When Victoria's Tim Wilkins realized his Health Canada license to possess medical cannabis was set to expire last year, he diligently filled out the eight-page renewal form, paid $65 to obtain his physician's signature and submitted the package to Health Canada's Marijuana Medical Access Division in Ottawa on August 22—13 weeks before it was due.

"I'd dealt with [MMAD] for a few years, so I knew how long it could take," says Wilkins, who declined to let Monday publish his real last name, fearing the stigma still attached to medical cannabis use.

On November 27 Wilkins' new license arrived—five weeks after the promised eight-week processing period had passed -- and three days after the old one had already expired.

"The system is set up to be as frustrating and confusing as possible and is really just a joke," says Wilkins. "I had never believed it possible that an arm of government could be so ass backwards, so inept, so slow and so frustrating."

The 35-year-old suffers from degenerative hereditary motor and sensory neuropathy, a muscle-wasting disease that leaves Wilkins, a former seismic exploration worker in the oil and gas industry, with "constant and chronic pain." Before a colleague suggested he try marijuana to relieve his discomfort in 1999, Wilkins says he had never experimented with any of the illicit products on Canada's list of controlled substances.

"I am, and have always been, a law-abiding citizen," says Wilkins. "But it was immediately obvious what [medical cannabis] was doing for me."

Smoking marijuana, he says, provides a degree of relief from his daily pain without the harsh side effects associated with many laboratory-produced prescription pharmaceuticals.

Today Wilkins' is one of a growing chorus of voices -- many emanating from the progressively, critically and terminally ill -- outraged by the bureaucratic tap dance required to win crucial government support to use the herb that can serve as muscle relaxant, pain reliever, anti-depressant and appetite stimulant for a variety of medical conditions.

Critics, lawyers and clients alike say despite repeated orders by Canada's court system for the federal government to provide citizens a consistent supply of medical cannabis, or the legal protections required to access one outside government control, Canada's MMAD and the Marihuana Medical Access Regulations [MMAR] that form the framework for obtaining therapeutic cannabis are plagued by a lack of political will that forces some of the country's most vulnerable citizens into a frontline fight for medication.

Why the government remains so reluctant to back medical marijuana with the same enthusiasm it offers other pharmacological treatments remains unclear. Conservative and Liberal governments alike have cited inadequate research and continuing obligations under the United Nations' Single Convention on Narcotic Drugs. Critics of that explanation contend government resistance has more to do with pressure from the United States' perpetual "war on drugs" and intervention from a pharmaceutical industry that fears an effective -- and natural -- product inundating the market.

Whatever the actual reasons, the upshot of the government's half-hearted foray into the realm of medical cannabis is clear. Medical cannabis proponents see Health Canada's MMAD as a barrier, rather than a conduit, toward a safe, affordable, reliable source of therapeutic marijuana.

Truth in numbers

"[The Marihuana Medical Access Division] is a program that was set up to fail from the word go," says Victoria's Jason Wilcox, who has been HIV/AIDS positive for 15 years. He uses medical cannabis as an appetite stimulant, pain reliever and counterbalance to the agitative effects of the steroids he uses to keep his body from wasting away. Wilcox claims medical marijuana allows him to avoid no less than four prescription drugs, including Stemetil, Restoral and Percocet. From his experience with the MMAD since its early days he identifies myriad problems, from delays to contradictory messages to a complete absence of advice on production, consumption and legal issues facing growers. Wilcox says one need only look as far as enrollment numbers to see the program is failing the very people it was ostensibly established to help.

As of December 2007, 2,329 Canadians possessed a government-sanctioned Authorization to Possess [ATP] dried marijuana -- a dismal record considering the program was initiated in 1999 and a 2002 study commissioned by Health Canada estimated 1.2 million Canadians use marijuana for medical purposes. By contrast, Oregon's Medical Marijuana Program (OMMP) -- also established in 1999 -- boasts 15,927 registered users for a population one-tenth the size of Canada's in a country engaged in a protracted drug war.

Of the 2,329 Health Canada licensees, only 488 Canadians are currently accessing government-grown marijuana. Critics say that number is likely far lower factoring in the number of clients who return their cannabis to Health Canada with complaints about its poor quality.

So despite the existence of an almost decade-old federal marijuana program that has had its own supply of pot since 2003, the vast majority of medical marijuana users continue to access their medical cannabis by means still considered illegal in the eyes of the law.

In Victoria, the Vancouver Island Compassion Society provides 745 members with medical cannabis and cannabis-based products -- with only a doctor's signature and proof of condition. VICS founder Philippe Lucas estimates only 60 of those members possess Health Canada authorization.

At Victoria's Cannabis Buyers Club, founder Ted Smith says his downtown storefront provides between 2,200 and 2,300 sick clients with medical marijuana, again with only a doctor's endorsement and evidence of an illness requiring therapeutic cannabis.

"Maybe between 100 and 150 of those clients have filled out Health Canada forms," says Smith.

Research conducted in 2006 by Wendy Little and Eric Nash, owners of Island Harvest, a Duncan company with the only organically-certified medical marijuana crop in Canada suggests compassion clubs supply approximately 15,000 people with medical cannabis.

By combining the number of medical marijuana users in Canada who access Health Canada cannabis (0.02 percent) with the number who rely on compassion clubs (1.3 percent), Nash and Little say that leaves 98.68 percent of medical marijuana users in the nation who turn to the black market -- that is, friends and street-corner dealers -- for the product. In a country where the judiciary has stated unequivocally that the state has a responsibility to provide safe, reliable and legal access to marijuana, this record is particularly troubling.

"If this was any other government-run health program, the public would be outraged," says Philippe Lucas. "But because it's medical cannabis, [the government] figures the same standards don't apply."

Jason Wilcox says medical cannabis users in the country have had to fight for every minimal right they've been accorded -- and those rights should extend farther than they do now.

"Why must the disabled and dying continue to go to fight for something the courts have already said we have a right to do?" asks Wilcox. "The disabled are being walked on."

Puzzled politicians

Perhaps it is no surprise the government seems hesitant, if not downright negligent, when it comes to holding the country's medical marijuana system to a standard clients deem acceptable.

The MMAD's origins are rooted not in compassion built on sound scientific and anecdotal research by the government, but in a hastily-mustered bureaucracy spawned because multiple levels of the Canadian courts ordered it to do so. Rather than launching credible appeals, the government chose to slouch toward compliance. As noted in the sidebar on page 10, since the 1999 Wakeford case, the federal government has done the bare minimum to fulfill its constitutional obligation to stakeholders, failed outright several times and has repeatedly been brought back before the judge to defend it actions.

In 2002, then-health minister Anne McLellan told the annual meeting of the Canadian Medical Association, "I understand the issues that we in this room have and feel in relation to the lack of scientific evidence, possible liability issues and the fact that the federal Department of Health does find itself in a slightly ironic position when I am responsible for the single largest campaign in the federal government—the anti-smoking campaign," she said.

McLellan forgets, or was perhaps not informed, that many Canadians who use medical marijuana do not smoke it in rolled form, but instead utilize vaporizers that neutralize most of the carcinogenic elements of the smoke, or ingest it in baked goods like cookies, inhale concentrated sprays, pop cannabis-packed capsules, slurp spoonfuls of tinctures and oils, or steep it in tea. The Victoria Cannabis Buyers Club has even developed a cannabis patch that reportedly relieves muscle and joint pain.

McLellan, speaking to the CMA, went on to add "I don't mean to say that the courts made me do it, or made [former health minister] Allan [Rock] do it, although there is some truth to that. The courts took us down a certain path."

The courts may have made the binding decisions, but it was sick Canadians that demanded government action in the first place. And it is sick Canadians that continue to demand changes to the way therapeutic marijuana is treated in this country.

Delays, damned delays

For many clients of Health Canada's MMAD, nothing underscores the program’s absence of compassion like the interminable delays that occur in the processing of forms and in the program’s response to telephone inquiries.

"Because of the problems I've had, I keep a log now," says frustrated client Tim Wilkins. "Every phone call, every email. It's like some sort of tragic comedy."

If marijuana were considered a legitimate form of medication by the government, the branch tasked with administering it would not deign to treat MMAD clients with the degree of contempt it regularly demonstrates.

The minutes of a July 11, 2006 MMAD staff meeting obtained by advocacy group Canadians for Safe Access through an access to information request provides a glimpse at the scope of barriers placed in the way of clients exercising their constitutional right to obtain their medication.

At that meeting, an MMAD employee identified only as Susan unveils the new protocol for MMAD call center staff to address clients phoning to inquire about the status of their renewal application, calling it the "standard line document."

"Due to the current volume of applications you can expect to wait eight weeks after the receipt of the final piece of information to complete your application or renewal," staff were instructed to tell clients. "If it had been less than six weeks since we received all required information for your application, your call will take your file out of rotation and will delay the review and processing of your application or renewal."

The release of this information seems to corroborate the longstanding rumor floating around the medical cannabis community that each time a client queried MMAD, their file would be pulled from its position, consulted, then placed at the bottom of the pile.

"There is only one phone number and address to reach them at," says Wilkins. "The number gets you to an exclusive answering service, they take your name and number and then twice a day they pass along the message to MMAD."

Despite Health Canada's promise to respond within three business days to all inquiries, Wilkins' telephone log shows he went 36 days without a returned call during his 2007 license renewal process. Last year he says he went 41 days.

These delays are understandable considering only two MMAD staff are tasked with fielding inquiries. The 2007-08 MMAD budget is only $941,109.

Delays cited by clients extend beyond phone calls to document processing times.

Duncan's Glenn Spicer told Monday he submitted his MMAD renewal forms four months before his ATP licence was set to expire, "and it still came two days late." The artist and biologist uses medical marijuana to relieve the pain of prostate cancer and its corresponding treatments.

He adds that Health Canada has made a simple matter "horribly complex and inefficient" with its mountains of paperwork. "I can get prescriptions for far more dangerous drugs with just a visit to my doctor," he says.

The initial MMAD ATP application form is a staggering 33 pages long and any changes to client information -- from addresses, to a change in physician -- require submitting amendment forms. The Oregon Medical Marijuana Program asks clients to submit only an eight page form at the outset.

MMAD clients are required to renew their license every year, regardless whether their condition is permanent or terminal.

VICS' Lucas argues that if Health Canada will not implement a program that can respond quickly to the needs of its clients, than some, or all, responsibility should be delegated to compassion clubs with corresponding legal protections.

He says that while medical cannabis often allows users a degree of lucidity in their final days, many are forced to die criminals because the government program can't meet their needs.

But, as Health Canada's chief of staff William King reminded Island Harvest's Nash and Little in a January 2007 letter, "Compassion clubs have no legal authority to produce, sell, or provide marijuana, and therefore the conduct of these activities is in contravention of the Controlled Drugs and Substances Act."

Since its first tentative steps toward a national medical marijuana program, Health Canada has never deemed it necessary to conduct a comprehensive client satisfaction study of the services it offers. It has led two stakeholder consultation sessions, though representation from actual clients was minimal and panel members included representatives from the law enforcement and pharmacology sectors.

An as-yet unpublished study authored by Philippe Lucas in conjunction with a University of Guelph professor does what Health Canada has never found it necessary to do -- it asks clients what they think. Some of the findings are particularly instructive about who is being harmed by Health Canada's lackluster approach to medical marijuana access.

For example, the largest segment of the survey group (28.6 percent) claim to have an annual income of between $10,000 and $19,000. Asked whether they were ever worried there would not be enough food in their household before they had enough money to buy more, the largest number (33.7 percent) checked "sometimes."

This supports the contention of many critics of the federal program that it is society's more marginalized members who are most in need of access to regular, affordable marijuana. The wealthy, they contend, can access marijuana on the black market with greater ease and less fear of legal persecution.

Jason Wilcox says mixed messages from the government further add to the cloud that hangs over the program. He is referring to the ongoing confusion about the status of licenses to produce under the MMAR.

"It remains the goal of Health Canada to eventually phase out Personal-Use Production Licenses," wrote Health Canada chief of staff William King in 2007, but that is small comfort to Wilcox who says the government has been said that since PPL's were first introduced.

Wilcox and his partner Ann Genovy, who is also HIV-positive, tend separate crops to meet their medical needs, but have been waiting for an answer from the government about the fate of the PPL's.

"They are holding us hostage by not letting us know what we can do," says Wilcox. "I don't want to move into a new home with my family, start growing, and then have the door kicked in by the police because they've changed the personal-production rules."

High cost of government pot

For a four-month supply of government-grown pot Jason Wilcox acquired last year while waiting for his own crop to flower, he now owes $6,726 with a 2.5 percent interest charge each month. Wilcox, who lives in public housing with his family, earns approximately $10,000 a year.

"We don't even open the bills anymore," he says.

Medical cannabis isn't covered by any provincial health plan in Canada, while compensation and insurance bodies rarely condone its use, leaving all medical cannabis clients to cover 100 percent of the costs out of their own pockets.

Wilcox and Genovy have opted to ignore Health Canada's payment notices until federal Health Minister Tony Clement can provide the pair an acceptable response to their queries about the 1,500 percent markup on MMAD pot between the price the government pays Prairie Plant Systems for the monoculture product it grows in an abandoned copper and zinc mine in Flin Flon Manitoba and the price it charges clients.

Wilcox and Genovy recently wrote Clement a letter tasking for clarification. While Clement himself didn't respond, he did task MMAD manager Ronald Denault with the job.

"Let me assure that there is no markup to the price charged for Health Canada's supply of dried marijuana," wrote Denault. "Health Canada strives to provide a consistent, high quality, legally available source of dried marijuana to authorized persons at a reasonable cost."

Denault's reply is a far cry from the findings of British Columbia Compassion Society researcher Rielle Capler, who in a July 2007 study found, through access to information requests filed with Health Canada, that the contract with PPS stipulates the government pays $328.75 per kilogram for 420 annual kilograms. It is important to remember, notes Capler, that each kilogram contains stalk, stem, seed and leaf, not only the potent flowering head that contains the highest concentration of cannabinoids.

By Capler's estimate, MMAD clients collectively are charged $5,000 per kilogram when purchasing it through Health Canada. Capler's numbers show that while Health Canada pays approximately $10 an ounce, the final price for consumers is $150.

At the time of the BCCS researcher's writing, consumers of Health Canada medical cannabis were more than $300,000 in arrears to the federal government.

As of April 2007, Capler writes that only 351 out of 1742 ATP license holders were accessing PPS pot while the total cost of the current contract with PPS today totals $10,278,276.

The issue of the PPS monopoly is of particular concern to those who recognize the medicinal value different cannabis strains provide different users. There is a profound difference in the physiological and psychological effects of sativa and indica strains; Health Canada authorizes PPS to grow only one strain, which company representatives have argued in the past ensures a consistent product for consumers.

But as noted previously, medical cannabis users rely on a host of ingestion methods, most of which Health Canada explicitly forbids MMAD license-holders from producing with their government-supplied cannabis.

Denault reminds Jason Wilcox of this in his letter when he writes, "Finally, I would like to remind you that other activities such as producing tetrahydrocannabinol by extraction with chemicals are outside the scope of the MMAR."

Capler says leaving legal medical marijuana distribution in the hands of the government does a disservice to clients and the taxpaying public alike.

"The 1,500 percent mark-up on cannabis charged to patients highlights the risk of Health Canada creating a monopoly over supply. Health Canada is requiring taxpayers to fund inefficient practices, capital upgrades and equipment for a private contractor," concludes Capler. "Health Canada has chosen a policy and program that seemingly creates a windfall for one monopoly supplier to the detriment of patients and taxpayers."

Times are a-changin' (slowly)

While the federal government sticks resolutely to its prohibitionist guns, medical marijuana is making a slow but relentless march toward acceptance by the general public. A 2006 study by University of Lethbridge sociologist Reginald Bibby found 93 percent of Canadians polled support legally using medical cannabis for health reasons.

However, public policy, and the nation's policy makers themselves, remain woefully behind the times. Observers say that this too may change in coming decades as the baby boomers -- the generation that embraced widespread marijuana use in the west in the 1960s -- grow older and grow ill.

"I think there's going to be a fundamental shift as the baby boomers begin to exercise their fundamental right to access medicine of their choice," says Island Harvest's Eric Nash.

But it will surely be an uphill battle to challenge the policies of a federal government bent on structuring public policy around ideology instead of information.

As Tim Wilkins attests, despite the benefits of his medical cannabis use, and despite his legal entitlement to do so, regular folks like him, sick and in pain, remain scared to step out of the shadows.

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SUPPORTING ARTICLE:

Doubtful Doctors

Medical establishment no great ally in battle for better access. Since the current incarnation of Canada's medical marijuana program was established, doctors have been forced by Health Canada to act as sentinel for a product whose complexities, methods of delivery and side effects they have little firsthand information -- a situation that leaves many physicians hesitant to sign their names to the documents required for patients to access government pot.

"Our number one complaint is that patients can't find a doctor who will endorse their MMAD application," says Eric Nash of Duncan's Island Harvest.

However, physicians' reluctance often has more to do with the bureaucratic reach of Health Canada than it does with their own personal misgivings about prescribing a drug that remains in legal limbo.

The Canadian Medical Association is slowly coming around to recognizing the valuable role medical cannabis can play in helping users achieve a higher quality of life, but as recently as 2003 then-CMA president Dana Hanson said, "Physicians should not be the gatekeeper for a substance for which we do not have adequate scientific proof of safety or efficacy."

Observers say the CMA's regularly-parroted line rings hollow when general practitioners regularly prescribe drugs with little more knowledge than what they were told by representatives of the pharmaceutical companies that manufacture them.

The Canadian Medical Protective Association, the organization that insures 95 percent of Canada's physicians, continues to issue its doctors a release form liability form that protects them from legal action relating to a clients use of medical marijuana. No such special form is required when prescribing addictive and dangerous drugs like Valium and codeine.

South of the border -- where the "war on drugs" drags on -- the 124,000-member American College of Physicians released a January 2008 position paper that supports comprehensive research into the therapeutic uses of medical marijuana.

It concludes, "Evidence not only supports the use of medical marijuana in certain conditions but also suggests numerous indications for cannabinoids. Additional research is needed to further clarify the therapeutic value of cannabinoids and determine optimal routes of administration."

In Canada, new government research on the therapeutic value of medical marijuana will be a long time coming given the Harper government's cancellation of the country's $4-million Medical Marihuana Research Program in 2006.

The continuing prohibitionist view of the product by Health Canada and its political masters necessitates a need to micromanage distribution of the drug. It is this overt control that makes doctors wary of becoming entangled in the bureaucracy that accompanies the MMAR.

Over the past few years, Health Canada has taken to phoning doctors directly to question attempts to prescribe more than five daily grams to a patient.

Physicians and patients alike see this as a gross invasion of their privacy. It seems Health Canada may also be awakening to that fact.

In a March, 2007 correspondence obtained by Canadians for Safe Access through an ATI request, MMAD division program manager Barry Jones tells MMAD manager Ronald Denault, "I also feel that we may be going more into the realm of influencing, rather than informing the renewals."

So Health Canada is now in the business of "influencing" physicians about dosage levels (between one and three daily grams is MMAD's recommendation) for a drug it claims to know too little about.

In his November 2007 letter to Victoria's Jason Wilcox, Denault writes, "The use of dried marijuana for medical purposes has not yet been proven scientifically."

Fortunately for chronically and terminally sick Canadians, the country's physicians are not so ill-informed as to overlook the benefits their patients derive from medical cannabis and often will endorse compassion club applications.

"Doctors would rather sign a form for a quasi-legal, grey market source like a compassion club, than get involved with Health Canada," says Vancouver Island Compassion Society's Philippe Lucas.

-- Jason Youmans

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SIDEBAR 1:

Illusion of Access

Medical cannabis program the product of many legal battles

It is only thanks to favorable decisions by a handful of committed lawyers and sympathetic judges that Canada boasts even the anemic national medical cannabis program it has today.

The slow march toward establishing the rights of the sick to access therapeutic pot began in 1999 when a superior court judge recognized Ontario resident Jim Wakeford's right to grow and possess cannabis to treat symptoms of his HIV/AIDS without fear of legal recourse by the state. In response to that ruling, Health Canada declared it would henceforth allow clients meeting its vague criteria to receive an exemption to Section 56 of the Controlled Drugs and Substances Act (CDSA).

In 2000, the Ontario Court of Appeals ruled the Section 56 exemptions unconstitutional in the case of Terry Parker when it was revealed there was no regulatory oversight and that discretion for who could, or could not, receive a Section 56 exemption rested entirely with the Canadian Minister of Health.

Philippe Lucas writes in the January 2008 issue of Harm Reduction Journal, "As a result of these legal challenges the constitutional validity of Canada's drug control program regulations is now legally dependent on the existence of a working federal medical cannabis program."

Today, that program is the Marihuana Medical Access Division, built from the ashes of the Office of Cannabis Medical Access.

However, in January 2003 the MMAD was found unconstitutional by Ontario Superior Court Justice Sidney Lederman, who accused the federal government of providing what he called the "illusion of access." Lederman's ruling required Heath Canada to supply authorized clients a regular and legal supply of medical cannabis.

"Laws which put seriously ill, vulnerable people in a position where they have to deal with the criminal underworld to obtain medicine they have been authorized to take, violate the constitutional right to security of the person," Justice Lederman said in his ruling.

In October that same year, the Ontario Court of Appeals ruled five MMAR sections constitutionally invalid.

In January 2008, Federal Justice Barry Strayer ruled it unconstitutional that licensed growers should be bound to grow for only one client. This ruling opens the way for licensed growers to begin supplying cannabis to multiple clients.

"In my view it is not tenable for the government to, consistently with the rights established in other courts for qualified medical users to have reasonable access to marijuana, to force them either to buy from the government contractor, grow their own or be limited to the unnecessarily restrictive system of designated producers," wrote Strayer.

Currently the Vancouver Island Compassion Society is in B.C. Supreme Court following a 2004 raid on its Metchosin production facility to challenge the constitutionally of the MMAD on the grounds the federal branch unnecessarily restricts access to the program, supplies an inadequate source of cannabis and imposes arbitrary limitations on production and distribution.

-- Jason Youmans

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SIDEBAR 2:

Ticket to Toke

MMAD licenses explained

• Authorization to Possess (ATP): Grants licensee permission to possess an amount of marijuana consistent with the recommendations of the endorsing physician.

• Personal-use Production License (PPL): A personal use production license permits the holder to legally cultivate marijuana in an amount consistent with their medical needs and the terms of the license.

• Designated-person Production License (DPL): Permits a designated individual of the license holder's choice to cultivate marijuana for the license holder, consistent with their medical needs and the terms of the license.

Possessing one of the above-mentioned licenses is no guarantee of easy access to therapeutic dope. The recent experience of Tim Wilkins is illustrative of the barriers that remain once a Personal-use Production License is issued.

Evicted from one apartment for growing -- despite the fact that he holds a license that permits him to do so -- and unable to grow in his new home, Wilkins posted an ad on internet classified site Craigslist inviting potential landlords who would be willing to host his modest grow operation. Eventually settling on a late middle-age professional couple who lived on a small hobby farm, Wilkins felt he had found the perfect spot. However, despite clear expectations of the access he would require to the basement where the cannabis would be farmed, Wilkins says the relationship with his landlords soon disintegrated.

They demanded keys to the padlocks Wilkins placed on the doors -- strictly forbidden under the terms of the MMAR. They refused access to the site at intervals crucial to achieving maximum yield from the plants, and finally, they demanded to be present whenever he was entering the premises.

Eventually Wilkins had to chop the plants and find an alternative drying and curing location -- which cost him 20 percent of his yield.

If any Monday readers know a place Wilkins can establish a legal personal-use medical marijuana grow, he can be reached at joebloggs35@gmail.com.

-- Jason Youmans

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SIDEBAR 3:

Weed for What Ails You

Who can qualify for medical marijuana?

Health Canada's MMAD has grudgingly identified seven conditions for which medical marijuana has demonstrated therapeutic value. These are:

• Multiple sclerosis: to treat symptoms of severe pain and muscle spasms.

• Spinal cord injuries: For treatment of severe pain or muscle spasms.

• Spinal cord disease: For treatment of severe pain or persistent muscle spasms.

• Cancer: For treatment of severe pain, cachexia, anorexia, weight loss and severe nausea.

• HIV/AIDS: For treatment of severe pain, cachexia, anorexia, weight loss and severe nausea.

• Severe arthritis: For treatment of severe pain.

• Epilepsy: To treat seizures.

—Jason Youmans