Colette Rivet, executive director of the Cannabis Canada Association, leading Canadian licensed medical cannabis producers, talks regulatory challenges, upcoming opportunities, export ambitions and collaboration with the provincial and federal government in light of the upcoming legalization of cannabis for adult use in Canada.
Colette, can you introduce the Cannabis Canada Association and your current main priorities to our readers?
Cannabis Canada started out in January 2016, and I am currently its first and only employee. Cannabis Canada today has 20 members that are all licensed producers, which means they have an authorization by Health Canada to cultivate and produce medical cannabis. However, this authorization does not mean they all have a license to sell their products. Furthermore, we have extended memberships to other players in the industry involved in medical cannabis, as we are striving towards an integrated network, so that information may circulate better.
Our strategic plan is comprised of a set of priorities. The most important one is to provide our experience and expertise we have been able to collect since cannabis has been legalized for medical use in 2014 to other stakeholders in this industry. This information, of course, is also being shared with governments in light of soon to come legalization of cannabis for adult use in Canada, scheduled to be implemented in summer 2018.
What therapeutic value can cannabis-based therapies bring to patients?
[Featured_in]
Since cannabis has been a restricted substance for so long, not much relevant research has been conducted as of yet. Some of our member companies partner with Israel and other countries in order to do so. We do not know if medical cannabis has the potential to heal, but we know it is highly effective in different areas, mainly pain control, especially when no other product seems to bring relief.
Conditions for which medical cannabis is most prescribed include pain management, in palliative care, as a complement to chemotherapy to increase appetite and neurological diseases such as Huntington’s, in which it helps to reduce the shaking. Likewise, it is prescribed for epileptic seizures, especially for children who can thus live seizure-free, and for multiple sclerosis.
Nonetheless, the stigma of medical cannabis is still very much alive. A lot still has to be done in terms of patient, physician and public education. We conduct conferences where we explain some of the lesser and more commonly known facts about cannabis to health professionals and/or the general public. Amongst those are the effects of different product forms of medical cannabis, warnings about impaired driving or the dangers of mixing alcohol with cannabis.
With one of the most sophisticated regulatory frameworks in the world, what are some of the challenges your members are facing within the Canadian medical cannabis landscape?
[related_story]
The medical cannabis market in Canada is highly regulated by Health Canada, and all our producers can prove that none of the cannabis produced and distributed has ever gone to the black market. This control in itself entails a number of challenges.
First and foremost, Cannabis Canada’s members are forbidden to advertise their products, and it is henceforth difficult for patients to find out how they can access medical cannabis. Moreover, only few physicians prescribe medical cannabis, and a prescription is absolutely necessary. This issue is due to the fact that only very few physicians have been educated in the benefits of medical cannabis and the details of its prescription and are consequently reluctant to put patients on a medical cannabis treatment.
Today, a licensed producer in Canada can spend over CAD 10 million (USD 7.8 million) for the construction of a medical cannabis facility, and will still not be allowed to grow medical cannabis at that time. Facilities are largely being inspected on a monthly basis. Regulations are usually even tighter than for conventional pharmaceutical products.
The regulations for the facilities are equally severe, having requirements for sterilization and testing for contamination with bacteria or pesticides. Whereas on the black market, none of these verifications apply, and the producers can advertise and promote products of which the origin is unknown! They are also freer in adapting their products to the wishes of customers, which for us poses the challenge to find the right product form that will hopefully prevent patients form turning to the black market.
Even once production and retail are authorized, new challenges arise, as the distribution in itself is complicated. Medical cannabis cannot be sold in stores, this is illegal. The patient has to find the product he or she wants to purchase online and it is then sent by Canada Post or Courier, the only legal way to access the drug.
The ongoing increase in demand for medical cannabis also means that our member companies had to increase their production. In addition to that, some producers are getting ready for the upcoming legalization of cannabis for adult use and wish to adapt their production capacity accordingly. There was however a regulation in place in Canada, forbidding production to exceed a certain amount or producers would lose their license. Health Canada has fortunately modified some of the regulations recently and licensed producers can now produce on the basis of their vault capacity.
Finally, we are calling for governments to pay more attention to the niche of medical cannabis. There is much potential in medical cannabis, in getting patients off opioids for instance, something that, in light of the recent opioid crisis in North America would not only be beneficial for public safety but durably and positively impact healthcare budgets. Cannabis Canada is advocating for medical cannabis to be covered by health insurances, which is currently not the case, and we also call for zero taxation, as is the case with any other drug in Canada.
With the planned legalization of cannabis for recreational use by summer 2018, how can Cannabis Canada collaborate with provincial, territorial and federal government to ensure best preparation for the post-legalization period?
Canada has already one of the highest rates of consumers between 15 and 24 turning to the black market for cannabis. We consider it essential to see legalization coming soon, as the black market is continuously growing. The main priority for the post-legalization period will be to keep consumers out of the black market. According to certain studies, 11 million people in Canada claimed that they will be trying cannabis for the first time after the legalization. If there will be none available on the legal market, they will most likely look for it on the black market, where quality controls are not in place. All of our members are not interested in venturing into the adult use sector, but those that are need to gear up their production.
The pricing and distribution strategy are two other factors we need to think about now, in order to be prepared for the legalization. Another study shows that if the price of cannabis were to increase by one dollar premium per gram, 35 percent of consumers would go back to the black market. Therefore, there is a lot at stake in terms of pricing, and governments have to ensure they maintain competitiveness. If production, retail and distribution are orchestrated by private companies, this will keep the prices down.
Cannabis Canada, as an expert in the field, is also eager to advise the provincial and territorial governments in their analysis of the best distribution channels to choose and ensuring a seamless process in post-legalization times. Our position is that, until details are being figured out, e-commerce is the best solution as it allows everyone to access the product, while controlling the black market.
As you mentioned, distribution is a challenge your members are already battling with. What are the specific characteristics of this concern?
Overall, there are more than 300 different products available in the Canadian medical cannabis market, varying in form but also THC (tetrahydrocannabinol, the hallucinogen in the plant) and CBD (cannabidiol, the “healing” compound) content. Patients need to have access to their selection of choice and you can see the challenge of holding 300 different products in storage. Hence, the online distribution was the best option for medical cannabis.
What do you see the future bring for the medical cannabis sector in Canada?
In Canada, there are over 250,000 patients on medical cannabis today, with 10 percent new patients per month and a 10 percent increase in physicians prescribing medical cannabis per month. Health Canada is licensing more and more producers, demonstrating that the sector is fast evolving.
Our members are most focused on are finding new product forms and new ways of determining the right balance of THC and CBD content, as appropriate. The medical cannabis plant has a different effect on every patient, and the right dosage and administration form are thus essential to ensure optimal treatment. The licensed producers are moving away from the dried flower and vaporizing and have launched oils that can be used under the tongue and capsules to optimize effects for patients. They are dedicated to finding means of administration that present alternatives to smoking.
The medical cannabis sector also comprises a series of economic opportunities. Can you outline the most significant ones?
The sector of medical cannabis has the potential to contribute importantly to the creation of jobs in Canada, especially in rural areas. I also see the potential for Canada to position itself as a preferred partner on the worldwide market, building a reputation as a vibrant export market for itself. Canada already exports to some countries as Germany, and other countries such as Denmark have only recently visited Canada to learn more about our regulatory frame and the potential for the medical cannabis sector.
From the invention of insulin to radiation therapy to stem cells, Canada has a long and distinguished tradition in medical R&D and innovation. The medical cannabis industry is a niche industry where Canada can pursue undisputed global leadership. What role should Canada be playing within the global medical cannabis sector?
I think we should lead. With our expertise we can say we have the ability to teach others, as we already are leading in this industry. The industry will continue to grow and we will see many more technological innovations coming to it.
How did you come to work in this sector?
I am a healthcare professional and saw the position published and thought “how interesting!” The more I read about the medical cannabis market, the more intrigued I was by the opportunities, knowing this was just the beginning and there was so much left to do. And the more I hear about the positive effects for patients who take medical cannabis, the more I am convinced that it is essential to develop this sector.
