Good morning, everyone. I thank you for the opportunity to be here today.
My name is Shelita Dattani. I'm a practising pharmacist and I'm the director of practice development and knowledge translation at the Canadian Pharmacists Association. I'm here today on behalf of Canada's 42,000 pharmacists, who are medication experts and whose job it is to ensure that drug therapy is safe and appropriate for our patients.
Every day, pharmacists act as medication stewards on behalf of Canadians. We make sure that each patient's medication and dosage are right for them. We check for and resolve potential drug-related problems, and we work with patients to ensure that they understand their drug therapy. We also address side effects and interactions, and we monitor our patients' progress throughout their therapy.
We've seen more and more patients using medical cannabis over the last decade or so, and pharmacists have become increasingly concerned about the health and safety of these patients, especially those who are using cannabis in combination with or instead of other traditional medications, often without the oversight of a pharmacist. Our concern for patients in the medical cannabis stream further increases as we move towards legalization of recreational cannabis.
We recognize that Bill C-45 focuses mostly on legalizing cannabis for recreational purposes, but it's important that the government understand how the proposed legislation could impact patients relying on medical cannabis as part of their treatment plan for pain, epilepsy, MS, and other conditions.
We want to focus our concern around three areas: the separation of medical and recreational cannabis, the role of pharmacists in medical cannabis, and the use of medical terms such as “dispensary” in recreational sales.
As of March 2017, Health Canada reported over 201,000 patients registered to obtain medical cannabis through licensed producers or personal production. These patients have unique needs that differ from those of recreational cannabis users. Medical users might need strains and forms to alleviate symptoms and minimize intoxication, such as those available through cannabidiol or CBD, whereas recreational users might be seeking euphoric effects and strains with higher THC levels. Medical cannabis users also require the clinical oversight that comes with any medication therapy.
Other jurisdictions, such as Colorado and Washington State, have moved to legalization of cannabis. They have maintained different streams by restricting product strains and forms, establishing distinct access channels for medical cannabis and treating the medical stream as unique.
We are pleased that the Canadian government has signalled its intent to follow these best practices by maintaining two distinct streams once recreational cannabis is legalized in 2018, but we are concerned that current shortcomings in the medical regime could be exacerbated with the move to legalized cannabis if there aren't policies and practices in place to clearly differentiate between medical and recreational streams.
One clear example of this is around costs. If the cost of recreational cannabis is more attractive than that of medical cannabis, or if access is less restricted, patients may choose to go that route and they will be left without medical oversight, which could increase health complications for high-risk patients. The safety of our patients is paramount, and we need to ensure that medical cannabis users are supported and protected through a medical stream once recreational cannabis is legal.
Another consideration is the securing of medical cannabis strains from the recreational market to ensure enough supply of unique medical strains to meet patient needs. Medical cannabis users are often vulnerable patients who may have tried multiple other therapies before turning to cannabis or found only one unique strain of cannabis that provides them with relief. The medical cannabis strains must be protected from the recreational market in order to safeguard against shortages of these particular strains for those patients who use medical cannabis, as other colleagues have said, out of necessity versus choice.
Finally, there are more systemic benefits to maintaining a separate medical stream. Separating the medical cannabis stream would facilitate more clinical research and understanding of this complex drug, and doing so would create a more robust evidence base around the therapeutic benefits and risks for health care providers to inform them in the management of patient care and in the further development of guidelines.
In order to reduce harm, particularly for those who use cannabis for medical purposes, government must take steps to clearly differentiate the two markets before July 2018. A logical first step would be to ensure pharmacists' clinical oversight in dispensing of medical cannabis in Canada.
Across Canada, pharmacists just like me are regularly asked by our patients about the use of cannabis for a variety of different conditions, but as the medication experts on a patient's health care team, we don't currently have a role in dispensing medical cannabis. Health Canada attests to the complexity of cannabis and its potential interactions with other more traditional medications. Given these risks, we believe it's essential that patients have as much support as possible from qualified health care providers to strengthen patient safety and health-system accountability.
As the system works now, patients consult with their physician who may issue a document for medical cannabis. Supply is then managed through mail-order distributors or patient-grown cannabis. None of these options include consultations with medication experts at the point of dispensing to ensure that patients understand why they have been prescribed the medication, the best route and dose of administration for the patient, and potential side effects.
Also, as I've said before, for many patients medical cannabis is a third-line or fourth-line treatment, and these patients are often on a number of other medications. For example, veterans using cannabis to control post-traumatic stress disorder symptoms or patients with mental health conditions are also likely to be on a number of other medications, including psychoactive, anti-anxiety, and hypnotic medications. The potential for drug interactions in these patients is considerable, and the need for pharmacists' oversight becomes even more important.
With over 10,000 community pharmacies in rural, urban, and remote locations across this country, pharmacists are patient-centred practitioners who are well positioned to dispense medical cannabis and provide the required clinical oversight. Canadians think of us and their relationship with their local pharmacist when they consider where they will get their medication and who will counsel them and guide them on their medication therapy.
Pharmacists work with controlled substances every day. They have the framework and ability to ensure the safety, security, and tracking of the products that we dispense every day. We regularly use our clinical expertise to detect possible drug-therapy problems, and we're able to mitigate the potential risks associated with medical cannabis, including contraindications in patients with a psychotic illness, for example, or in pregnant patients. Further, we're often able to identify potential addictive behaviour which could lead to misuse or abuse. We should learn from our experience with opioids and the significant potential for addiction to psychoactive medications. We shouldn't make the same mistake by underestimating the need for clinical oversight with medical cannabis and all of its unique complexities.
While CPhA doesn't endorse any specific production or supply system for recreational cannabis other than a regulated process with health promotion as a priority, we believe that for medical cannabis it's essential that patients have as much support as possible from qualified health care providers. Patient safety should be the primary consideration. For this reason, we urge policy-makers to include and support pharmacists in dispensing medical cannabis and ensuring safe and effective use by patients in the medical cannabis strain.
Finally, in line with our call for separate streams for medical and recreational cannabis and the need for pharmacist oversight in the medical stream, our position is that recreational suppliers and retailers of cannabis be prohibited from using pharmacy-related terms such as “dispensary” or symbols such as the green cross.
Since the government announced its intention to legalize cannabis, we have seen a proliferation of so-called dispensaries across the country that claim to sell medical cannabis. As medical cannabis is legal in Canada under certain conditions, many Canadians are unaware that these are in fact illegal operations. The use of the term “dispensary” along with pharmacy symbols further compounds this misconception. We would urge the government to restrict the use of the word “dispensary”, and pharmacy terms and symbols for non-medical cannabis retail sites. These promote the notion that recreational cannabis has health benefits or is a medication, that the retail site is a pharmacy, or that the site has professional oversight from pharmacists. This regulation is particularly important to ensuring public safety and to further distinguishing between the recreational and medical cannabis streams.
Thank you again for the opportunity to represent Canadian pharmacists today. Pharmacists are committed to ensuring that our patients have access to appropriate medication therapy and that their therapy is both safe and effective.
As we move forward with the legalization of recreational cannabis, we're asking the committee to endorse the clear differentiation between the recreational and the medical cannabis streams, to recommend restrictions on the use of pharmacy-related symbols in the recreational stream, and to help strengthen clinical oversight of the medical stream by supporting pharmacists in dispensing and managing medical cannabis in the care of their patients.
Thank you. I'd be pleased to take your questions.