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Water Today Title November 20, 2017

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AD-Good Guys
2016/10/3
Medical Marijuana
ACMPR Version 1.0

FROM MMAR THROUGH MMPR TO ACMPR
THE MADNESS OF REGULATING MEDICAL MARIJUANA IN 2016


You can smell it in the air at public concerts and summer fairs of a summer evening. It's prime time fare in print and on air. There's a new article or interview almost every day about how soon it should be legalized, who might sell it to Canadians (Loblaws, drugstores, now liquor control boards depending on the province), and how old the consumers would have to be to consume it.

Pot sells ads on medias and is an interesting topic around the water cooler. Problem with that is recreational pot - weed, hoot, cannabis,smoke, marijuana, whatever you want to call it - is completely illegal. The Federal government, provinces and in some cases municipalities have as many ways of dealing with recreational pot as there are institutions themselves.

Medical marijuana is a totally different story. Health Canada has been working on legislation that will eventually bring all parties under one set of rules - when producing, selling or consuming medical marijuana (cannabis for medical purposes now being the preferred term) - since 1999. The last iteration of the ever evolving regulation, the Access to Cannabis for Medical Purposes Regulation (ACMPR) was released in August 2016, replacing the MMPR that replaced the MMAR which had proven to be unmanageable.

The provinces, especially Ontario where the premier is not doing so well in the polls, see medical cannabis as a bonanza both for votes and taxes, so there is a lot of pressure not to mess with the huge windfall that it could be.

On the municipal level, the battle is in the street, medical cannabis outlets are popping up across the country. The city of Vancouver, overrun by self-coined medical dispensaries doesn't have the resources to get rid of them and doesn't really want to since the Van population is well known for being ground zero for the legalization movement. As far as we know, Vancouver is flaunting federal laws and provincial laws to avoid riots in the streets or at least pushing the industry underground where the consumers are eagerly taken care of and supplied by gangs, and various organizations with mob ties.

In any case, when the number of marijuana-related businesses in Vancouver grew from 60 to 100 businesses, in the first six months of 2015 , Vancouver became the first city to regulate medical marijuana outlets.

    "The City of Vancouver's decided to use bylaws to create a regulatory oversight in an environment where there was none," says Andreea Toma, Chief License Inspector, City of Vancouver. "Shutting down dispensaries is not effective because they just pop up again in a different location."

    "We do not oversee product quality, our framework governs business licensing and zoning only. Although dispensaries are not allowed to sell edibles, only seeds, plants and oil."

    According to Toma, Vancouver is in talks with other cities looking at regulating dispensaries, such as Victoria and Toronto. .
For all the proliferation of dispensaries in cities across the country, officially, the supply of medical marijuana in Canada is heavily regulated and largely restricted to licensed producers . Or it was under the last MMPR rules. The ACMPR - Health Canada's response to the the Federal Court of Canada's February 2016 decision in Allard v. Canada - provides stop gap measures until the legislation is tabled in the House of Commons, allowing individuals with a prescription to grow their own, or ask a designated grower to do it for them. Essentially reopening the can of worms it has sealed with the MMPR.

And the beat goes on. All and all, what with the MMAR, the MMPR and the ACMPR and the illegal/regulated dispensaries, one would be forgiven for having no idea what is going on.

Throw in some anecdotal stories of Canadians getting turned back at the US border for admitting that he inhaled(really?); a well known pot activist backing a conservative running for the leadership of the Conservative party, and some First Nations talking about developing facilities to grow and distribute marijuana - this being none of the Feds' business - and things like the wild west come to mind.

We will attempt to clarify matters as much as we can with conversations with a lawyer knowledgeable in these matters, Health Canada's own responses to emails sent about the home growers and current bandaid solutions they offer, and look into some of the more pressing issues raised by of the biggest bonanza in agriculture since the beginning of confederation.

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We talked to as wide a cross section of professionals as possible to better understand the legal, insurance and workplace health repercusssions of the new ACMPR . ( Transcription of these conversations can be found below)

One such conversation we had was with Andrea Hill, a Toronto lawyer with Skylaw, who reviewed the roles and responsibilies of the federal, provincial and municipal governments with regards to medcial marijuana.

We talked with Adam Duncan of ADI Benefits who as far as he knows is one of the first insurance brokers to offer health insurance coverage to medical marijuana users without the added smokers penalty.

Adam explained some basics of the insurance business, how health coverage works, and how people who have marijuana prescriptions can now claim medical marijuana under both Critical Illness and employers' Health Spending Account. Q&A with Adam Duncan

We found out that while Adam will contact insurance companies that offer medical marijuana in their health coverage on your behalf, other large insurance companies we contacted said they were looking at doing this but hadn't as of yet. It is common knowledge in the industry that there are three camps, one in favour of medical marijuana one that doesn't care and one that is 'stuck in the fifties'. There are, to be fair, some pretty dug in points of view about marijuana on both sides.

Following up on the conversations with Adam, we talked to Barry D. Kurtzer, the Medical Director of DriverCheck Inc., a company that offers policy advice to employers regarding such things as drug and alcohol assessments and work-related fitness. According to Kurtzer, most companies really don't have a policy for medical marijuana and often prefer facing claims in human rights arenas than shouldering the responsibility of establishing a policy that could backfire on them. Kurtzer explained in an email:
    "We are aware of certain clients who have stated they have been or will be challenged in human rights arenas to justify terminating workers based solely on the fact such workers use medical marijuana, and where a detailed review of each situation on its own was not carried out to determine whether or not an individual worker is or is not impaired by his/her use of medical marijuana.

    Automatic termination in the absence of specific regulations requiring automatic removal from safety sensitive work (such as U.S. Department of Transportation drug and alcohol testing regulations) combined with failure to accommodate such workers could be interpreted as real or perceived discrimination, hence the human rights complaint issues.

    Since there are currently few resources available in Canada to carry out precise medical marijuana fitness for duty assessments of workers to determine whether or not it is safe for such workers to perform safety sensitive work, it would not be unexpected that some employers might elect to allow arbitrators, courts, and human rights commissions to make the final decision about a worker's fitness for duty, thereby, in effect, potentially removing the bulk of the liability off the shoulders of the employer should a problem occur later on relating to a worker's use of medical marijuana.

    We encourage all employers to create policy to address the use of any medication or medicinal having the potential to impact safety in the workplace, and to review each worker's use of medical marijuana as it relates to safety on the job.

It comes down to this. Let's say you're an aircraft pilot and you have a legitimate medical marijuana prescription, what happens then? In most cases no one is sure.

One could see passengers on a flight being more than a little bit worried if their pilot was on medical marijuana, which begs the question of whether, as pilot or a policeman you would want to let your employer know that you're doing this? Do you have to? It didn't go well for one east coast Mountie a few years back if you recall.. Other people in workplace policy told us in no uncertain terms (off the record) that, if the case arose, companies were pretty much offering the employees a desk job and if that wasn't the direction they wanted to go, then they were dismissed. A quick search of human rights complaints seems to bear this out. There is a growing trend of policy decisions being made by human rights tribunals, because companies would rather see how the wind blows before creating a coherent medical marijuana policy.

Then there is the loss of expertise that could result from creating big harma-type conglomerates to grow and distribute marijuana. According to a designated grower, who preferred to remain anonymous, as they get squeezed out by the billion dollar Licensed Producers, the LPs will sort of one by one lose the know-how that goes into the right seeds for this ailment or that ailment, lose the strains themselves and eventually the price per gram of medical marijuana will go up or be set by the large growers. Once the designated growers are marginalized, the licensed producers will push harder and harder for ridiculous prices per gram of medical marijuana and essentially push people back to the underground sources that have always existed in Canada.
    "Why or how could a veteran pay up to a hundred dollars a day for medical marijuana. It's just not plausible. The hells angels and other clubs would be more than happy to get new customers and retain old ones," he says.

Thaddeus Conrad, of Med-Man-Brand fame has a different perspectives on this matter. Read our interview.

On a final note, in the midst of all this, the Canadian Medical Association is saying wait a second, how come this falls on us? How do we guarantee a designated grower's THC level, and if it's going to be recreational anyhow why do we have to go through this? A recent grad explained that his was the first generation of doctors that even covered this in medical school but that there is now admirable work going on at McGill, Guelph and other universities.

So good luck to everyone across the industry, patients, supplier home growers, doctors, researchers and the various levels of governments...the line has been drawn in the sand. Sort of.


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HEALTH CANADA Q&A
WaterToday - What motivated Health Canada to change the name of the regulation from marijuana to cannabis

Health Canada - Marijuana or marijuana is used to describe the plant only. Cannabis refers to the marijuana plant and its derivate (i.e. oil). As simple as that.

WaterToday - How many licences will be allowed at 1 property or production site?

Health Canada - A maximum of four registrations will be permitted per site.

WaterToday - What is the maximum allotted amount of plants per license, will there be a limit?

Health Canada - The regulations specify that individuals will be limited in the number of plants that they can grow for their own medical purposes. The limits are based on a formula that takes into account both the individual's daily dose (as authorized by their health care practitioner) and the average yield of a plant under certain growing conditions, such as indoor or outdoor growing, and the number of growth cycles expected in a year. In general, every one (1) gram of dried marijuana authorized will result in the production of five (5) plants indoors or two (2) plants outdoors. Individuals must indicate in their application whether they intend to produce marijuana plants indoors, outdoors, or partial indoors/partial outdoors.

WaterToday - How much time do the grandfathered licences have to enroll in the new program?

Health Canada - Individuals who were previously authorized to possess and/or produce marijuana under the former MMAR and who meet the terms of the Federal Court injunction order may continue to do so until the Court orders otherwise. Individuals covered by the injunction who wish to change the terms of their licence, such as a change in address or designated producer, will be able to do so by registering with Health Canada under the new regulations.

WaterToday - How fast can licences be changed to new addresses?

Health Canada - Health Canada has been prepared to accept registration applications since August 24, 2016.

A guide to understanding the new Access to Cannabis for Medical Purposes Regulations is available at: http://www.healthycanadians.gc.ca/publications/drugs-products-medicaments-produits/understanding-regulations-medical-cannabis-medicales-comprehension-reglements/index-eng.php

WaterToday - If someone is authorized 100 grams a day, they can grow 500 plants? Wasn't this a MMPR concern about having too many plants? Or is the maximum daily limit 5 grams and 25 plants?

Health Canada - The regulations specify that individuals will be limited in the number of plants that they can grow for their own medical purposes. The limits are based on a formula that takes into account both the individual's daily dose (as authorized by their health care practitioner) and the average yield of a plant under certain growing conditions. Health Canada is satisfied that this formula strikes an appropriate balance between ensuring reasonable access to marijuana for medical purposes, and the public safety needs of communities.

On average, health care practitioners currently authorize daily amounts of dried marijuana at 2.7 g/day (as of May 31, 2016), as opposed to the average of almost 18g/day seen under the MMAR. This will impact the number of plants that individuals would be authorized to produce under the ACMPR and helps to address many of the previous concerns.

http://whowhatwhy.org/2016/08/26/everything-need-know-medical-marijuana/

https://www.newcannabisventures.com/canadian-cannabis-rules-changes-ahead-an-industry-insider-perspective-on-mmpr-and-legalization/


WaterToday - Apparently people who are designated growers can rent the space out in their green houses to people who want to grow their own. Is this true?


Health Canada - Under the Access to Cannabis for Medical Purposes Regulations (ACMPR), there are requirements regarding where production can occur, including:
  • In cases where an individual is seeking to register to produce a limited amount of cannabis for medical purposes in a place other than their residence, and they do not own the property, consent from the landlord must be obtained and submitted to Health Canada.
  • There can be a maximum of four registrations per site, that may include individuals growing a limited amount of their own cannabis for medical purposes, or persons designated to produce it for them.
  • If an individual is producing outdoors, the boundary of the land where they are authorized to produce cannot have any points in common with the boundary of the land where a school, public playground, or other public place frequented mainly by persons under 18 years of age is located. If the greenhouse is a temporary, seasonal greenhouse that is not a permanent structure, which can be easily moved, it is considered "outdoor".


WaterToday - I was told by a source that non-profits who are designated growers have a different set of rules than other people. Is this what Health Canada thinks?

Health Canada - The Access to Cannabis for Medical Purposes Regulations (ACMPR) establish one set of requirements that apply to all persons who are designated to produce a limited amount of cannabis on behalf of another person who is authorized by their healthcare practitioner to use cannabis for medical purposes. An individual could be designated to produce a limited amount of cannabis for a maximum of two individuals who are unable to produce for themselves.

Designated persons can only produce a limited amount of cannabis for another individual, in accordance with that individual's daily dose as authorized by their healthcare practitioner, and they must abide by the maximum plant storage limits. A designated person must undergo a police record check for drug offences. The limited amount that they are allowed to produce under these circumstances may not be sold to, or shared with, persons other than the individual(s) for whom it is medically authorized.

Those who wish to produce a limited amount of cannabis for their own medical purposes, or as a designated person, must identify a site that meets certain requirements:
  • The consent of the property owner is required if the cannabis will be produced in a place other than the individual's residence, and they do not own the property.
  • There can be a maximum of four registrations per site.
  • If an individual is producing outdoors, the boundary of the land where they are authorized to produce cannot have any points in common with the boundary of the land where a school, public playground, or other public place frequented mainly by persons under 18 years of age is located.
  • If the greenhouse is a temporary, seasonal greenhouse that is not a permanent structure, which can be easily moved, this would be considered "outdoor" production.
It is possible under the ACMPR for a person to provide or rent space to other individuals for the purposes of producing a limited amount of cannabis for medical purposes. This would, however, be limited to a maximum of four registrations per site, as mentioned above.

Only an individual can be named as a designated person, not an organization, including a non-profit organization. An organization wishing to produce and distribute cannabis would need to apply to become a commercial licensed producer under the ACMPR.

For more information about how the ACMPR works, please see
Understanding the New Access to Cannabis for Medical Purposes Regulations




CONVERSATION WITH ANDREA HILL, SKYLAW

Watertoday - I was reading your article in the Globe and Mail and as you pointed out the ACMPR really throws back to the MMAPR in a sense with the personal growers and the designated growers. Can you elaborate on that?

Hill - I think that the ACMPR is a blend of the immediately previous regulations which were the MMPR, and the regulations prior to that which were the MMAR. And as you pointed out it's now sort of this mash up of the two of them working together but in some cases I think there's a little bit of overlap. But we have many potential production sources now for marijuana in Canada. And so that's a very interesting development. I think it was brought on primarily by the courts, the federal courts decision in a case called Allard, where the plaintiffs were challenging the MMPR and saying that look they're requiring us to purchase marijuana from licensed producers where under previous regulations we were able to grow it ourselves. And the quality and the consistency of our access has really not been the same.

And so the court agreed it was primarily an access based argument. Based on cost but not entirely on cost. There is also the fact of the availability of supply factored in as well. So the court basically found that yes the MMPR were unconstitutional in that they had restricted access to the plaintiff's medicine which they needed in order to be healthy.

That is something that is unconstitutional in Canada. The government cannot require you to choose between your health and your liberty. And so the court found as a result that the MMPR were unconstitutional and struck them down and gave the government 6 months to fix the situation so that we didn't have a lawless atmosphere. So the government kept the MMPR in place for 6 months and decided not to appeal Allard but rather to change the regulations governing marijuana for medical purposes. And the ACMPR are the result.

So effectively what's been done is that a lot of the MMAR have been brought back and blended with the MMPR such that the established industries that started up under the MMPR , thelicensed producer industry and all of its ancillary industries could continue.

And it wasn't just the industry side of it there's a regulatory side as well. That was something that the government must have perceived was working well. And they wanted to keep that. So they kept those parts of the MMPR but they added in some parts of the MMAR which recognized personal production and designated production by another individual.

Watertoday - Are the regulations which allow for two licenses per designated grower and four per property designated the same as the MMAR were?

Hill - Yes that was the same.

Watertoday - I think what they add though which is good is that they can have their product tested now.

Hill - That's a really valuable addition. And that's a great improvement upon even the MMPR which wasn't clear on that point. And that's really valuable both for people who are looking to produce their own medicine and for people who are hoping to produce it for others.

Watertoday - It does open a can of worms from a regulatory enforcement point of view doesn't it? I was talking in the city of Vancouver which is going ahead with its licensing dispensary model. And their feeling is Ė "They're there anyways even if we close them they'll pop up again, so we have to have some regulations", and they're regulating only the business licenses and the zoning, But is that not in contradiction in your view with this new federal regulation or do you think down the road that's what we're going to have to do?

Hill - That is a bit of a contradiction. And that's been a difficult thing for both the federal government and these various municipalities to handle. Because on one hand they're absolutely right, if you shut down a dispensary it just opens again the next day, either in that location or maybe in a slightly different one. But it's impossible to use the criminal law to regulate these businesses because the criminal law is not built for that, it's not designed for that. It's not what cops are supposed to be doing day to day.

And you know these businesses are pliable enough that they sort of can withstand a great deal of stress from their environment and they can keep going. So it doesn't work very well. And of course the existence of dispensaries is contrary to federal law in this kind of subject matter. There is no recognition of dispensaries in the ACMPR and there never has been official recognition of them in any marijuana related regulation that we had. However they have existed for quite some time about 20 years in Ontario and probably much longer in BC.

Originally they served a very important role. And for many people they still do serve a very important role where they provide access through a means where that consumer can, not only kind of be guaranteed access even if their paper work isn't quite in place, or if they're waiting for paperwork from the government.

Originally that was the case where you had a government authorization to use marijuana and renewal or replacement of that authorization could sometimes take a great deal of time. And other things could go sideways in the process as well. So patients would sometimes be left without official documentation permitting them to grow or to purchase marijuana. And so these dispensaries were operating in a way that allowed them to have the safe and continuous access to their medicine.

In other circumstances the dispensaries have offered for example some of them offer lower prices. than LP's and others offer other ancillary services such as counselling, nutritional consultation and other important things that kind of look at the greater picture in terms of the patient's heath. So these dispensaries can do good things. But they have become so numerous and so populous that in many cases it comes down to the bottom line.

And yes in that circumstance where you have this plethora of dispensaries all trying to do essentially the same thing, or many of them trying to do the same thing, you have a supply that is unregulated, it is unsupervised and it's untested. and it's undermining the government's attempt to have a strictly regulated and controlled industry where more product has been tested and is safe.

Watertoday - Do you know if the clinical tests they're offering, are they free or do they have to pay to have them?

Hill - Oh I don't think the clinical test are free at all. I think they're quite expensive. Those laboratories are for profit organizations.

Watertoday - What's the role of the province in there from a legal point of view?

Hill - The provinces under the constitution have jurisdiction over a bunch of different things. They don't have jurisdiction over criminal law which is why we have a single criminal code which is federal in nature, but they do have jurisdiction over what the constitution calls property and civil rights in the province. So that phrase, no one really knew what it meant. So it's kind of been a basket clause that has had a bunch of stuff thrown into it.

And in most cases property and civil right in the province have been interpreted to include things like the finer details of how federal regulatory regimes will play out province by province.

For example the federal government is able to regulate in the area of criminal law which they have done. They have created a Criminal Code the Controlled Substances Act, which is a criminal statute, and they have created several other criminal statutes along the way.

But those are the biggies. And of course the ACMPR regulations are related to the Controlled Substances Act. So they are criminal law. When we come down to what the federal government can do versus the provincial government. The federal government from the case law that we know of is able to walk through and sort of make broad prohibitions and penalties. So they can say you shall not possess, produce or distribute marijuana or you know cannabis of any from unless the provinces allow it. And so in that case it would up to the provinces to say, ďYup in this province you're allowed to do it. And this is how it's going to look. It's going to be sold in this way. Your store hours could be between here and here. The minimum age for persons who can be here, very much like we see with cigarettes and alcohol Those are provincially regulated and ...

Watertoday - So the municipalities then would come under the provinces regulations?

Hill - That's right. Provincial governments are technically the boss of municipalities, although the municipality has kind of a more hands on grasp of what the public wants and what is important to the public. So they're getting increasing air time, and increasing weight when they want to weigh in and state what they think is best for them. But ultimately it is the provincial government which has that power.

Watertoday - have some provinces rejected this program? I'm not aware.

Hill - Not explicitly. We do know that in Quebec, and this would be more of a medical thing; that the college of doctors in Quebec has asked that patients only be prescribed marijuana for medical purposes as part of a formalize research study. And there's one other option. I'd have to get back to you with the exact details on that. But it is much more restricted vision of what medical marijuana would look like in that province, but that's coming from the doctors not from the provincial government. So when we look at provincial governments I don't think any of them has outright rejected the possibility of having marijuana available medicinally or recreationally. Medicinally they couldn't. Every patient has a constitutional right to access it. So they will have to allow medical marijuana to continue. But when we think about recreational marijuana regimes which are promised to be coming down the road, that will be ultimately up to the provinces and we will have to see what they think.

Watertoday - So is it your feeling that let's say ACMPR was devised in one sense to stop all the legal challenges I guess they would have had right? If they had said no designated, no home growers. I think they would have had a lot of issues.

Hill - Yeah. It's hard to say. Definitely the ACMPR is done deliberately in response to Allard, and Health Canada was very explicit about that. We all, the industry knew that something had to change by August 24th because that was the deadline imposed by Allard. But the ACMPR is really something of a stopgap measure produced by Health Canada in order to, as you said, kind of pacify a lot of the interest of the litigants who were continuously challenging this legislation. But also in order to kind of buy the government some time to figure what it wanted this program to look like in the long term.

Watertoday - And it seems that it's with a view to legalization that they moved forward...

Hill - I think you're right. I think there is a consciousness that things will be changing down the road. And Health Canada has been explicit that these are designed to provide an immediate solution, those are their words, required to address the court judgement. This is not something that Health Canada envisions being in place over the longer term. So I think you're right; they're conscious that things will be changing although they don't come out and kind of talk about that very much.

Watertoday - So you sort of expected what they said then. Is that what most of the legal people expected?

Hill - I don't know if anyone really expected that they would keep as much of the MMAR, which is effectively is what they've done. I think that that was a bit of a surprise because there are some aspects of the AR which has been rendered somewhat redundant by the MMPR. So for example the point I made in my article was that the designated producer has now been effectively replaced and improved upon by the model of the licensed producer which you know must be subject to all of these strict regulatory controls and tests.

So it was kind of a surprise to see that in there. But at the same time I understand I think the sentiment which was - let's kind of calm the waters for now and just make sure that we're in compliance from a constitutional aspect. And then you know as the government continues to roll out its policy initiatives we can adjust things later on.

But this is very much kind of a peace bond , or maybe an olive branch is a better term for it, that has been extended for the moment in order to calm the waters and give the government some time to process things.

Watertoday - Well I think that that's what they want to do now is a regulatory framwork for the product itself. And you know defining the dosages more precisely in order to move inot such things as edibles.

Hill - I think you're right. I know it's going to be a huge development in how different forms of cannabis are thought about. There's a lot of business chomping at the bit to get started on that kind of thing.

Watertoday - That's totally illegal right now kind ins't it?

Hill - You can make your own.

Watertoday - But you can't sell it.

Hill - But you can't sell it. That's right. It's kind of a little bit difficult for a business to get off the ground in that respect. But definitely everyone is hoping that we will eventually get there. Well not everyone but a lot of people for sure. And yeah that's highly anticipated. There are couple other forms of cannabis that are just getting started. So the oils are sort of being rolled out by a lot of LP's now, and fresh marijuana plants and seeds are another category which will be brand new under the ACMPR.

Watertoday - The only thing that's a little disappointing I think for the quality of the product is that most of the designated growers were the experts in strains and starting material now they're not allowed to sell.

Hill - I think there is a way of regulating that and that has been accomplished through the security clearance aspects of the MMPR, and now the ACMPR. What the government was concerned about was that in opening up this industry to commercial production, it did not want to have any kind of organized crime get involved. And that's a really reasonable concern. And I think that's a very smart concern to have. And so the security clearance process is designed to eliminate anyone who could potentially have connections to people who had charges or convictions on their record that would concern the government about you know their ability to be regulated. And under that process a lot of people who had for example possession or trafficking charges on their record from the MMAR where they were growers were unfortunately excluded from participation in any role that required security clearance.

That did not exclude them from being a part of an LP, being a shareholder or holding some kind of role that which did not require security clearance. So in no way did the MMPR actually explicitly keep any of these people out of the industry. But the effect of the security clearance is that a lot of them were unable to be in charge of production operations and you know, contribute to their maximum potential. So that was unfortunate but it didn't stop people from learning. There has been that a lot of people who didn't maybe have a lot of experience growing marijuana before the MMPR came out have now learned quite a bit. You can see how many licensed producers have kind of developed over time, and how their offerings have consistently improved and their product selections have improved and their reviews have improved.

Watertoday - Have their prices have gone downÖ

Hill - In many cases prices have gone down. I know Bedrocam offers compassionate pricing of $5 per gram. And many others do as well. This is a medical industry and a lot of patients don't have piles of money to pay for whatever strain of marijuana they want. So in many cases licensed producers have to be very conscious of that financial capability of their clients.

Watertoday - So I guess the big question that remains is the enforcement of the designated growers which is why MMPR was started in the first place I believe? So the issue is still there in a way.

Hill - The issue is still there. Yeah. We'll see whether we have lots of designated growers carrying under the ACMPR that have to be approved as such by Health Canada. That will be a process in and of itself. Health Canada doesn't have all of these resources to police all of these guys. And it's not really their role to do that either. They're a regulator. They should be doing things like policing and supervising the LPs because they've done a really good job of that so far. But at the same time designated growers, there were so many of them under the old regulation. it was a problem to maintain a consistent law enforcement approach across various different jurisdictions and you know fire authorities were occasionally involved as well. It's just a really complicated system to manage.




CONVERSATION WITH INSURANCE BROKER ADAM DUNCAN OF ADI

WaterToday - I've read that you're one of the few who offers better insurance rates for people who smoke medical marijuana, is this right? .

Duncan - Well I'm not an insurance company, I'm a broker. As such, I work with different insurance companies. In this case Wawanesa is offering non-smoker rates to Life and Critical Illness clients that pass their medicals. So any broker that uses Wawanesa has the same access as I have, the same rates that I have access to. Everyone's in the same boat that way. I just think that right now I'm one of the only brokers that's promoting it. .

WaterToday - And is Wawanesa one of the few companies that does it? Or the only one? .

Duncan - To be honest I don't really know. I mean I've heard that there are other insurance companies that are coming out and offering it. Even though I am a broker, I work a lot of times with Wawanesa. I do have access to other markets but I find that Wawanesa is one of the more proactive insurance companies in Canada. And this is a good example of that. You know that the Critical Illness policy is being issued at non-smoker rate. That said the insurance industry is very follow-what-the-other-guy's-doing. So I would not be surprised if not every insurance company is offering this already or very, very soon they'll be doing the same thing or something similar.

WaterToday - Is the rate substantially lower? .

Duncan - It's extremely lower. It's usually about double if you're a smoker.



WaterToday - Oh really?

Duncan - Yeah. And depending on how long you've had a policy in place, you know. Say you've had a Life policy in place or a Critical Illness policy in place for three years and you were classified as a smoker because of your marijuana use. If we went back to the insurance company and asked for them to review that and treat it as a non-smoker, now the rates probably wouldn't be half but it would be very, very close to half.

WaterToday - Are you getting a lot of people asking about this?

Duncan - Not yet. I think, you know, it's still not known. You know I'm going to do a Facebook campaign and get it out there. I've contacted, some of the license producers, some of the bongs and pipes retail locations and I've asked them, all of them for some help to just get this message out so that I can help their clients.

So it's just a matter of time before it gets out there, because I really do think that specifically to the marijuana coverage and the issue with the life insurance and the critical illness there's two types of people. The ones that have considered getting it in the past but haven't wanted to disclose that they are using drugs. Because there is a stigma to it I guess. And there's the persons that already has coverage and they were classified as a smoker already and we can get those rates changed for them and get them a non- smoker status.

So that's what I see. You know once it kind of gets out there, who doesn't want to pay half of what they're paying now? And if anyone is worried about having to admit marijuana use they won't have to anymore with the applications they've been changing, specifically with Wawanesa where they're not even going to ask that question anymore. There's just no need to.

WaterToday - Oh they won't ask but the person can say that they're a non-smoker?

Duncan - Yes. They would just ask that question. And specific to tobacco they would say have you in the last two years smoked a cigarette, cigarillo, cigar and you know they list a bunch of tobacco products, and if you say yes to that that's different. But then there's another section on their applications that asks you specifically some drug questions. You know harder stuff like cocaine or barbiturate things like that. And marijuana is also one of the questions. They're just going to take the marijuana question out. Because there's just no, there's no point to asking it anymore.

WaterToday - I see.

Duncan - So they'll still ask, you know, the harder drug questions, as they should. But with the marijuana specifically it's not even going be asked anymore.

WaterToday - Do you have any statistics or any knowledge of how many people this could affect?

Duncan - No I don't. I mean for me personally I can say that within the last twelve months I've had about 6 clients that were tobacco users that contacted me and said, "I haven't smoked in over a year. Can we go back to the insurance company and ask them to reclassify me as a non-smoker?" And in every case they did it.

WaterToday - Do they try to prove it somehow?

Duncan - Yes. You have to take another medical and then you have to fill in a form, a specific form, a change form. So you have to take another medical. And the medical is really just peeing in a cup. And the tobacco will show up in your urine.

And if you have been smoking and if they find it, obviously then you're declined and you stay as a smoker. But six out of the six cases that we've taken to the insurer this year have all been approved as non- smoker. So you just sign a form swearing that you haven't smoked in over a year and then you take the medical.

You know if you smoked a joint yesterday and you want to be classified as a non-smoker you'd still have to take the medical, you'd still have to sign the form. But they wouldn't care if the marijuana showed up in your urine. They're only looking for tobacco. Or obviously harder drugs.

WaterToday - Do you think this will uphold if marijuana goes into edibles. Would that be another issue or would that not be an insurance issue? .

Duncan - No as I understand from the insurance companies, specifically again Wawanesa, it doesn't matter how it's consumed. So it can be vaporised, it can be smoked, it can be in edibles, they don't care. .

WaterToday - So really they don't consider marijuana a drug like cocaine or something else?

Duncan - Not at all. I think that's what they are saying and as I said to some other people that I've spoken to, nobody's dying, we certainly don't hear any stories of anybody dying from marijuana use. So the life insurance treat someone as a non-smoker with a life insurance coverage. And what I think it really is meaningful is the critical illness coverage. Because the big three critical illnesses that are covered in a policy are heart-attack, stroke and cancer.

So essentially by treating marijuana consumption however it is consumed by treating that as a non-smoker I think what the insurance companies are saying is that they're confident that marijuana is not causing heart-attacks, strokes or cancer.

Or else they wouldn't issue it at non-smoker rates. And they'd charge the double amount. And they're not, they're not stupid. They got smart actuaries working for them. They're not in the business of losing money. So they've done their homework on this.

WaterToday Fair enough. You also sent us an email about Health Spending Accounts. I'm trying to understand what that is because I've never heard of it.

Duncan - A Health Spending Account (HSA) is a new form of employee benefit plan. With traditional employee benefit plans offered by such companies as Blue Cross and Great West Life, you'd get a little bit of life insurance; you'd get maybe a disability insurance and health and dental insurance. Now there's this other program that's come out; it also came out a long time ago but not a lot of people know about it and it's called the Health Spending Account (HSA). And what the HSA does is it provides every employee with their own budgeted amount.

So an employer might decide to give each employee $1,000 that they can spend on health and dental claims. So the employee would go to the dentist. They would pay out of pocket say $100 to get their teeth cleaned. And then they would be reimbursed out of that budgeted amount of the $1,000 ,they'd be given back the $100.

What this does for an employer is it creates cost containment. Because they know that they are only going to spend a maximum of $1,000 per employee and that's it. Once it's gone it's gone they won't spend over that. And a broker like me doesn't come to your office every year and say , "Sorry but your employees overspent. They over claimed what you paid in premium so now you're getting an increase." Most employers don't like the traditional plan because you don't know from year to year what you're going to have to pay in premiums. But with a Health Spending Account they know every year they are only going to give $1,000; and I'm just throwing $1,000 out. They can make it whatever they want. They can make it $100 per employee. They can make it $5,000 per employee. It's what they can afford.

How that relates to our conversation is that I contacted National Health Claim which is the company I use to set up my Health Spending Accounts (HSA). And they now accept medical marijuana claims, if it's from a licensed producer where the patient has a doctor's note. Plus the employer doesn't know what the employee is claiming on. As long as it is a medical and dental claim, it doesn't say that it was medical marijuana that was purchased. I also since heard back from one insurance company, Sun Life, and they have confirmed that they will accept medical marijuana claims through a traditional plan.

WaterToday - That's interesting.

Duncan - They didn't used to but the email was quite interesting, I'll read it to you. It says, "With the health and drug landscape changing in Canada we have seen an increase in request to cover medical marijuana. Currently this drug does not have a DIN number." (Every prescription has a DIN number that is the exact same number across Canada. So that when the claim is made you know you're claiming on that DIN number that is related to that drug. But apparently medical marijuana has not been given a DIN number yet). The Sun Life email explains, "currently the drug does not have a DIN number and has been deemed ineligible as an expense under our base plan. In the past we've only been able to cover medical marijuana under HSA accounts.

Recently we changed our business practice when it comes to medical marijuana. Clients now have the option to cover this expense under their HSA as it qualifies as an expense under the income tax Act, as well as through our Cost Plus arrangement." (Cost Plus is very, very similar to Health Spending Account; slightly different but pretty much very close to the same).

So they're moving; they're not quite there yet but if they're making those types of changes then it's just a matter of time again before they do provide it with a DIN number and you are able to claim it just like a regular prescription for diabetes.

Watertoday - Do you have any other comments to add?

Duncan - What I think has happened is that the insurance companies are making these changes but they're not exactly driving the bus on this where they're letting people know. They've been proactive in making the change but I don't think they're being proactive in letting anybody really know about it. I think they're leaving it up to is the broker to get out there and get the word out. And the problem with that is that marijuana use is such a polarizing topic. And so if you got a broker who thinks that marijuana use is evil and it's a gateway drug and it's just like cocaine and all those that destroys lives, I don't know how active that broker is going to be in getting out there to let people know of these changes.






CONVERSATION WITH MED-MAN-BRAND'S, THADDEUS CONRAD

WaterToday - Okay so can you tell me your essential reaction to this new ACMPR?

Conrad - Iím very excited and pleased with the decision because human rights were being infringed upon. So itís a good win for human rights.

WaterToday - As a designated grower who has been providing starting material to Licensed Producers, what do you think about the licensed producers now being the only ones that can sell this?

Conrad - Well you know what? With all due credit to the licensed producers, theyíve done a lot of hard work to get to where they are. And most of them have compiled a lot of really good start-up material. But on another note, businesses like me will still continue providing materials and items for growers that canít be provided by the bigger licensed producers.

And another problem that I see arising is the licensed producers trying to fight the court order saying that they have to provide start-up material, because I could see them trying to protect all of the hard work that theyíve respectively done.

WaterToday - What about enforcement? I mean itís all very nice to put all these rules in but you have dispensaries in Vancouver that are going ahead and keeping going.

Conrad - Health Canada has openly and blatantly stated that dispensaries are operating illegally. But you see this is where the problem lies - is if we remove the marijuana and we talk about human rights for a second, if people need to access a certain strain that none of the LPs have and they can access that strain at a dispensary or an online mail-order dispensary then in fact the dispensaries are providing a much needed service thatís neglected by the regulations.

So itís a regulatory issue and a human rights issue, not so much a marijuana issue. And so companies like Med Man Brand and other progressive people have said, ďHey thereís a need here and weíre not really breaking the rules or breaking the law weíre actually doing what the regulation should be allowing for.Ē

And then weíre going to be in a position to help them write the regulation that theyíre going to need to make a better, more broad, more open system that helps everybody and doesnít exclude anybody; because itís the people that are getting excluded that are suffering the most.

And then itís the people who are getting arrested by helping those people or getting shamed by society for helping those people. Whatever those negative consequences are,they have to be wiped away from the whole program. And thatís what Iím hoping legalization will do.

WaterToday - On the other hand how do you control the quality if any dispensary? I mean theyíve put so many rules on the LPís about how they grow, how much security is needed and all this.

Conrad - I would say that thatís a multi-tiered question. Whatís great about the LPs but which also works against them is - they have irradiation programs where they put all of this time and effort into growing a pharmaceutical grade product. And in order to pass the contamination tests they irradiate massive batches of marijuana.

And through the irradiation they in effect take away a lot of the terpenes and they affect other molecules that are actually the medicine in the plant. So guys like me have built up a reputation where people know that Iím providing quality that I care about it.

Have I validated it? Why, I donít really have a lab that will verify my stuff to be contaminant free. But what people do know is when they smoke my stuff, or when they eat my stuff and they compare it to the other LPs that theyíre signed up wit.h they say that mineís far superior.

WaterToday - That is what many designated growers are saying, is that the expertise will be lost in this sort of ďBig PharmaĒ model that theyíre setting up.

Conrad - Well you know what the truth is Ė people who legitimately care about other people are going to continue doing what theyíre doing. When people do a valued community service thatís necessary whether itís within or outside the boundaries of regulation, at the end of the day they will be absorbed into the program and they will be appreciated and all of their knowledge will usually be used. Itís just that it takes time.

WaterToday - I think that maybe the legalization will take care of a lot of these issues.

Conrad - Yup. But Iím telling you right now, the biggest problem with illegal mass production for profit of recreational marijuana is the pesticides, you know, the fungicides and miticides. All the pesticides that are used in its production are actually potentially harming the young. Itís generally the younger people that have to access it illegally and in effect who knows what type of side effects these pesticides are giving to these younger people.

So thatís why legalization is so important because if 99% of marijuanaís produced in regulated environments then everyone consuming it itís going to be a healthy product. Whereas right now we could just say 90% of commercially mass produced unregulated marijuana is actually harmful with respect to the pesticides or additives that are put in the marijuana. And all the spin-off crimes connected to it. And thatís a regulatory problem. Itís the laws that cause those problems. Itís not the marijuana itself.

WaterToday - Okay is there anything else you want to add?

Conrad - You know what? Iím just really happy that Canada especially Justin Trudeau and his administration are being very progressive. And I am looking forward to being a part of a newer world where thereís a lot more respect and reverence for a plant that can help millions and even billions of people for, who knows, hundreds of thousands of ailments. And itís in one plant or a specific strain in the family of that one plant versus people having to take up to thirty doses of probably unsafe pharmaceutical drugs that were passed right through the system to make profit. So it is an exciting time and platform for Canada right now.

Related series of articles on the MMPR
MED-MAR - Part 1 -: How to do business in medical marijuana like big pharma
MED-MAR OP/Ed: a looking glass into the future
MED-MAR - Part 2: The art of legally prescribing an illegal drug
MED-MAR - Op/Ed: Isn't it ironic?
MED-MAR - Part 3: Medical marijuana, food, and the final frontier
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