Canadians are changing their perspective of cannabis. People are using it as medicine and access has never been easier. Why is this bad? Why should anyone care how we access our medicinal cannabis? Canada is one of the few countries with federally legal cannabis. However, Canadians are not all benefiting from the creation of the Cannabis Act. There are barriers doing cannabis clinical research. Many prescribers and provincial health systems still refuse to help patients safely access medicinal cannabis despite legalization. This is just not good health care according to Dr. Lynda Balneaves. Her team set out to quantify patients’ hurdles with the Medical Cannabis Access and Experiences in Canada Study. In this episode, Kirk and Trevor explore how medical cannabis is different from recreational cannabis and how the status quo of lumping them together is just not good for patient care.
E104 – Just not good health care - Lynda Balneaves PhD
Meet our guest
Lynda Balneaves
Research Links
Music By
Kid by The RevivalistsDesiree Dorion
Marc Clement
(Yes we have a SOCAN membership to use these songs all legal and proper like)
- Medical Cannabis Access Survey Summary Report (457 Downloads)
- Regulating the Legal Cannabis Market: How is Canada doing? (506 Downloads)
Episode Transcript
Trevor: We're back.
Kirk: Hey Trevor. How are you?
Trevor: I am good. So this was one that I think you and I both heard on sort of the local news, you know, cannabis researcher, you know, surveys, medical patients or something along that lines, I think was the headline on the local news. And it turns out it's a previous guest of ours, Dr. Lynda Balneaves.
Kirk: Yes. Professor at University of Manitoba. Episode 48 Doctor Nurse. So, yes, I got a hold of her very quickly. As soon as we heard the news report on it, the news release, she did a Medical Cannabis Access and Experience in Canada study. That's sort of a medical cannabis access survey where she got involved with another guest of ours, which was Ashleigh Brown, the founder and executive officer of SheCann and other advocacy groups. And they put out a study and captured a large group of people who use medical cannabis and yeah, ask them a bunch of questions. So basically it's what do I have here? Basically, 5744 individuals were accessed across Canada, 5433 of those people, so 95% reported taking medical cannabis and 54% of those individuals have current medical authorization. So yeah, she talked to 5700 people who identify as taking cannabis as medicine. 54 of them have a medical authorization. It's a good study.
Trevor: It was. And we'll let her talk to this sort of more because her study and she does it better. But the headline I remember when I first heard it on the news and honestly still sticks with me. Surprising. Not surprising. But how noteworthy was two thirds of individuals, medical people who say I'm using this for medical purposes or are getting it from the recreational system. So you and I talked to people who use cannabis. So I don't think either of us were shocked by that. But it is one of these you know what? What's wrong with our system if, you know, the medical patients are going, you know, I'm not saying they can't go to their local rec shop, but that was not the intent. And as we've mentioned several times before and I think comes up in your conversation and is it's nothing against the bud tenders, but the bud tenders are legally not allowed to discuss medical stuff with people. So, you know, having medical people going to a rec store, I'm not saying they can't, but it seems like there's a breakdown in the medical system of that's where where they end up going.
Kirk: Yeah. What what I like about this conversation is she validates what I think we knew. And what we're also doing is that at the end of the the conversation with Dr. Balneaves is that we also have a My Cannabis Story that we've been holding on to that actually speaks to this subject. And we can maybe introduce that My Cannabis Story at the end, after this conversation. But yeah, this whole episode will be about how people access their cannabis as medicinal users. So no surprises. But it's for me, it's scary. You want to just get right into it and we'll come out and discuss it.
Trevor: Absolutely.
Dr. Lynda Balneaves: I'm Lynda Balneaves. I'm an associate professor in the College of Nursing at the University of Manitoba.
Kirk: Wonderful, I just finished reading your Medical Cannabis Access Experiences in Canada survey. So this is what I want to chat with you about. So let's start the question by you did a survey. What were your goals in doing it?
Dr. Lynda Balneaves: You know, we actually started talking about doing this survey back in 2020 when we knew that there was going to be a review of the Cannabis Act and regulations, including the medical cannabis program in Canada. And I was talking to some of the patient advocacy groups in Canada, and we all started getting a little bit concerned that Health Canada and the federal government may not prioritize medical cannabis as part of that review. And we were a bit concerned that the experiences and the perspectives and the needs of Canadians using medical cannabis were not going to be well represented. And so we started talking about doing a national survey and having it completed before the review so that we could share that with Health Canada and the federal government and other, you know, key policymakers just to ensure that Canadians who use medical cannabis would have their perspective included and their voice represented.
Kirk: And did you and did you meet that goal?
Dr. Lynda Balneaves: I think we did. We ended up with 7000 participants all from across Canada. And I think, moreover, we had a webinar last week and we invited the expert panel that's been tasked with reviewing the Cannabis Act, and they all showed up. And we had numerous individuals from Health Canada, from various ministries of health across the country that signed up to attend or to get access to our recording. And we've had numerous people in the last week cite our report and its statistics and talk about how important it will be for the future review of the Cannabis Act. So we're very pleased with the response and the uptake to date.
Kirk: Fantastic. I also participated in the cannabis Review question and I thought it was all very interesting. I think the last five questions and the way they wrote the questions made me think, Oh, they're thinking, they're thinking of moving it to the rec side. And so I was quite worried. So I'm glad you've got this survey done. So let's get into it and we can discuss the results afterwards. So one in three individuals reported taking cannabis, so I guess in last ten years. So I guess my question is, how did you find your sample?
Dr. Lynda Balneaves: You know, we had to go through social media. This was a study that was done off the side of our desks. We were unable to obtain any funding to do it. So this really has been a labor of love. And so we actually went through our patient advocacy groups. They sent out emails, they went through their newsletters. We posted it. Somehow we got past some of the sensors through Twitter and through Facebook and Instagram, and we think it just snowballed from there where people were sharing it within their communities. So this really was a community effort in terms of gaining that sample. It's perhaps not as representative as if we were doing a telephone survey, but we do feel we really captured people that were very experienced in using medical cannabis. Most people were saying that they had been using it for five or more years, and the Health Canada survey that was actually conducted after ours began, they have most people that were using it since legalization. So we've actually captured people that were part of the legacy market that really have seen it change over the years, including since the legalization of non-medical cannabis.
Kirk: Fantastic. And, you know, 7000 people, it's not a it's a good it's a good size, good sized study.
Dr. Lynda Balneaves: It actually is. And we do feel like we you know, we have people from all across the Canada from west to east and north to south. You know, we would have loved to get a little bit more diversity in terms of ethnicity, but we still had, you know, most of our major groups represented and we had a really good age range from 18 all the way up to over 80. So as I said, I think we got a good perspective of what people's experiences were with medical cannabis.
Kirk: Are you surprised by the results?
Dr. Lynda Balneaves: You know, there were some surprises to us, you know. One is that I was so surprised that so few Canadians were able to get any type of insurance coverage for medical cannabis. You know, it's it is, you know, a legal program that's a legal substance in this country. We've had a medical cannabis program for over 20 years, and there's a growing body of evidence to suggest that it can be a useful treatment for many individuals. And so I was surprised that only 6% of those with medical authorization were actually able to claim expenses. And so a lot of people were saying that the out-of-pocket expenses, particularly within the legal market, was just too expensive. For them. And they found themselves moving into the recreational market or they were moving actually into the unregulated market. So that was a surprise to me.
Kirk: Yeah, I must admit, what I found interesting was that how is recreational cannabis, because two out of three individuals get the medical cannabis and rec store, which I want to explore later, but I want to explore the question about why is medical cannabis more expensive? My understanding was the whole compassion pricing. Of course, taxing. They still tax medical cannabis, which is one issue. But why is medical cannabis more expensive?
Dr. Lynda Balneaves: You know, I think there's a variety of reasons. You've laid out the taxes and that came up over and over again in both in our survey. And we also did qualitative interviews with 43 individuals. And taxes kept coming up. And in some provinces like Manitoba, they actually apply the PST to medical cannabis but not to recreational cannabis, which I cannot understand for the life of me. And so that's makes it more expensive than if you're getting the same product through the recreational market. I think the other thing and you know, I guess this hadn't really occurred to me and it should have, is that for some individuals moving into the unregulated market, it's because they were perhaps using something like an edible and they were able to get an edible that had a higher THC content, you know, to manage their symptoms of pain or nausea or vomiting or whatever. And what happened is that if they tried to stay in the legal market because of the restrictions around THC levels, they said it just became way too expensive. I would need five edibles a day, whereas I can get away with two, you know, if I pull from the unregulated market. So I think sometimes our restrictions around THC content, around how our products are formulated in Canada or through that legal market has really pushed some people to look outside. And part of that again is cost. You know, that I'd have to buy more of the legal product in order to get the same result from a product that I could get at the unregulated market.
Kirk: Yeah, I also I also found it interesting how there is barriers to people getting getting the medical cannabis. Do you want to discuss some of those barriers?
Dr. Lynda Balneaves: Sure, sure. And so we've talked about cost, which I think was was number one. And, you know, we had so many individuals tell us that they were actually removing themselves from the legal market, the medical cannabis program. But what also came up and I guess I was a little bit shocked with this is how many people said that they were still experiencing stigma or difficulty identifying a health care professional that was willing to support their authorization. And so as a consequence, they had to move into the recreational market because they weren't able to have that medical document that allowed them to go through the license sellers. And, you know, we still had them saying that my doctor or my nurse practitioner was not knowledgeable enough and felt comfortable enough then supporting my authorization. People were saying they were unwilling to even talk about it, you know, which to me is just not good health care, you know? And we still had people that were saying that they were actually being told to just go to the recreational market. You know, I don't even need to do this document. That rec market is there. Off you go. And all of this really raised concerns to me about, you know, our people actually having a dialog with their health professional. Is there a conversation about whether, you know, what type of cannabis they should be using, how much, whether it could potentially interact with any of their medications that they were using? You know, the other thing that was a striking finding is that we had many individuals say that they were using it to actually reduce their use of other medications, including opioids. And so to me, again, that should be a conversation that you're having, you know, with your health care provider if you're doing that replacement and that you're having that follow up care to make sure that you're getting good symptom management, you know, good, you know, pain control or whatever, and that we're not seeing any interactions that shouldn't be happening because of the other medications you're taking. So.
Kirk: Yeah, I, I found this fascinating and I'm going to stray off the study a little bit, but where do you think the disconnect is? I mean, cannabis has been federally legal for, what, 18? I mean, depends on what you go 1999 and 2001. But we've been federally legal as medicine for for a long time. So where's the disconnect? Why are provincial doctors and I guess I have to say that and provincial college, professional colleges not recognizing cannabis yet?
Dr. Lynda Balneaves: You know, I think the bottom line is we still don't have that high quality evidence that they're looking for. We have tons of studies that have the patient experience well documented. We've got qualitative research. We've got people sharing their own experience, but we don't have those Randomized Clinical Trials, particularly with plant based products. Which is what we're talking about within the medical cannabis system. You know, we have studies on things like nabilone, but patients often say that they come with a lot of side effects. And so without those trials that are focused on the plant based products that people are accessing, I think doctors and nurse practitioners very rightly are saying, I don't know how I can support this or recommend this if I can't find that clinical trial or that systematic review or that meta-analyzes, that's telling me what dose I should be recommending, what type of products are appropriate, what should be the THC CBD ratio. There really then reliance on just patient experience. And I know for many clinicians they get a little bit uncomfortable. They're used to having clinical guidelines. They're used to having systematic reviews to draw on. And so to me, we have this huge gap in research, which unfortunately, legalization has not helped. In fact, it made it more challenging. You know, we now have regulations around, you know, you can't just use a product that patients are using from a store. You have to use a product that is GMP quality, which is not required by the recreational market. And so industry really has no skin in the game to go that extra mile and create these GMP products that then are suitable for us to do to do our clinical trials. And so we're at this standoff. From a researcher's perspective where we can't get the trials even off the ground in Canada, and it's going to take us probably several years to get enough GMP product of enough variety to address the different kind of health conditions that we need to be doing the trials in. And as that happens, we have these health professionals saying, you know what, you can do this yourself. I don't need to be part of this. I'm sure there's liability concerns. And so we're at this kind of stalemate. And at the same time, we're not getting cannabis, you know, as a therapeutic agent into our curriculums. You know, we don't see it, you know, on our exams for physicians and nurses and pharmacists. You're lucky if you have, you know, a teacher or an instructor that's comfortable enough and knowledgeable enough to teach about it. And so as a consequence, we're not even producing, you know, the next generation of clinicians that have that knowledge and feel comfortable and even starting that dialog with their clients.
Kirk: But yet, but yet we do have Internists and specialists out there that we've interviewed that have said, you know, those studies are there, yes, we need more. But there are enough studies to say to justify my practice. So there are, Internists, and we call Internists the Doctors' doctor right? They're out there practicing cannabis medicine. So and their colleges must be supporting them. So again, where is the disconnect? You know, I had a conversation with a doctor, and I'm sure I've said it in the podcast someplace sitting in an airport in Thompson talking to a doctor. And I said, What do you think about the new research in Cannabis? And he said, You know, Kirk, the problem with cannabis is I don't want to be that doc. I don't want to be the doctor just puts out the cannabis prescription. I said, But what if cannabis is the miracle drug and we'll cut down your narcotic use? He says, Well, then I missed the boat. It's like, is that not laziness?
Dr. Lynda Balneaves: And you know, I'm coming right now with my R.N. license on. And, you know, I know that there's a lot of clinicians that have clients where none of the conventional treatment options are working. You know, they come in with a lengthy history of trying cannabis, doing their own end of one study pretty much, and finding it effective. And I think when you're in that situation, there is then just laziness, ignorance, stigma that makes them go, I am not going to support you and allow you to be able to do this in a legal sense and have access to all the benefits of being, you know, legally authorized. But at the same time, I'm always surprised when I dive into the literature and be like, okay, I want to find my RCTs for this condition. You know, looking at this, you know, type of cannabis, and I'm always amazed that I might be able to pull up one or two studies and that's it. You know, and there can be design issues or flaws, and most often they're very small studies. They may not be sufficiently powered. You know, the outcomes were minimally significant, or they're using a product that isn't the one that patients are telling me is most effective, often because if they're coming from the U.S. or some other countries, they may be limited in the type of product that they're allowed to use that's available for clinical trials, for example, in the U.S.. So I still think that for, you know, I think the laziness is that our research community and our, you know, federal government, Health Canada, you know, that they have not sat down and gotten the clinical trials department together with the cannabis branch, with the controlled substance branch. And everyone got in a room together and actually said, how do we facilitate research? How do we create a medical cannabis, you know, research strategy in this country, and how do we become leaders in that? That's where I see the laziness. You know, there are some trials out there. There are some, you know, patient experience, you know, studies that are out there that show positive effect. But I think we need to do a lot more and then we need to do a better job of translating that into the education system so that people are aware of it and they have no choice but to include that as part of their their clinical kind of toolbox. Right?
Kirk: Right. Right. It fascinates me because, again, you know, it's only been 75 years that we had prohibition on cannabis. So we really have had a millennium of practitioners using cannabis. Right. So it fascinates me that we don't have we don't have more studies or even more interest in it. So I guess we should go back to your study here in regards to what you discovered. I think the biggest one "participants of medical authorization shared that they wanted to get their cannabis in person, such as a clinical community pharmacy. I know that's one of Trevor's biggest beefs, is that he can deal with opiates, he can deal with all sorts of other pharmaceuticals, but a bag of weed is threatening his license. So that gets back to the whole stigma that cannabis has. And I wonder if maybe that's what your study really, really came up with. The bottom line is that there's still stigma in the medical community.
Dr. Lynda Balneaves: There really is. And again, I don't think it's just medicine. I think it's in nursing. I think it's in pharmacy as well. It's hard when you had a century of prohibition, you know, you've got a century and you still in many, you know, just look to the south, you know, cannabis is still a substance, you know, a federally controlled substance, even though the majority of their states have it legalized, not only medically, but now recreationally. But if you go across the border, you know, from one jurisdiction that's legal to another, you could still be charged and banned from entering. So and I think that there's also I'll be honest, I think the legalization of recreational cannabis has turned the attention to cannabis as a recreational drug, even more so. And, you know, we've seen the bulk of the research since legalization to be focused on things like use of ER rooms, you know, increased in impaired driving. You know, what has happened to our youth? You know, looking at the problems of recreational cannabis use. And so when you see that out in the media and you see that focus in the scientific literature, they're not seeing the other side of it, which is the therapeutic benefit. So I think in some ways, as legalizing recreational cannabis has made some people even more resistant to it. And I think what's also happened and what we've seen in some of our qualitative work is that certain people now are feeling more comfortable now that it's legalized to actually consider using it therapeutically. And so I think that we have a lot of physicians and nurse practitioners that have become overrun with people coming in saying, what about cannabis? And I don't think anybody wants to be asked about something that they know nothing about. And so I don't think it's surprising that we're having that reaction of I don't want to talk about it because I don't know anything about it, and every second person is asking me about it. So I'm just going to say hard and fast. I don't talk about it and I don't do authorizations, which to me, again, this is not patient centered health care.
Kirk: Right. Well, I know that in my experience, I was it's not the first time I broke ribs, but I was looking several years ago to to use cannabis for pain because it was a very acute at the time. And I went to my family, doc and he said, No, no, not for this. And I respected that. So obviously I had to go elsewhere and I have connections in the health care field and I found a cannabis doctor that gave it to me. I grow my own. That's one of the reasons why I don't. That's one of the reasons why I don't understand the cost of medical cannabis, because I wonder why more people who use medical cannabis don't grow their own, because that would be the cheapest way. You did find, was it? I don't have the numbers that 20% grow their own.
Dr. Lynda Balneaves: I don't have that in front of me. But it's it's a large amount. And to be honest, it's it's not a stat that we've been sharing widely. It's not a focus that we've been pulling out from our study, even though we had a lot of people that were saying that they were growing it because we know that there is a real interest in getting rid of personal production, that there's a real concern. It's been really pushed by law enforcement. It's been really pushed by, you know, fire, that this is a real hazard. Even the real estate agencies, you know, have jumped on board and said that, you know, if you're known to have grown, you know, you're not going to get insurance, You know, you're not going be able to sell your home in the future. So it's a very scary concept. I think the other thing, though, is you have to remember that almost 30% of our sample, we're living at $35,000 a year or less. These are probably people that may not be owning their own home, are unable to. And so they're living in things like social housing, They're living in apartments. And when you're in that scenario, you often will have a landlord that will say, Absolutely, I don't care that you have a license. There is no growing a cannabis in this facility. And and even though you have that medical authorization, I think there are so many barriers to people going down that route that might be more economical to them. I think you also have to recognize that for people that are living, you know, what we would say is a very low income level. You know, they may have other priorities in terms of just housing, you know, in terms of, you know, their health care, in terms of food insecurities that, you know, growing is is for someone that's experienced, you know, is not a struggle. But for people that may not be experienced, you know, getting the equipment, being able to manage it, have the knowledge and the expertise and the time. I think we just have to recognize that for some people, they may not be privileged enough to be able to to grow their own.
Kirk: Right. Right. I my experience is those that do grow their own tend to be the most knowledgeable. You know, they truly, truly passionate about their medicine. Now, what I found interesting, I guess, in the discussion we're having right now, I'm not surprised by these numbers. Currently, 54% of the people have medical authorization. So really half the study. So these are you got a sample of people who understand cannabis. You've got a sample of people who say that they use cannabis as medicine. So half the people have medical have medical authorization while half don't that, I'm not surprised by that from what we've just talked about.
Dr. Lynda Balneaves: You know and I think a lot of people very rightly so, we saw this in our interviews as well. They said, why in the world would I bother going into the doctor, get my form, have to send it in, I have to wait, you know, then I have to wait for it to be couriered. Maybe it will get lost. So you're like, that's a lot of hassle, particularly for people that are well experienced. You know, many of these people had over ten years experience or like I've already talked to my doctor, I've been down that route. We know it works. I just want to be able, the product I need is available through my local store. I can just walk down and grab it when I need it. I'm not going to end up not having sufficient supply, etc. Right. And for some people then I don't have to also pay for courier costs or, you know, other costs that might be applied to it. So I understand why we had that. But at the same time, I worry that we may now have people that are just walking into a store where, they're not supposed to be getting, you know, medical health advice. You know, often these are.
Kirk: It's illegal.
Dr. Lynda Balneaves: It is. These are very well intentioned, bud tenders. But they can be 20 years of age and they're on commission. And, you know, they are really not supposed to be providing that advice. As you said, it's illegal. And so what worries me is that we do have individuals who have been shut down maybe in their doctor's office, you know, or looking at the cost. And I'm like, I can't go this route. So they're just walking into a store and they're really doing it trial by error, you know, And they may have a good experience, but they may also find that they're using products that are not appropriate. They may be finding it's not working because they're not using the right product or they could be experiencing things like interactions. They could be using too much and having things like paranoia or hyperemesis. And they may not have the knowledge or the person to speak to to understand what's going on. And that's not good health care, you know, that we're not having that conversation with a health professional that's not follow up care. And we're really you know, and the other thing that's not acknowledged is that if we got rid of the medical cannabis program, what would happen to our pediatric patients?
Kirk: Right.
Dr. Lynda Balneaves: What would happen to compassionate pricing? What would happen to people that are able to kind of claim it, including our veterans? You know, all of that would would be lost. And again, bottom line, that's not good health care.
Kirk: You know, the irony, you raise the issue with the children and usually children suffering seizure conditions. You know, pharmaceutical company will come up with a medication. They will find an area where it fits. And all of a sudden, it can be prescribed. Well, we know we do have enough studies. We do have enough knowledge to know that cannabis helps children with seizure activity. We know that we have enough studies. So why can't that be the wedge in the door? Why can't that be? You know.
Dr. Lynda Balneaves: Can I show you my cynical side?
Kirk: Certainly.
Dr. Lynda Balneaves: My cynical side is that we are starting to see the pharma industry talk about DIN numbers. They're talking about doing drug development. They're looking at cannabinoids, they're looking at how they can shift them into the pharmaceutical market. I would not be surprised that some of the greatest resistance against us having medical, you know, plant products out there are people that have investments in pharma and are seeing this as the next wave of drugs that they can profit from. And so we see something like Epidiolex, which is used for children with Dravet syndrome and severe epilepsy. You know, it's five, $600 a bottle in the U.S. You know, why would you want to have CBD oil available for $40 a bottle? That's a plant product that can't be patented. So I'm a bit cynical that even though there is some research on certain conditions and we know it works, I think that there's probably a movement, you know, and this is just me being cynical. I have no proof of this, but I'm concerned that there is a real push to try to get DIN numbers. To get, you know, physicians and nurse practitioners only comfortable with DIN quality products and that it's driven by profit, which, you know, we've seen it within the recreational market. So I would not be surprised if that's also driving what's happening in the medical cannabis field so. That's me being cynical.
Kirk: That's been a complaint of the cannabis culture forever that if there's profit, that's when we have to worry. I was just trying to search my computer here. I thought I had received an email from NORML that somewhere, someplace they had. Didn't they have a DIN number associated THC now? Someplace? Is that not new?
Dr. Lynda Balneaves: I know I've been talking to a few groups that are actively in the process of trying to get DIN. I don't know if they've been successful or not, but I know it's in the works. And again, you know, we have a culture in conventional medicine, which I'm part of, that, you know, if it's from pharma and it has a DIN number, then it's better, you know, it's better standardized, it's better quality. I know what I'm getting, you know, and as someone that's done research on natural health products, it's like the same it's the same dialog that we've had in that field as well. And I just think it's ironic and it shows the medicalization of our health and our well-being. And that's why we see such hesitancy around people are in traditional medicine in terms of sharing their formularies because they know that if there's profit to be gained, they will be taken away from that traditional context and made into a pharmaceutical remedy. And, you know, I would hate to see that happen to cannabis because it seems completely unnecessary. It seems that it's taking advantage of a vulnerable population. And I don't see why we don't have the expertise and the scientific method. To use plant products in a way that are still highly standardized and high quality. And I just I see it as an unnecessary step, but it's one that comes with profit for others.
Kirk: Yeah. Any limitations to your study? What did your study tell you that you need to look deeper into? What are the limitations of the study?
Dr. Lynda Balneaves: Well, number one is that we tried to get caregivers into our study so that we would have more of that pediatric perspective represented. We were unfortunately not able to capture the caregiver community, I think, because a lot of them filled it out themselves as people that use cannabis. And when they went to use it as a caregiver, it saw them as coming into the survey a second time and they were blocked. So that's a group that we really need to work on more closely. The other thing that's a limitation is we just needed more diversity. You know, people that were homeless, people that are incarcerated, people that don't have access to Internet or technology, they weren't able to complete this online survey. And I think the other group, too, that was missed is probably more marginalized groups. So people that might be new immigrants to this country pulling from the indigenous community. Again, it was it was challenging just doing it through social media. We did try to reach out to some of the various groups that were more marginalized, but it was really hard to kind of get uptake. So I think we could do better in terms of sampling groups that were unrepresented in our survey.
Trevor: So Kirk, what were your big takeaways from that? Like I said, I'm still going with my it was sort of the headline of the headlines was two thirds of the patients are getting it from a rec store. Again, not blaming the patients just seems like a system failure. I don't know. I know you seem to be at least hearing the conversation shocked by prices. Do you want to talk about that at all?
Kirk: It still floors me that we tax medical cannabis and it still floors me that it's easier for people to access cannabis through rec stores than getting it through a pharmacy. But no, some of the things that came out to me was the sourcing of medical cannabis. On page 41, she gets into that and basically talking about how over half of the respondents, 57 of them report obtaining medical cannabis from more than one source. And, you know, part of the reason for the Cannabis Act was to eliminate the alternative market, the gray market, the unregulated market, as Lynda was calling it. But yet what we got here is we got 59% getting it from rec stores, 42% getting it from mail order, 31% getting it. What is this now? In-person stores, mail order stores, recreational stores and home grown. So the answer to the question about home grown was 25% grow their own, 22% get it from family and friends. And there's one here about the unregulated market where they're obtaining it. Common among individuals is 26%. So there's, you know, over half of the individuals without medical authorization were getting it from the unregulated market. So people still find it easier to get cannabis. You know, so the Cannabis Act isn't working there for those people.
Trevor: No. And on a sort of a side thing, but it has to do with some other stuff. I'm looking at slash working on. Research, how it was easier to do research before cannabis went recreationally legal and just you know, we've heard that a couple of times before, but one of the what she made just a comment that kind of stood out for me that now that it's become recreationally legal, if you want to do research on plant, you know, dried flower X or or oil x, it's actually harder now because now it has to be sort of a level of purity. Call the CMP or good medical practice. But anyway, it's got to be.
Kirk: Good manufacturing practice.
Trevor: But that's that's a high level. Not so that's bad. Yes, we want stuff the highest level. But to sell at a rec store, you don't have to be that high. So people are using stuff that are that this purity. But the researchers can't research with the stuff that people are actually using because the researchers are only allowed to use the stuff that's a higher purity, which just makes it more and more difficult for the research to to give stuff to the patients and the patients are actually using anyway. So it's just another one of these kind of makes your head spin on why are we making this so hard to do research on cannabis?
Kirk: Yeah, no cannabis. There is such a disconnect that I'm just doing casual research on the Manitoba web page, not really relevant to this, but just again, a disconnect. You know, I have questions about how the government of Manitoba sees cannabis, for example, the Liquor Gaming and Cannabis Control Act, which is, you know, because liquor, gambling and cannabis have so much in common, they put it in one Act. What I found curious and this is the first time I've picked up on this. Yeah, Part three is liquor operations. Part four is lottery operations. And I was telling you that part four has section 47, which is the operations on Remembrance Day. Now, the statement 47.1, which would suggest it's related to the Remembrance Day line. Right. Thinking.
Trevor: mm hmm Yep.
Kirk: Part 4.1 Cannabis Operations. So cannabis operations, according to the Act, operates under the Remembrance Day segment. And you know what? I. I've read a lot of Acts. This one confuses me. Why? 47.1, 47.2 and 47.3 is cannabis is under the remembrance. So I see that as a disconnect. The other one I found interesting, and I know this kind of you kind of rolled your eyes at this one on me, but I think this is also interesting because in the province of Manitoba, your college discourages pharmacists from dealing with cannabis, right? So the average pharmacists in cannabis is not knowledgeable. Right. The average Manitoba.
Trevor: They didn't specifically say knowledgeable. My understanding so college don't beat me up. Trevor's understanding is they don't want the physical plant or plant products or cannabis products inside the store. I don't know if they specifically said we can't know anything about it.
Kirk: Oh, okay. Well, that's good because they're encouraging people to talk to pharmacists in the provinces to mental, which is a good thing. But it's just funny. I wonder how many pharmacists are aware and maybe they should be listening to our podcast, but because we do a lot of pharmacy episodes, but on the Cannabis in your Health, the Manitoba government encourage you to go. So that's that's a good thing. I think Lynda's study, we'll have it on our web page, which is reefermed.ca. I think people who are interested will find it interesting. Is there anything else specific, though, you want to pick out of her study?
Trevor: Yeah, you guys hit a lot of it. But again, I'm going to go back to price. I know what you guys might have beat it to death, but you know, it is like, why is it so expensive on the medical half? Why is it I know these are not what Lynda was looking at, but why is it so expensive on the medical have? Why is it so taxed on the medical half? And, you know, she said like a goodly chunk of the people she had were the the earning $35,000 a year or less like I know there's there's a lot of stigma out there saying, you know, we shouldn't be using this medically. But it's been there's been there studies that say it's good and more importantly, it's been approved. Like if you really don't want to be used medically, then, you know, remove. Find the fact that it causes harm and remove it from approval. Like we've been, as you said before, you know, 20 plus years of medical approval of using this. So why are we making it so difficult for people to afford it yet?
Kirk: Yeah, and me, I really have a round on the fact. Why is it so difficult to get. Tylenol? You can buy Tylenol at grocery store. You can buy Tylenol over the counter at the pharmacy. Tylenol is one of the most toxic drugs out there. It is abused, misused. And I have dealt with a lot of Tylenol misuse and overdose. And yet cannabis is hidden away. And although you can have a very bad day and and there are some side effects, it's less deadly than Tylenol. Off the top of your head. What's the LD of Tylenol?
Trevor: I can't remember. But and before the makers of Tylenol yell at us, we're not saying all Tylenol is bad all the time, but it is definitely something that it is in overdose. They can be take too much of it. It can be can be deadly. And people tend to forget about that.
Kirk: In an insidious way. However, we digress. This episode is more about more about just talking about how medical cannabis is still misunderstood, not only by the government, but also I think, from the medical communities. And that includes nursing, pharmacists, you know, doctors. And this gets to our My Cannabis Story. You want to to my cannabis story?
Trevor: Yeah. What we talk about a little bit but you, back when it was -40 with a wind you walked down to our newest cannabis in store in Dauphin.
Kirk: Well, the new Delta9 has come into town, and this must have been January when we when we bumped into there. And I walked in there and was like walking, walking at -40 degrees and crossing highways to get this story. So this is sort of Melissa, who is the manager of the story. We're getting a road story, right? I mean, we have we have Michelle and I traveling the highways of Canada, stopping in it, talking to bud tenders. So this is just us walking into the new local store in Dauphin. We now have three. But so we walk in and I get the story and it turns out to be a little bit more than a My Cannabis Story. So I held it until we could do Lynda story and it matches. So let's, let's get right into it and people will see why we help.
Melissa: Oh, gosh. Okay. Well, I'm Melissa. I am the new manager of Delta9 in Dauphin. Brand new store that I watched get built from the ground up. It's been quite a journey, a long one. But here we are. And it's been really fun. And this is also Madison.
Madison: Yeah. Hi, I'm Madison. I'm. I guess Melissa's right hand girl when it comes to all this stuff. She came over to my previous workplace, said, Hey, I want you to come work for me. And I was like, I mean, okay, let's go.
Kirk: Okay. So do you have cannabis experience? Did you work elsewhere?
Melissa: I haven't. No, I'm more of the retail aspect of the store things, but it is definitely the beginning of my cannabis journey. I'm going to be definitely learning about it all. I'm definitely probably going to be more into like the CBD aspect of it for myself personally.
Kirk: So medicine?
Melissa: Yes.
Kirk: Do you sell a lot of CBD here?
Melissa: We do, yeah.
Kirk: Really? You've been open three days, right?
Melissa: Yeah, since Monday. So I've actually five now. Four and a half.
Kirk: So people are buying CBD from recreational shops store.
Melissa: Yeah, absolutely. Yeah, we definitely have. We sell other gummies and it's mostly the older generation that does come in for that stuff. But there are don't get me wrong like the younger is as well, myself included so.
Kirk: Interesting. So are you a medical cannabis user? Do you have a prescription for it?
Melissa: I do not. No.
Kirk: So if I can. If I can pry. Why are you using CBD?
Melissa: It was just something that I learned about and then became kind of interested in.
Kirk: So what's it do for you, though?
Melissa: The only one I have tried so far and it was just very recently, was the like Wana Quick Midnight Berry Gummy and that's more of a CBD for helping the sleeping.
Kirk: Okay yeah. So are you doing for sleep. Okay. So three days and how many like is it been Busy.
Melissa: Extremely busy. Yeah, Surprisingly low. Not really. Surprisingly, I guess. I mean, I think people have been kind of waiting for a little competition to Tweed. Our hours are kind of really good. Where the 10 to 10 a day and we got great deals, great prices. So people, of course, it's like a shiny new toy, right? So they want to come in and check things out and see what we got. Our like our product, not just the cannabis, but also the what's it called, like the bongs and all that stuff. I'm sorry,
Madison: The accessories.
Kirk: We used to call it paraphernalia.
Melissa: Has lots of people really interested in there. We sold quite a bit, actually. Candles, especially. Like we don't have any, like, specific candles or, like, bath and body works in Winnipeg or something, Right? We don't have that. So they're coming here, seeing our candles right away.
Kirk: And what kind of candles. CBD?
Melissa: No, no, They're all just. The smoke killer ones.
Kirk: Smoke killer candles. Okay.
Kirk: So, what brought you to the cannabis industry? No. No. What brought you to the cannabis industry.
Melissa: What brought me? Um, well, a former manager of mine actually reached out to me because she also works here out of Winnipeg, though. And she's was just telling me about how there's going to be a new Dauphin location. And she's like, You have the experience and you can just it's this product, it's this and this and this. And she just talked it right up and it just it was too good to say no to.
Kirk: So have you taken any cannabis courses? Have you taken any Cannabis 101? So what are you learning in those courses? Delta9 provides it for you.
Madison: It mandatory to be able to work here ya.
Kirk:: Okay, so what do they teach you in that course?
Melissa: They go over everything with you? Yeah, they go right back down to like, the history of how the government stigmatized cannabis and everything like that. And over all the types of different products that we will carry, they even go over how to use certain type of pipes and just everything.
Kirk:: Okay, how about the Endocannabinoid system? They talk about that.
Melissa: Yes, they do. That's another big one. Yep.
Kirk: So what we got is we've got a study that says people use recreational stores for their medicinal cannabis. And we've got anecdotal experience of a manager who sees people coming into a rec store to get their medical cannabis. We also learned bud tenders learn about the endocannabinoid system where health professionals are not.
Trevor: Yep. Yep. We couldn't do planned it better. It's kind of it's almost like the personification of Lynda's study. This is what the. Yeah, I'm not blaming the new manager. I thought that was great. You just saying yep, some older folks are coming in and asking for CBD gummies for their aches and pains, and that's kind of what the study says is happening.
Kirk: There it is, man. So we've got to change the world. Cannabis is medicine.
Trevor: So we say who we are. I'm Trevor Shewfelt I'm the pharmacist.
Kirk: I'm Kirk Nyquist the Registered Nurse and we are Reefer Medness - The Podcast.
Rene: Right on, guys. That was another good one. It's Rene here back at the studio. Couple of things left to do. One of them is we always like to mention that Reefer Medness - The Podcast likes to acknowledge that we produce our shows on Treaty two Territory and the Homeland of the Metis, and we always like to pay our respects to the First Nations and Metis ancestors of this land, and we reaffirm our relationships. We also like to offer our guests song to end the show with and Lynda Balneaves had asked if it would be alright to play a Kid by the Revivalists, and so we shall. Thanks again, everyone.