Medical cannabis can be accessed by four different routes:
- Health Canada approved cannabinoids from a regular pharmacy;
- Medical products from a Licensed Producer (LP);
- Cannabis grown at home by the authorized user, or by a designated authorized grower;
- Medical products from an unlicensed dispensary.
The two cannabinoids currently available by prescription in Canada are nabilone (Cesamet®) and nabiximols (Sativex®). Nabilone is a synthetic THC analogue tablet for swallowing. Nabiximols is a standardized extract of cannabis containing 50% THC and 50% CBD, administered by spray to the inside of the cheek for transmucosal absorption. Nabilone is usually prescribed starting at 0.5mg q8h prn, and cannabinoid-naïve patients start with once a day, increasing as needed as tolerated. Higher strengths are available. Nabiximols is usually prescribed as one spray q4h prn, adjusting according to effect.
Legal medical cannabis plant products can be purchased by the patient by mail order from a number of LPs. Up to date contact information on LPs is available on the
Health Canada website
. Medical authorization forms are to be found on each LP’s website and have to be completed by a physician. The medical document has to include the period of use (days, weeks or months) and the maximum dispensed daily amount that should be provided to the patient. The patient submits this original medical document to the LP of their choice, along with a registration form provided by that LP. The prescriber should file a copy in the patient’s medical record. The LP will fill and ship the applicant’s order by mail, based on the daily amount of dried cannabis indicated on the medical document. The medical document must be completed annually or more frequently if the prescriber recommends a shorter period. Extracts such as capsules, tinctures or oils are only very recently becoming approved by Health Canada and are often in short supply with LPs.
Cannabis products are available for purchase in person from a large number of storefront dispensaries. The quality of service provided by the dispensaries varies markedly. They are currently unregulated and there are no controls on hygiene, labelling or product quality, including potential contamination with moulds or pesticides. Dispensaries however usually provide extracts in forms such as capsules, tinctures, suppositories, creams etc., which are not available from LPs. The dried plant product and oils (when available) is often cheaper than through LPs. If a patient requires a product not available through an LP, or is unable to afford a prescribed or LP product, there are well-established non-profit dispensaries in some communities which provide good service.
Home-Grown or by authorized designated grower
The Access to Cannabis for Medical Purposes Regulations allows patients to grow their own cannabis for medical purposes, within some limits, or to designate another person to grow it for them. These growers have to register with Health Canada. This method is not recommended as the product may not be free of mould or other contaminants, and is open to diversion.