Pubdate: Tue, 11 Aug 2015
Source: Canadian Medical Association Journal (Canada)
Contact:  2015 Canadian Medical Association
Website: http://www.cmaj.ca/
Details: http://www.mapinc.org/media/754
Author: Shannon Lough

DISPENSARIES: THE WILD WEST OF VANCOUVER

Vancouver has entered unchartered territory as the first Canadian 
city to regulate marijuana dispensaries, with proponents arguing that 
regulation protects people's health and restricts access.

The chief medical health officer for Vancouver Coastal Health, Dr. 
Patricia Daly, who helped inform the decision to regulate, says that 
"city council may be seen as the Wild West, but they're stepping in 
to reduce potential harms associated with the complaints they had 
from the community."

Over the past few years, 100 marijuana dispensaries have opened in 
Vancouver. Only 25 licensed producers, which deliver their product by 
mail, have been approved by Health Canada to sell medicinal marijuana 
from federally sanctioned growers. The remainder presumably obtain 
their cannabis from black market sources. These businesses were run 
without any city bylaws restricting how the illegal drug was sold.

"By regulating this, people under 19 won't be allowed in these 
places, they won't be selling edible products, and it's actually 
going to improve the situation from what it is currently," Daly says.

The new city bylaws ban the sale of marijuana in baked goods or 
candies. Daly directed city council to emerging evidence from the 
United States, showing unintended exposure among young children who 
consumed edibles has increased in states that have legalized 
marijuana for recreational use. "The lesson from the US is that the 
edible products are a problem and they probably should have been more 
strictly regulated."

The federal government opposes the city's decision and hopes that the 
police will enforce the law prohibiting marijuana, but Vancouver 
Police Chief Constable Adam Palmer has made it clear that shutting 
down dispensaries is a low priority.

Dispensaries and compassion clubs are considered illegal by the 
federal government; the only legal way to obtain cannabis is for a 
"health care practitioner" to complete a medical document for the 
patient. Doctors are, in effect, the gatekeepers of medical marijuana.

The President of Doctors of BC, Dr. Charles Webb, says that 
physicians have no training in medical marijuana composition, how it 
will alleviate symptoms of an illness or what the long-term effects 
might be. "Doctors really have no guidance, or instruction, or 
training in how to prescribe it."

Webb says that Vancouver's new regulations won't affect doctors.

However, the drug may become more accessible within the province. 
Victoria city council is considering following Vancouver's lead in 
regulating its 19 dispensaries.

Under Vancouver's bylaw, dispensaries must pay $30,000 a year for a 
business licence, while compassion clubs, which are usually 
not-for-profit, member-run and offer wellness services, must pay 
$1000. The new bylaw bans dispensaries from operating within 300 
metres of schools, community centres and other marijuana shops.

Daly acknowledges that a lot of people are visiting the shops for 
recreational purposes. She asked that some of the licensing funds go 
toward educational programs in schools and city council agreed. "We 
want [youths] to understand the harm associated with marijuana. So 
they have good information and can make an informed choice about 
whether to use this product."

The dispensaries will also have to provide information to their 
clients outlining who shouldn't use marijuana for medicinal purposes, 
including people with schizophrenia and pregnant women.

Not everyone agrees with Vancouver's new regulations. They pose a 
public health threat, says Pamela McColl, spokesperson for Smart 
Approaches to Marijuana, a national advisory board made up of 
researchers and physicians. "Any move to legitimize storefronts is a 
move towards normalization and commercialization. It will increase 
use by youth and other people."

The city's former drug-policy coordinator for 12 years, Donald 
MacPherson, disagrees and says that the supply of cannabis would 
remain the same even if all of Vancouver's dispensaries were to close 
tomorrow. "All that's happening is that part of the market is 
becoming more above ground and regulated."

He compares Vancouver's dispensaries with Insite, a supervised 
injection clinic introduced by the city in 2003. "It's a municipality 
trying to come up with a solution that works with the locality." 
MacPherson says that dispensaries have been around for many years.

Just because dispensaries are now regulated doesn't mean that people 
will become addicted to marijuana, adds Dr. Benedikt Fischer, a 
senior scientist at the Centre for Addiction and Mental Health in 
Toronto. He compares the current marijuana situation with the 
temperance movement and the prohibition of alcohol in the early 20th century.

Back then, the only place people could get alcohol was in the 
pharmacies for supposed medicinal purposes. "These weren't 
chronically ill people discovering that alcohol was a medical cure 
for the chronic illness they had; it's just a substance they wanted 
to consume for a variety of reasons."

He says that with marijuana, there is actually some evidence of 
therapeutic benefits, although more research needs to be done. The 
difficulty is that many "medical marijuana users are using it for 
psychological issues like stress, sleep problems or well-being, which 
are not so easy to categorize in terms of the symptoms and the outcomes."

Many agree that more research is needed, but while everyone waits for 
that to happen, Vancouver is taking matters into its own hands.
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MAP posted-by: Jay Bergstrom