new regulation. Investing in Research As cannabis is becoming becoming legalized in Canada, we have an opportunity to be world leaders in expanding the evidence base of benefits and risks of medical cannabis. While Canada is facing an opioid and overdose crisis, cannabis and cannabinoids have tremendous potential as a harm reduction tool. Recommendation #7 - Research: Invest significant resources in human clinical research to further quantify the medical utility of cannabis and cannabinoids, prioritizing researching the potential of cannabis in managing pain and as a harm reduction tool for addiction and substance abuse. The BCCCS has acquired tremendous experience with people struggling with chronic dependence and problematic substance use using cannabis as a harm reduction tool. Our experience indicates there is great potential in high potency edibles and resins as effective use-reduction tools for recreational and medical opiates, methadone, alcohol, cocaine and crack. Considering the opioid epidemic Canada is facing, the BC government has a responsibility to explore the of role cannabis and cannabinoids in substance substitution and harm reduction.

5 Conclusion In the 20 years the BCCCS has been distributing medical cannabis, we have amassed a vast and unique knowledge base and continue to offer this knowledge freely. We implore this government to do everything in its power to protect the community-based, standard setting, front-lines harm reduction organization that pioneered the medical cannabis movement and industry. The 7 recommendations offered in this submission identify key issues that need to be addressed in order to adequately take care of Canada s most vulnerable groups, critically and chronically ill patients, affected by cannabis legalization. Summary of Recommendations Respect, Acknowledge and Protect Historical Canadian Cannabis Institutions Recommendation #1: SPECIAL CONSIDERATION. The Government should give special consideration to Canada s historical medical cannabis institution, the BCCCS. Protect our subsidized wellness centre and standard-setting education services and dedicated suppliers. It is imperative that the health care services provided to the BCCCS s 11,833 members is not interrupted, and our unique knowledge is not lost. Colorado and Washington are examples of jurisdictions which prioritized transitioning long standing medical cannabis institutions into the new regulatory framework. Affordability - Status, Tax and Insurance Recommendation #2: STATUS. Since cannabis was made accessible through the courts, it s in a unique situation not shared by any other prescribed medication. The province should advocate for a fast-tracked regulatory pathway for medical cannabis to be approved as a drug or medicine. Treat medical cannabis like other medical necessities to by: Changing the language in the ACMPR to call the medical document a prescription Giving it a Drug Identification Number, or something akin to it. An approved drug status would facilitate both fair taxation and cost coverage through insurance. Recommendation #3: TAX. Support patients by encouraging the federal government to amend the Excise Tax Act to that clarify the medical cannabis obtained through a physician is GST exempt to relieve the unjust financial burden carried by critically and chronically ill patients. Medical cannabis should be zero-rated like other medical necessities and prescription medicines. Recommendation #4: INSURANCE. Medical cannabis needs a Drug Identification Number (DIN) or something akin to it, to facilitate insurance coverage. This is a complicated process. An alternative route to facilitating and encouraging insurance coverage for medical cannabis is for the government of BC to lead the country and the world by including coverage in the plan for employees of the provincial government. Range of Products Recommendation #5: ACCESS. Advocate to ensure legal access to cannabis products in all of its various forms and potencies, including but not limited to: herbal cannabis, capsules, tinctures, topicals, resins, suppositories and finished edible products. Otherwise patients will continue to access them in the unregulated market. This move would bring federal policy in line with the recent Supreme Court ruling, R vs. Smith Advertising Restrictions Recommendation #6: EDUCATION. Ensure advertising restrictions to not unduly limit the capacity for service providers to provide education and convey product characteristics, in order to help instil consumer confidence in this new regulation. Investing in Research Recommendation #7 RESEARCH. Invest significant resources in human clinical research to further quantify the medical utility of cannabis and cannabinoids, prioritizing researching the potential of cannabis in managing pain and as a harm reduction tool for addiction and substance abuse.