4/20: Cannabis could be safe alternative to toxic drug supply, so why is access being cut off?

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      By M-J Milloy and Marilou Gagnon

      As British Columbia struggles to implement and scale-up safer supply programs to blunt the unprecedented overdose crisis, why is provincial law enforcement shutting down community-level groups providing a safer supply of cannabis to people at greatest risk of overdose?

      At the beginning of March, officials from the Community Safety Unit (CSU) operating under Minister of Public Safety Mike Farnworth raided the Blue Door, a dispensary selling unregulated cannabis to people in Vancouver’s Downtown Eastside neighbourhood, the epicentre of Canada’s overdose crisis.

      That followed multiple raids on the Cannabis Substitution Project, which hands out free cannabis every week from an RV near Hastings and Main, and two raids at the Victoria Cannabis Buyers Club, one of the province’s oldest sources of low-cost medical cannabis for more than 8,000 members living with chronic health conditions, including chronic pain. The club now faces more than $6.5 million in fines.

      While differing in location, ownership, and operations, these three groups—and others across the country—face legal jeopardy for allegedly distributing cannabis from producers not licensed under Canada’s official framework for legal cannabis. They have been swept up in the efforts of Canada’s governments to eliminate cannabis profits for organized crime groups, one of the key aims of cannabis legalization.

      “We have been very clear that once legal cannabis retail outlets became operational in a community, the illegal retailers would face increasing enforcement activities from the CSU,” Farnworth said in a press release after the raid on the Blue Door.

      Farnworth’s statement reflects a narrow interpretation of the public safety purpose of the Cannabis Act and blatantly ignores its public health purposes. Eliminating important sources of low-cost cannabis for people at highest risk of overdose does not increase public safety nor does it meet the public health benchmarks set out in the Act.

      It also fails to take into account public interest and the harms of taking away these sources of cannabis in the midst of the overdose crisis.

      Promising but preliminary research from our research groups at UVic and UBC have raised the possibility that cannabis is playing a beneficial role in the overdose crisis by providing a lower-risk alternative to the toxic supply of opioids and stimulants and other drugs, especially for people using drugs for pain relief.

      For example, among almost 1,500 people who use drugs in the DTES interviewed at the start of the overdose crisis, almost two-thirds reported recent use of cannabis—and, of those, more than 75 percent reported at least one medical reason for using cannabis, including treating chronic pain and substituting for other drugs.

      In a dozen studies in peer-reviewed journals, we have documented how cannabis use was linked with lower rates of beginning to inject drugs, a key risk factor for overdose, and higher rates of ceasing to inject opioids. Daily cannabis use was also strongly associated with better engagement in medication for dependence on opioids.

      In another study, we found that people using drugs living with chronic pain—an experience that lies at the root of opioid use for many dying of overdoses—were less likely to use opioids if they were using cannabis.

      While there’s no lack of cannabis in the DTES and other communities decimated by the overdose crisis, it’s not hard to understand why almost none—less than one percent, according to our research—comes from the legal system. The key reason is cost. Although legal cannabis is getting cheaper, it is still more expensive than unregulated cannabis, especially at the lowest quantities, thanks in part to the federal government’s $3 excise tax on each product. And, due to federal regulations, some products are not available in the legal market, such as high-dose edibles.

      Thus, our research suggests that by providing a dependable and consistent supply of low-cost cannabis and products currently not available via government sanctioned stores, these unregulated outlets are filling a gap in the legal cannabis market.

      In fact, in one study we found that people using cannabis primarily to treat pain had approximately 30 percent lower odds of experiencing an overdose—and they were twice as likely to report that their most important source of cannabis was an unregulated outlet like the Blue Door.

      Deaths as a result of the toxic drug supply in this province have never been higher and the province has stated it’s expanding access to safe supply. Yet the ongoing policing raids and closures of low-barrier cannabis suppliers says otherwise.

      Who is being protected by these raids is not clear; it’s certainly not people who are at risk of dying.

      M-J Milloy, PhD, is an epidemiologist, research scientist at the British Columbia Centre on Substance Use and the Canopy Growth professor of cannabis science at the University of British Columbia. Marilou Gagnon, RN, PhD is a Professor at the School of Nursing, Faculty of Human and Social Development at the University of Victoria and Scientist at the Canadian Institute for Substance Use Research.