This is not my writing
I wish it was
It is a reprint
A Jan 2012 PubMed Commons Article
I am reprinting it here because I want all of my friends and followers to find out just who we are as Customers relating to Health Canada and how as a group in 2007-8 we were utilizing and obtaining our cannabis supply.
It’s just a snapshot in time but it’s sad to see things are even more complicated after 7 more years of Government interference and Physician obstruction but remarkably SameOh! SameOh!
I should warn all you potential readers that it is a long read of many pages but reading it is well worth the effort. Fortunately it is broken into shorter segments that stand individually and I learned a lot I was ignorant of in the utilization of the HERB.
The Quality of Service Assessment of Health Canada's
Medical Cannabis Policy and Program
BACKGROUND:In 2001 Health Canada responded to a series of Ontario court decisions by creating the Marihuana Medical Access Division (MMAD) and the Marihuana Medical Access Regulations (MMAR). Although Health Canada has conducted a small number of stakeholder consultations, the federal government has never polled federally authorized cannabis patients. This study is an attempt to learn more about patient needs, challenges and experiences with the MMAD.
A Brief History of Cannabis as a Medicine
By the late 19th Century, cannabis-based preparations were manufactured and marketed by Burroughs-Wellcome & Co. In England; and Bristol-Meyers Squib, Parke-Davis, and Eli Lilly in North America. The development of vaccines to prevent the spread of common infectious diseases, the increased use of opiates (with the introduction of the hypodermic syringe), and the discovery of aspirin at the end of the nineteenth and early twentieth century resulted in cannabis-based medicines losing their prevalence in the market place and Western pharmacopoeia.
In Canada, the non-medical use of cannabis was outlawed as part of the Opium and Narcotics Drugs Act of 1923, largely based on a series of misleading articles written by Emily Murphy for MacLean's Magazine in the early 1920's which claimed cannabis turned people into raving, blood-thirsty lunatics. The US Pharmacopoeia listed Cannabis until 1941 and stated that cannabis can be used for treating fatigue, coughing, rheumatism, asthma, delirium tremens, migraine headaches, and the cramps and depressions associated with menstruation.
Medical Cannabis Access in Canada
According to this report, one of the main reasons for the small number of applicants to the program is reluctance by physicians to act as gatekeepers to medicinal cannabis. Citing a perceived lack of information on dosage, side effects, and alternate routes of administration to smoking, both the Canadian Medical Association and the Canadian Medical Protection Agency (which insures nearly 95% of Canada's physicians) have warned against the therapeutic use of cannabis, and have recommended that doctors not participate in the federal program.
For example, a CMA press release dated July 9th, 2003, declares:
The CMA has consistently raised concerns about the lack of evidence-based decisions to support the Medical Marijuana Access Regulations," said Dr. Dana Hanson, President of the CMA. "Our unease over use of medical marijuana has been ignored in this new policy. Physicians should not be the gatekeeper for a substance for which we do not have adequate scientific proof of safety or efficacy.
Such warnings have been a particular deterrent for medical specialists, whose support was initially necessary for all applicants to the program that were neither terminally ill nor likely to die in the next 12 months, such as those suffering from MS, HIV/AIDS and hepatitis C (terminal patients only required the support of a single physician). In addition, specialists were simply not available in many smaller rural communities. When compounded by the bureaucratic hurdle of filling out a 29-page application that sometimes took in excess of 12 months for Health Canada to process, the challenges to participation in this program ranged from onerous to impossible for many potential applicants.
Quality of Service Assessment of Health Canada's Medical Cannabis Policy and Program
The 50 item self-administered survey combines multiple choice and open-ended questions, and includes items informed by validated questionnaires like the Short-Form Patient Satisfaction Questionnaire (PSQ-18) and a 2005 questionnaire designed by Belle-Isle and the Canadian AIDS Society to identify barriers to medical cannabis experienced by Canadians affected by HIV/AIDS. In addition to basic socio-demographic data, survey questions generated by the researcher to address the history of involvement and experiences with the federal program, cannabis use patterns, and specific symptoms and conditions that cannabis has relieved.
Patient Use Patterns and Preferences
This creates a stark contrast between access through Health Canada and through community-based dispensaries. While Health Canada offers a single strain of raw cannabis and no alternatives to smoking, dispensaries make multiple strains and methods of ingestion other than smoking available to patients, including edibles, oils, tinctures, salves, and even oromucosal sprays.
Patient Access to Medical Cannabis
Patient Experiences With Health Canada Marihuana Medical Access Division
In addressing the statement "I find the application for a federal authorization simple and uncomplicated", only 21.8% "agreed" or "strongly agreed", while 71.2% "disagreed" or "strongly disagreed" (42.5%), suggesting that for most patients the federal application process is onerous and challenging.
When asked to comment on the statement "Employees at Health Canada's MMAD act too businesslike and impersonal towards me", 54% "agreed" or "strongly agreed", while 28.7% "disagreed" or "strongly disagreed".
In regards to the statement "I am dissatisfied with the service I receive from Health Canada in regards to my use of medical cannabis", 68.9% "agree" or "strongly agree", while only 18.3% "disagree" or "strongly disagree".
However, when asked if "Employees at Health Canada's MMAD treat me in a friendly and courteous manner", respondents were split, with 35.6% "agreeing" or "strongly agreeing", 27.6% "uncertain", and 36.8% "disagreeing" or "strongly disagreeing".
When the statement "I have full confidence in the ability of the Health Canada employees that administer this program" was put to patients, 76.8% "disagreed" or "strongly disagreed", with only 5.9% "agreeing" or "strongly agreeing" with the statement, and 17.4% stating that they were "uncertain".
Finally, when asked "I am able to get help from Health Canada in regards to my medical use of cannabis whenever I need it", 8.2% "agreed" or "strongly agreed", while 70.6% "disagreed" or "strongly disagreed", with 21.2% uncertain.
The final question of the survey asked participants to rate their overall satisfaction with Health Canada's medical cannabis program, and 15.1% of patients state that they are "completely" or "somewhat satisfied", 12.8% uncertain, and 72.1% either "somewhat" (20.9%) or "totally unsatisfied" (51.2%).
This suggests a very poor patient perception of the service quality at Health Canada Marihuana Medical Access Division, with many potential improvements in application processing times, cannabis selection and quality and overall responsiveness to patient queries and concerns.
Thousands of seriously ill Canadians must therefore choose between breaking the law to use the therapy of their choice, or going without, which in many cases compromises their well-being and quality of life.
The high bureaucratic burden on both patients and physicians is reducing participation in the program, so allowing healthcare providers to treat cannabis like any other medicine would likely improve uptake and might also alleviate some of the social stigma associated with the therapeutic use of cannabis. Since this study and Health Canada's own statistics show that the majority of participants in the Canadian federal program chose to produce their own medicine, policies and procedures should be put in place that maintain the option of personal production while also ensuring that both patients and communities are protected from the dangers of poorly-cultivated cannabis.
This could range from basic information from Health Canada on safe production practices to electrical inspections at the municipal level. Additionally, with over half of respondents currently accessing cannabis through dispensaries and growing evidence that these organizations build social capital and provide an environment that is conducive to health and healing, the federal government should work with dispensaries to develop regulations that would incorporate this community-based model of access into Canada's medical cannabis program.
Finally, many of the challenges faced by the MMAD could have been addressed or avoided through a more robust and active strategy for patient engagement and involvement. Although there are many stakeholders directly or indirectly affected by the federal medical cannabis program - municipalities, police, physicians, etc. - the key stakeholders are the Canada's critically or chronically ill who could or do benefit from the use of cannabis. Unfortunately, the short history of the MMAR/MMAD shows that the needs and concerns of patients has all too often been ignored or overshadowed by other interests and concerns.
The future success of this cutting-edge program will depend largely on the willingness of the federal government to create a truly patient-centered approach to medical cannabis access, including active and ongoing engagement with end-users, support for research into the potential harms and benefits of medical cannabis, and increased options for patients, potentially through the regulation of community-based dispensaries.