Shutting Down Cannabis Compassion Clubs Hurts Patients and the Public

Canadian courts have long recognized the constitutional right of people to consume cannabis to manage health conditions and symptoms.

In 2001, following the landmark Ontario court decision in R. v. Parker, a federal medical cannabis program was created to ensure that people who medicate with cannabis are not criminalized and punished for accessing an effective medical treatment, thereby forcing them to forgo access or to choose less effective and potentially harmful alternatives.

In theory the federal medical cannabis program was intended to protect people who medicate with cannabis and provide them with access to medical cannabis.

In reality, people who tried enrolling in the federal program reported many barriers to obtaining an authorization and accessing affordable, safe and effective cannabis — these barriers remained despite different iterations of the program, mandated by successive court rulings.

As a result, thousands of people medicating with cannabis have continued to rely on compassionate access to medical cannabis via dispensaries, compassion and buyers clubs and community groups or initiatives. In British Columbia, many of these low-threshold access points had developed specialized in-house expertise and meaningful patient engagement based on over a decade of experience predating the federal program.

After cannabis was legalized for non-medical purposes in 2018, these low-threshold access points faced an uncertain future. Nearly five years later, the majority have closed or switched to the recreational market to comply with the regulatory scheme and avoid severe sanctions. Those who continue to provide compassionate access to medical cannabis now face important sanctions and an impending risk of forced closure.

For example, the province’s decision to dedicate extensive resources to target low-threshold access points, such as the Victoria Cannabis Buyers Club, is especially alarming. Since legalization, the club has been raided three times, evicted from its 20-year-old location and fined a total of $6.5 million. Founded in 1996, this club serves approximately 8,000 members who medicate with cannabis.

In 2022, the Victoria Cannabis Buyers Club submitted an application to secure a federal exemption from Health Canada that would allow them to continue serving members while also working to develop a system that would meet the federal and provincial regulatory standards. Many of us wrote to Health Canada to express our support. The City of Victoria also voiced its support.

As B.C. researchers working with people who medicate with cannabis, we are particularly concerned with the punitive approach adopted by the province and the impact of dismantling a system of compassionate access to medical cannabis amid a toxic drug overdose emergency.

We see a lack of equitable access to cannabis for people who need a middle ground between the recreational market, which does not cater to medical use, and the medical program, which lacks affordability, storefront access and personalized care.

For people who already face intersectional barriers to health-care access (for example, people who use drugs, people living with disabilities, people who are unstably housed) and experience income insecurity, losing access to a community space that, in addition to providing support and education, provides access to affordable cannabis products is particularly harmful and unjust.

In the absence of compassionate access to cannabis, it is also unclear where that leaves people who live with complex health conditions and symptoms such as chronic pain.

Cannabis is commonly used as a substitute for pain medications, most notably opioids. This has been documented in Canada and internationally, including a recent survey of close to 6,000 people who medicate with cannabis in Canada. For this reason, cannabis has been increasingly studied as a harm reduction strategy among people who use unregulated opioids in Canada. British Columbia is home to a number of cannabis substitution programs that are showing benefits in reducing exposure to fentanyl, risks of overdosing and opioid use.

Furthermore, it has been proposed that cannabis can provide “three important windows of opportunity" to reduce opioid use in the treatment of chronic pain: 1) before patients are prescribed opioids 2) to reduce opioid use among patients who are already taking opioids and 3) as a part of opioid use disorder treatment in order to increase treatment success rates.

Collectively, our research supports this approach and points to the potential benefits of cannabis for people who live with chronic pain, people experiencing opioid use disorder and severe alcohol use disorder, and people needing support as they undergo medication-based treatment for opioid use disorder. Our work also points to additional health benefits including increased well-being, improved symptom management and treatment adherence and higher quality of life.

Given what we know about cannabis, we see no justification to continue punishing the Victoria Cannabis Buyers Club and other low-threshold cannabis access points that are designed to reach people who face the most barriers in accessing cannabis for medical and harm reduction purposes.

We are calling on Health Canada to intervene and urgently grant an exemption to VCBC to prevent further harms to the community and provide protection from additional sanctions and the risk of closure. We believe that exempting the Victoria Cannabis Buyers Club and preserving compassionate access to medical cannabis is in the public interest, given the current toxic drug overdose emergency and the absence of a strategy to ensure equitable access to medical cannabis for structurally vulnerable communities.

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Marilou Gagnon, Bernie Pauly, Karen Urbanoski and Tim Stockwell are scientists at the Canadian Institute for Substance Use Research. Gagnon and Pauly are nursing professors at the University of Victoria, where Urbanoski is associate professor in public health and social policy and Stockwell is emeritus professor in psychology.

Zach Walsh is a psychology professor at the University of British Columbia and affiliated scientist at the BC Centre on Substance Use, where Hudson Reddon, a postdoctoral research fellow at UBC, is a research scientist. Rielle Capler is an adjunct professor at the School of Population and Public Health in the faculty of medicine at UBC.

Stephanie Lake is a postdoctoral research fellow at the University of California Los Angeles.