When Canada legalized recreational cannabis, it was globally celebrated as a monumental positive shift in policy. Yet, while the Canadian Cannabis Regulations under the Cannabis Act provided a framework for access for recreational users, one group was left behind: medical cannabis patients.
Legalization promised accessibility. But, in reality, the shift from medical cannabis regulations under the Access to Cannabis for Medical Purposes Regulations (ACMPR) to the Cannabis Act ended up creating new barriers for the very people who rely on cannabis to manage pain, anxiety, insomnia, and other chronic conditions.
Recreational consumers can walk into any cannabis retailer with an ID to buy what they want. Medical patients, meanwhile, are stuck navigating a system shaped by cannabis policies that continue to stigmatize cannabis as medicine. Instead of improved access and care, patients face delays, confusion, and structural barriers that make safe, effective treatment harder instead of easier to obtain.
1. Recreational products do not suit the needs of patients.
2. Budtenders are legally prohibited from providing medical guidance.
3. Most compassion clubs have closed their doors due to having no avenues for licensing.
4. Cannabis patients are unfairly taxed on their medicine.
For a deeper dive into the realities of the failed medical cannabis regulations in Canada, watch our full conversation with Hilary Black of the BC Compassion Club Society, Ted Smith of the Victoria Cannabis Buyers Club, and pharmacist Trevor Shewfelt in episode 44 of The State of Craft.
Under the current model, Canadian retailers are set up for recreational consumers, not for those seeking therapeutic relief. One of the more glaring examples of this is the product types and formats stocked for recreational customers.
Patients searching for low-THC, high-CBD, or terpene-rich strains often find their options severely limited. Retailer shelves are dominated by high-THC products, which aren't appropriate for many medical needs. While THC may still be the number one priority for recreational users, many patients prefer less intoxicating options that don't trigger anxiety, paranoia, and other unwanted side effects.
On the flip side, the very same THC products that dominate recreational shelves still aren't strong enough for a separate subset of medical patients who need much larger THC dosage to effectively target symptoms.
Current cannabis regulations cap edible & suppository products at 10 mg of THC per serving. This is limit has nothing to do with medical need. Many patients require 30 mg, 40 mg, 50 mg, or even more THC to manage serious chronic symptoms. Under today's model, that means chewing through a handful of 10 mg gummies just to reach the prescribed dose, or even worse, having to insert multiple suppositories anally/vaginally. That's absurd.
And just in case you weren’t aware, patients use suppositories because THC is non-psychoactive when taken in that format. You can get all the medical benefits without getting high.
A final challenge for patients seeking medicine through the recreational market: product selection. There is a very real disconnect between medical and recreational cannabis because of the limited types of products typically stocked.
The top sellers on the recreational side of things are smokables/vapables, edibles, and drinks. But these formats aren't always a good fit for patients, particularly those trying to avoid respiratory stressors. Oils, tinctures, topicals, suppositories, and tablets, all of which are standard therapeutic formats, do not have anywhere near the type of meaningful variety that smokables/vapables do on the recreational side of the industry. And even when there is variety, most options include lots of THC.
How many times a day is a budtender asked for medical advice? A 2023 study found that 87.7% of Canadian retail staff regularly received medical cannabis questions. Another study found that approximately 45% of respondents reported handling 6-10 medical inquiries daily.
Patients and recreational customers alike regularly ask for recommendations to help them sleep, to relieve pain, and to manage complex medical conditions. Yet, with Canada's current cannabis regulations, budtenders are legally barred from discussing how cannabis treats medical conditions.
Imagine needing advice on pain relief but being told, "sorry, I can't discuss that." Instead of getting support at the point of purchase, as you would at a traditional pharmacy, patients are punted back to their doctors (if they have one). This is a story we heard from Kala Sanmartin of Vital Holistic Care and Kirk Nyquist of the Reefer MEDness podcast in episode 43 of The State of Craft.
With the medical system continuing to stigmatize cannabis, this translates to lengthy delays for patients trying to book appointments with their health care provider. And often, that appointment is quite frustrating for the patient, since their doctor or nurse practitioner are almost never trained on the nuances of cannabis as medicine.
For a patient in pain or managing other chronic symptoms, this is a completely unnecessary hurdle to receiving the care they deserve. Many patients end up turning to friends or, worse, Dr. Google for medical advice.
Think about it: patients are expected to "figure it out" at a retail counter, and the budtender isn't allowed to guide them around the most basic considerations for using cannabis as medicine.
Patients deserve easy access to knowledgeable professionals, whether it's pharmacists, physicians, or medical cannabis specialists who can help them make informed choices at the point of purchase, the same way they would with any other medication.
Before legalization, compassion clubs filled this knowledge gap between patients and medical cannabis. These organizations provided guidance, education, advocacy, and often access for those choosing cannabis as medicine.
As members, patients received personalized support. Staff had the expertise and training to offer practical advice tailored to their needs and tolerances. The majority of clubs prioritized access to medical cannabis over profit-driven sales.
Unfortunately, despite the Senate Special Committee on Illegal Drugs recommending that Health Canada include compassion clubs in their framework, all but one compassion club were forced to shut down after legalization… and the one remaining club is in an active legal battle and facing millions of dollars in fines. Where do these thousands of patients now go when they need support for a cannabis prescription? We can only assume that most now shop at their local cannabis retailer, a space without any patient support. For all those who relied on these organizations, the shift has been a step backward.
Want to learn more about the history of compassion clubs in Canada? Check out Episode 38 of The State of Craft, featuring VCBC founder Ted Smith.
In Canada, prescription medicines are "zero-rated," meaning they're exempt from both excise duty and sales tax. This keeps medicine affordable for patients who need it. So what's with the title of this section?
When it comes to medical cannabis, the government decided to completely ignore the policies that govern literally every single other medicine in Canada. Medical cannabis is taxed like recreational cannabis. It’s the only exception to the prescription medicine tax exemption. Despite requiring a prescription from a doctor, medical cannabis is hit with both excise duty and sales tax, and patients have to pay these costs out of their own pocket.
This strange state of affairs is all because cannabis prescriptions are technically "medical documents," not "prescriptions." In our opinion, this is a wild way to classify a medicine, and it ultimately harms patients. Canada is the only jurisdiction in North America that taxes medical cannabis the same as recreational cannabis. It's completely backwards.
Patients are struggling under the Cannabis Act/Cannabis Regulations. The current framework is failing the very people it was designed to help. That's why a comprehensive overhaul is needed.
After speaking with medical cannabis advocates, compassion club founders, pharmacists, nurses, and patients across the country, we've heard loud and clear about what needs to change about the current paradigm. Here are the most urgent changes Canada must make to truly serve medical patients:
Canada's cannabis regulations work well for recreational users, but as we've discussed, medical patients have been left behind. The system needs to shift from a one-size-fits-all approach to one that recognizes the unique needs of medical cannabis users.
Patients shouldn't have to fight for access, support, or affordable options. They deserve a system that prioritizes relief over profit and health over high-THC recreational products.
It's time for Canada to fix medical cannabis access, because legalization should benefit everyone, not just people who want to get high for fun. If the Canadian government wants to truly support medical cannabis patients, the current medical cannabis ecosystem needs a major overhaul.