Pubdate: Tue, 02 Jan 2018
Source: National Post (Canada)
Copyright: 2018 Canwest Publishing Inc.
Author: Geoff Zochodne
Page: FP1


New 'sin tax' may create 'barriers' for patients

Canada is riding high when it comes to cannabis. By next summer, the
country could be the first G7 economy to have legalized recreational
marijuana, creating an allnew industry expected to generate billions
of dollars in cash for companies and government coffers.

But while pot smokers and the companies that will serve them
celebrate, the concerns of the medical marijuana industry seem to be
getting short shrift.

For one thing, the federal government in November proposed to subject
medical cannabis to the same excise tax - or "sin tax," as some refer
to it - as its recreational cousin. The mere prospect of a medicinal
marijuana tax has been taken as a slight against the drug's
therapeutic properties, since critics note that other medicines are
not subject to such a charge.

"The taxation proposal clearly illustrates the government is not
taking cannabis seriously as a medicine," said Jonathan Zaid, founder
and executive director of Canadians For Fair Access to Medical
Marijuana, a national non-profit organization. "Patients are already
facing affordability challenges and this tax is really going to
compound barriers to access for patients across the country."

Canada, understandably, is paying more attention now to recreational
cannabis than its existing medical regime, but it is doing so at a
sensitive time for the latter, as the tax brouhaha

The number of clients signing up to receive medical cannabis has
exploded to more than 200,000, but doctors remain hesitant to
prescribe cannabis.

There are high expectations for demand and the amount of money the
medical sector will be worth - even after the recreational market
opens - and the current regime also remains ripe for some innovation,
since patients still receive the product via mail.

Mackie Research Capital in September estimated that the number of
registered marijuana patients would hit 630,000 people - or
approximately 1.7 per cent of the population - by 2024. With that many
potential customers, Mackie projected the value of the medical market
would be between $1.9 billion and $2.6 billion.

"The nice thing is that I think the medical market will continue to be
the most valuable market because of the direct relationship between
producer and patient, or customer," said Chuck Rifici, chairman and
chief executive of Cannabis Wheaton Income Corp., which helps
fledgling pot producers with financing.

"There is no way for provincial or for any level of government to
intermediate themselves into that medical relationship between
producer and customer."

But PwC said in a report earlier this year that some industry
stakeholders felt the federal government's "tight timeframe" for
recreational legalization would lead to a lack of consultation and the
potential to miss the opportunity to right the medical regime.

"Because decision-makers will have so little time for regulatory
development, the focus will be exclusively on recreational cannabis,
to the detriment of changes that may be required for medical
cannabis," PwC warned, adding that changes to the medical regime could
be as far away as three years as a result.

One outstanding problem is that doctors may still be hesitant to
prescribe cannabis to their patients, creating a bottleneck in the
system for both patients and producers.

"This incarnation of the medical cannabis market in Canada came about
four years ago," said Neil Closner, chief executive of Markham,
Ont.-based medical marijuana producer MedReleaf Corp. "And the single
biggest challenge that patients and physicians have been encountering
is actually obtaining a medical document, or from the physicians'
side, understanding or becoming comfortable with how to prescribe."

Some of the discomfort physicians may have with prescribing pot was
touched on by Dr. Shawn Whatley, president of the Ontario Medical
Association, which represents the province's 30,000 doctors, during
his testimony at a provincial legislature's justice committee in November.

"There is a need for more research on cannabis and at this time there
is a gap in knowledge," he said. "When considering medical cannabis,
it is critical to emphasize that physicians receive requests from
patients for prescriptions. Given the lack of evidence and knowledge
around dosing, drug interactions and the prescription process, this
puts many docs in a very difficult position."

As such, he added, "the OMA would like to reiterate the importance of
further research to inform broader clinical evidence for prescribing,
coupled with education programs to support prescribers and patients."

Patients are also upset with the federal government's proposal to levy
an excise tax on all forms of cannabis.

Canadians For Fair Access to Medical Marijuana has launched a campaign
it hopes will stop Ottawa from slapping a sin tax on medical cannabis,
which has prompted more than 12,000 patients to send letters to their
Member of Parliament.

All prescription medications in Canada are "zerorated," Zaid said,
meaning they have no sales or excise tax on them.

"And that's a smart policy approach to taxing medicine," he said. "The
purpose is to make it accessible for those who medically need it,
whereas the purpose of a sin, or excise, tax, is to reduce consumption
and limit access and that's fundamentally not what the government
should be doing when it comes to medical cannabis access."

Twelve different health-related organizations - including Canadians
for Fair Access to Medical Marijuana, as well as the Arthritis
Society, Canadian AIDS Society and Cardiac Health Foundation of Canada
- - sent a letter calling for medical cannabis to be zero-rated on Dec.
7 to the federal government as it consults the proposed excise tax.

"In combination with severely limited insurance coverage and the
application of sales tax, the affordability of cannabis for medical
purposes is already pushing Canadians to make excruciating decisions
about their health," the letter said.

"There is an ongoing contradiction in the Canadian system in that
cannabis for medical purposes is authorized by health-care
practitioners as a medicine, yet not treated like one."

But perceptions may have already begun to shift in a favourable
direction for medical marijuana, something that may be helped along by
the legalization of its recreational cousin.

"Now that recreational is coming, it's almost widely accepted now, 'Oh
yeah, medical cannabis, everyone knows about that, everyone's using
it, it's out there,' " Closner said.

Saskatoon-based CanniMed Therapeutics Inc. commissioned two studies of
doctors' attitudes and behaviours toward medical cannabis in 2014 and
2016, finding that the results suggested "a shift in attitudes and
prescribing practices among Canadian physicians."

The percentage of doctors willing to prescribe cannabis rose to 21 per
cent from 12 per cent, according to Mackie Research.

To put physicians more at ease around cannabis, MedReleaf in November
said it was introducing a "groundbreaking, patentpending" genetic test
called ReleafDx.

The test starts with a cheek swab at a doctors' office that gets
analyzed by LabCorp-owned Dynacare, which then sends information back
to the physician on what sort of dosage and cannabis product would be
appropriate for that patient.

"We're combining substantial patient data that's been collected over
time, with academic research that's been performed in terms of writing
or designing this algorithm that spits out for the physician the
answers to these two questions," Closner said.

"It's our belief that if we make these two questions much easier to
answer for the physician, then the number of physicians that will be
interested and feel more comfortable in prescribing will grow
substantially across the country."

The methods by which patients can actually buy medical marijuana could
be ripe for change as well. Under current rules, medical cannabis can
only be distributed to patients through the mail.

Meanwhile, provinces are preparing varying combinations of retail
systems for recreational marijuana, but customers will likely be able
to purchase both in-store and online.

One proposed avenue for expanding retail sales of medical marijuana is
through drugstores. Shoppers Drug Mart Corp., Canada's largest
pharmacy chain, made waves in December when it was announced a medical
cannabis supply agreement with Leamington, Ont.-based Aphria Inc.

Canaccord Genuity called it a "watershed moment" for Aphria and the
cannabis business, and at least two other producers have since
announced supply deals with drugstore chains.

Allan Malek, executive vice-president and chief pharmacy officer at
the Ontario Pharmacists Association, said his group, which lobbies on
behalf of the drug stores, is "basically saying pharmacies are the
most logical location for medicinal cannabis to be

Malek said it could be argued that discussions around reforming the
medicinal cannabis system should have come before legalizing the drug
for recreational purposes.

"If you're defining first what the recreational space is going to look
like, and you've got people who are suffering from many of these
conditions that could be treated medicinally, you've got people who
are going to start self-medicating," he said.

"People may be self-selecting or getting advice from a non-health
professional on a product that may not be helping their condition."

The federal government's cannabis consultation paper suggests some
tweaks to the medical system.

One potential change is eliminating a rule that blocks licensed
sellers from filling multiple orders within a month that would provide
a client with more than a month's supply of cannabis. This would,
presumably, allow patients to ensure they have a sure supply of
medical marijuana.

The medical marijuana system and its patients may eventually get the
change they need. Rifici noted the foundations of the system are built
on a very one-sided legal battle between patients and governments,
with the latter always losing.

"The regulatory evolution on the medical side has certainly slowed
down, some would say far more than it should," he added. "We'll see a
balancing effect post-legalization."
- ---
MAP posted-by: Matt