Time to reduce unfair financial barriers to medical cannabis

Nearly 300,000 people in Canada use medical cannabis to manage various health issues, including chronic pain. And yet, despite medical cannabis adding much-needed benefit, choice, and positive outcomes to our health care system, unfair taxation means patients face a major barrier to accessing this effective treatment option. Cannabis products for both adult recreational use and medical use have been subject to an excise tax since legalization in October 2018. But unlike recreational users, medical cannabis patients need to visit a doctor and receive a medical authorization, similar to a prescription, making medical cannabis the only treatment of its kind taxed back to the patient. Rick Savone is senior vice-president of government relations at cannabis producer Aurora Cannabis Inc. Photograph courtesy of Aurora This is no small cost. The expense adds a significant financial burden on patients who are already facing chronic health challenges, and makes medical cannabis entirely inaccessible for many. The Task Force on Cannabis Legalization and Regulation reported that patients can pay up to $500 a month for their medical cannabis. The Arthritis Society, meanwhile, has reported that sales and excise taxes on medical cannabis cost an average arthritis patient nearly $2,000 per year. And that’s a large sum when you consider arthritis is the third most common medical condition Aurora patients are relying on cannabis to treat. Similar costs do not exist for more standard pharmaceutical treatments, even when they present far more adverse outcomes related to patient tolerance, treatment quality, and safety. For many patients, the cost difference between medical cannabis and pharmaceuticals removes their right as a patient to choose the medication they need. This choice is limited even further when coverage plans for prescriptions refuse to cover the costs of medical cannabis. There is building evidence that many patients find medical cannabis more effective and tolerable than standard pharmaceuticals. In the federal government’s 2021 Canadian Cannabis Survey, 52 per cent of medical cannabis consumers reported they were able to reduce the use of other medications through the addition of medical cannabis to their treatment regime. This is all while scientific evidence supporting the efficacy of cannabis to treat a wide range of medical symptoms and conditions also continues to grow. Specifically, there is a large body of evidence for the treatment of chronic pain with cannabis, including four consensus recommendations in peer-reviewed journals. A growing number of peer-reviewed studies also suggest cannabis is being used as a substitute for conventional pharmaceuticals, such as opioids. In these studies, patients reported that medical cannabis improved their overall quality of life and symptoms, and caused fewer adverse events than their previously prescribed conventional pharmaceuticals. By using cannabis, patients reported reductions in their daily opioid dosages and even stopped using opioids entirely. North America’s opioid crisis underscores just how important affordable, accessible medical cannabis is. The National Institute on Drug Abuse in the U.S. suggests that roughly a third of patients prescribed opioids for chronic pain misuse them, and between eight and 12 per cent develop an opioid use disorder. Closer to home, the Public Health Agency of Canada has reported that between January and September 2021, there were more than 5,300 apparent opioid toxicity deaths in Canada. In the April through June period alone, this equated to an astounding 19 deaths a day—and 66 per cent higher than the same period two years prior. Despite its prohibitive cost, medical cannabis is relatively safe. According to the WHO Expert Committee on Drug Dependence, a lethal dose in humans is so high that “such a dose could not be realistically achieved in a human following oral consumption, smoking or vaporizing.” Researchers have also found that cannabinoids do not directly affect respiratory or cardiovascular function, unlike opioids which significantly depress respiratory function when overdosed. For patients, this comes down to a difficult choice—and not one based solely on effectiveness and safety. Instead, it’s between a pharmaceutical that has significant risk of addiction and overdose, and medical cannabis, which has a large safety margin but comes at a higher cost. Unfortunately, as long as financial barriers to accessing medical cannabis remain, patients will be pushed towards more affordable—and often riskier—options. Continuing to tax medical cannabis is taxing essential medicine, and as such, taxing people with legitimate health issues and disabilities. Removing all taxes on medical cannabis evens the playing field, allowing patients more affordable access to effective treatment. The recent budget announcement unveiled a cannabis strategy table that should make this objective an early focus. As we near a post-COVID era, many of us are rethinking what the future of health care in Canada looks like. As we do, it’s time to make cannabis a more accessible part of medical treatments, especially to help patients who find themselves chronically using or misusing opioids to manage pain. No patient should be placed in the precarious position of having to choose between their preferred choice of medicine and putting food on the table—especially when the financial barrier is primarily because of an unjustified tax. Rick Savone is senior vice-president of government relations at cannabis producer Aurora Cannabis Inc. In this role, Savone oversees Aurora's relationships with governments around the world, helping them to create legislation and regulatory frameworks that will allow greater patient access to medical cannabis products. He is also chair of the board of the Cannabis Council of Canada. The Hill Times