By Marilou Gagnon and Adrian Guta
It is common for people living with a chronic illness to use cannabis to manage symptoms such as appetite loss, wasting, nausea, vomiting, pain, anxiety, depression, stress, and insomnia.
Reasons for using cannabis as a symptom-management strategy include its effectiveness, delivery methods, ability to treat multiple symptoms as opposed to just one, low potential for side effects and interactions in comparison to medications, and additional beneficial effects on mood, stress, and overall well-being.
Historically, people who live with a chronic illness have faced important barriers to access medical cannabis in Canada. As a result, many have had to rely on illegal sources to access cannabis to manage their symptoms.
Cannabis legalization is a step in the right direction, but in its current form, it is not a panacea. From a medical-cannabis perspective, it is unclear how legalization will help address the barriers to access, and it may create new challenges. People who use cannabis for symptom management should be able to access it through their health-care providers, include it in their treatment plan, and benefit from lower costs, coverage, and tailored products and dosages.
However, we posit that they are likely to continue using the recreational (including illicit) market to relieve their symptoms. This market provides people with more control and affordable choices while taking cannabis out of the hands of medical providers whose attitudes are often unfavorable.
This is where things might get complicated for people living with a chronic illness.
Now that the government has taken over the recreational market, it creates a major shift in access for people living with a chronic illness who have been relying on illegal sources of cannabis for symptom management for years.
First, those who may not be able to afford or access government-sanctioned cannabis risk harsher punishment than before if they purchase or grow cannabis outside the regulatory structure. In fact, police departments across the country have already committed to ramping up policing and interventions to tackle cannabis production and consumption outside this regulatory structure.
Second, they may face a gap in access created by the threat of severe criminal penalties for the sale of illegal cannabis (up to 14 years in prison) and the shortage of supply of government-sanctioned or medical cannabis (which is already being reported). In other words, it could limit access to previous suppliers such as a trusted dealer, friend, or acquaintance while also failing to provide a constant sanctioned supply.
Third, they may face important barriers due to forced closure of local dispensaries. For example, just two days after the official legalization of cannabis, police raided and shut down five dispensaries in Toronto. This trend is expected to intensify and spread across the country. People living with a chronic illness tend to be overrepresented among dispensary users in Canada. As such, their access could be significantly impeded because of legalization.
Fourth, they may have limited access to other ways of consuming cannabis that pose fewer health risks and provide enhanced benefits for symptom management. For example, edible products have not been included in legalization and they can only be accessed through unsanctioned channels or via home production.
Finally, people who smoke or vape cannabis may experience serious barriers to consumption due to newly created by-laws, zoning, renter regulations, and ticketing practices.
In sum, legalization may actually make it harder for people living with a chronic illness to access and benefit from cannabis, and even more so if they experience poverty and housing insecurity.