Taxing medical cannabis hurts vulnerable patients

With so much attention focused on the Trudeau government’s plans to legalize recreational cannabis, it is important to not forget the thousands of Canadians currently benefiting from treatment with medical cannabis. Unfortunately, some of the decisions the government is making today are disadvantaging those patients. In order to legally purchase medical cannabis, patients require the written authorization of a physician, similar to the prescription required to receive the vast majority of medications. However, unlike all other prescription medications, which are tax free, medical cannabis is subject to HST. The government recently announced that not only will this sales tax continue, but that medical cannabis will also be subject to the same excise tax as recreational cannabis. Cannabis is a very promising medical treatment, already recognized as having substantial evidence of efficacy for a variety of conditions and is already helping improve the lives of many Canadians. However, the government’s plan is to have medical cannabis taxed not just once, but twice. This tax treatment already creates a significant hardship for patients and the addition of the excise tax will only make it harder for them to afford the treatment they need. Medical cannabis is not covered by any of the provincial drug benefit plans and only very sparsely by private plans, so most patients have to pay out-of- pocket for their medical cannabis, even though they are covered for most other medications. Even worse, the government’s taxation plans may hurt efforts to fight the opioid crisis. Medical cannabis has been shown to be an effective treatment for chronic pain, and has the potential to substitute for a significant percentage of opioid prescriptions - reducing side effects and the potential for abuse. Opioids, however, are fully covered by most drug insurance plans and are not subject to taxation, meaning that patients will have to pay significantly more to use medical cannabis than they will for continuing with (or starting) opioids. The government should be encouraging patients to substitute medical cannabis for opioids where appropriate, not discouraging them through higher taxes. Medical cannabis has also been shown to help reduce use of other medications, such as benzodiazepines, which in certain circumstances present challenges for both physicians and patients. The proposed tax regime will have the same discouraging effect on pursuing cannabinoids as an alternative to benzodiazepines. The government has argued that they plan to tax medical cannabis because otherwise Canadians will get medical cannabis authorizations without true medical need in order to avoid paying the tax on cannabis they really want for recreational purposes. This is, quite frankly, an insult to both Canadian doctors and the patients for whom they prescribe cannabis. If those who want to use cannabis recreationally are so able to easily secure a doctor’s authorization, then why is there such a push for legalization? Doctors take their responsibilities seriously, and the 200,000 Canadians benefitting from medical cannabis today are suffering from serious health conditions, not simply finding a way to use recreational cannabis. Further, many of the conditions (e.g. chronic neuropathic pain, spasticity in patients with MS, and anxiety) for which cannabis has substantial evidence of efficacy need to be managed by physicians. If patients with legitimate medical need pay just as much tax for their cannabis as do those Canadians looking to use cannabis recreationally, fewer of these patients will bother going to their doctor when they can simply buy cannabis at a retail store. This will hurt their overall quality of medical care. If the government sees a genuine need to discourage recreational users from attempting to secure medical cannabis, then a better and fairer solution is to authorize the availability of more advanced dosage forms of cannabis for medical users. Licensed producers have long asked the government to allow them to supply cannabis in forms such as tablets, metered dose inhalers, and topical including transdermal patches. These forms would more clearly be recognized as medical products and would be more acceptable to doctors and patients while also being of far less interest to recreational users. Canadians pride themselves on a public healthcare system designed to ensure that all Canadians, no matter their income, can get the treatment they need. Taxing medical cannabis directly contradicts this principle, putting effective treatment out of reach of many lower and middle income Canadians. As they work to get the rules in place for recreational cannabis, the government should not forget those thousands of Canadians benefiting today from medical cannabis and the many thousands more who could benefit. Gordon Fox is the CEO of Emblem Corp, a licensed producer of Medical Cannabis in Canada. The Hill Times