Policy commentary
Medical Marijuana programs: Implications for cannabis control policy – Observations from Canada

https://doi.org/10.1016/j.drugpo.2014.09.007Get rights and content

Highlights

  • Cannabis use is prevalent, and traditionally controlled by prohibition, in Canada.

  • In 2001, a ‘medical marijuana’ (MM) access program was created for severely ill people.

  • While the government rejects general reform, new MM rules were implemented in 2014.

  • Doctors can authorize MM for any health problem, to be supplied by licensed producers.

  • New MM regulations constitute ‘de facto’ legalization under a veil of ‘medicalization’.

Abstract

While prohibition has been the dominant regime of cannabis control in most countries for decades, an increasing number of countries have been implementing cannabis control reforms recently, including decriminalization or even legalization frameworks. Canada has held out from this trend, although it has among the highest cannabis use rates in the world. Cannabis use is universally criminalized, and the current (conservative) federal government has vowed not to implement any softening reforms to cannabis control. As a result of several higher court decisions, the then federal government was forced to implement a ‘medical marijuana access regulations’ program in 2001 to allow severely ill patients therapeutic use and access to therapeutic cannabis while shielding them from prosecution. The program's regulations and approval processes were complex and subject to extensive criticism; initial uptake was low and most medical marijuana users continued their use and supply outside the program's auspices. This year, the government introduced new ‘marijuana for medical purposes regulations’, which allow physicians to ‘authorize’ medical marijuana use for virtually any health condition for which this is considered beneficial; supply is facilitated by licensed commercial producers. It is expected that some 500,000 users, and dozens of commercial producers will soon be approved under the program, arguably constituting – as with medical marijuana schemes elsewhere, e.g. in California – de facto ‘legalization’. We discuss the question whether the evolving scope and realities of ‘medical cannabis’ provisions in Canada offer a ‘sneaky side door’ or a ‘better third way’ to cannabis control reform, and what the potential wider implications are of these developments.

Introduction

In many jurisdictions around the world, cannabis control and policy are subject to intensive current debate. These debates relate to the general control of cannabis for ‘recreational’ purposes, but also increasingly to provisions for ‘medical cannabis’ use, i.e., the use of cannabis for therapeutic purposes. While these are generally examined as two separate matters, few analyses have examined the interactive potential or implications of developments in these arenas for cannabis policy reform overall. In the below, we do exactly this, based on recent developments in Canada.

Section snippets

Cannabis control: history

Cannabis became included in the scope of international drug control in 1925, and total criminal prohibition – even for personal (i.e., non-scientific or -medical) use – as dictated by the international treaties since the 1961 Convention has been the control framework of choice in most industrialized countries (EMCDDA, 2008, Levine, 2003, Room et al., 2010). Pushes to reform prohibition as the main control mode are almost as old as prohibition itself, yet gained in variety and vigour since the

Evolution of Canada's ‘medical marijuana’ program

In the years leading up to 2000, a series of higher court decisions responding to constitutional challenges resulted in the Canadian federal government being forced by the courts to establish provisions that would allow for severely ill individuals to freely use and access cannabis for therapeutic purposes without punitive consequences (Belle-Isle et al., 2014, Bogdanoski, 2010, Lucas, 2009). Consequently, in 2001, the then (Liberal) federal government established the ‘Medical Marihuana Access

Wider implications for cannabis control policy

The MMPR has created a ‘medical marijuana’ regulation framework that has evolved a long way from the original MMAR. In practice, under the MMPR, it is now conceivably possible for any adult in Canada to become an authorized (medical) marijuana user shielded from punitive consequences of the existing drug law, which continues to categorically prohibit cannabis possession/use as a criminal offense (Fischer et al., 2003, Hyshka, 2009). While the federal government – in line with its neo-liberal

A ‘sneaky side-door’ or the ‘better third way’ for cannabis control reform?

Third – as the perhaps most complex issue – the question arises whether the described ‘legalization through medicalization’ scheme described for Canada constitutes a potentially better, more pragmatic and politically feasible ‘third way’, or rather a sneaky ‘side-door’ for the cause of cannabis control reform, especially when aiming for or referring to principles of ‘good public policy’ (Gerston, 1997). One aspect for consideration in answering this question concerns the nature and dynamics of

Conflict of interest

The authors have no conflict of interest to report.

Acknowledgements

The authors acknowledge Ms. Chantal Burnett's skilful assistance in preparing this manuscript. Dr. Fischer acknowledges funding support from a CIHR/PHAC Applied Public Health Chair Award.

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