Dear Herb: Is there any chance the medical cannabis system is going to be overhauled to allow patients to pick up their medicine from a bricks-and-mortar location? Mail delivery is nice, but not always the fastest option. And ordering online or over the phone can create complications for those without credit cards or internet access. — Frustrated Patient
Dear Frustrated: You might have to be a patient patient for a while longer, but I do believe there's a chance that medical cannabis could eventually be sold at storefronts in Canada.
Right now, medical cannabis patients registered with Health Canada's medical cannabis program can only receive medical cannabis products from licensed producers by mail, or grow their own with a special licence. The medical cannabis system is entirely under federal control. Provincial governments regulate the sale of recreational cannabis in stores, but have basically nothing to do with the medical cannabis regime.
That could change in the future. In a background document made public on legalization day, the federal government explicitly said that the existing medical cannabis system "will be reviewed by the Government of Canada within the next five years," i.e. sometime before October 17, 2023.
Could future reforms to the medical cannabis regime actually result in legal medical cannabis being sold in physical stores? The Canadian branch of a major generic pharmaceutical manufacturer is working behind the scenes to make that happen, although their specific vision involves medical cannabis being dispensed in-person at pharmacies.
"If cannabis is now becoming an option of treatment by the physician, why is there a single monopoly track of distribution by mail via the manufacturer? We think it doesn't make sense, and that's why we're advocating for open distribution in pharmacies," says Michel Robidoux, the president and general manager of Sandoz Canada.
"We're currently working to influence the provinces and Ottawa to make those changes," added Robidoux, who described those efforts as something of a chicken-or-the-egg conundrum.Advertisement
In Robidoux's telling, Sandoz Canada initially approached the federal government and asked them to amend the medical cannabis regime to permit medical cannabis sales in pharmacies. He says Ottawa wouldn't amend those rules unless they received a request to do so from the provinces, so now Robidoux is trying to drum up support from provincial governments. In turn, he says, those provincial governments want the support of their respective provincial colleges of pharmacy — and in some cases, the support of their physicians' colleges as well.
"We're essentially guiding the provinces, and we are seeking alignment on the need to have medical cannabis distributed in pharmacies," says Robidoux.
He thinks it's possible that change could take place during the five-year review of the medical cannabis system, although he says "we hope it could be achieved sooner."
"We think that the first province who will request Ottawa to allow them to permit pharmacy distribution, I think will influence the rest of (the) provinces thereafter," he says.
(At this point you might be wondering why Sandoz, a pharmaceutical manufacturer that doesn't actually operate retail pharmacies, cares about how medical cannabis is distributed. The answer is two-fold: first, Sandoz has entered the medical cannabis market via a branding and research deal with licensed cannabis producer Tilray. Second, pharmacies are a key distribution network for Sandoz's generic non-cannabis pharmaceuticals — so presumably, anything that boosts business for pharmacies would be good for Sandoz in general.)
Another way that cannabis could be dispensed by pharmacists at bricks-and-mortar pharmacies is if certain cannabis formulations are granted a Drug Identification Number (DIN) by Health Canada. That's the government's official regulatory designator for prescription and over-the-counter drugs, and Robioeux says a cannabis product with a DIN would be permitted for dispensing by pharmacists.
"We are also looking at this route with Tilray, but it's a long road because you need to do more clinical studies," says Robidoux.
"And the pathway and the (financial) return, not having (intellectual property protection), necessarily, is challenging for us to contemplate."
At least one cannabis-derived, non-synthetic cannabinoid pharmaceutical has been granted a DIN in Canada before, in the form of Nabiximols (Sativex) — so it's not impossible. Regardless, it looks like the possibility of actually picking up your physician-authorized medical cannabis in a herbal or oil form at a pharmacy is still a long way off. In the meantime, many of the products sold through the medical cannabis stream are also sold at licensed recreational cannabis stores.
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Updated on Wednesday, June 19, 2019 at 1:09 PM CDT: Fixed misquoted words in two quotes from Michel Robidoux. Fixed erroneous spelling of Robidoux.