CONROY & COMPANY JOHN W. CONROY, Q.C.* Barrister and Solicitor Telephone: (604) 852-5110 Facsimile: (604) 859-3361 2459 Pauline Street Email: [email protected] Abbotsford, BC V2S 3S1
September 16, 2020
The Honourable P. Hajdu [email protected] Minister of Health
The Honorable D. Lametti [email protected] Minister of Justice
Dr. Teresa Tam [email protected] Chief Medical Officer
Joanne Garrah [email protected]
Mike McGuire [email protected]
Cannabis Licensing and Security Health Canada HC.licensing-cannabis[email protected]
The Honourable John Horgan [email protected] Premier of British Columbia
The Honourable Michael Farnsworth [email protected] Minister of Public Safety and Solicitor General
The Honourable Adrian Dix [email protected] Minister of Health
The Honourable Attorney General David Eby [email protected]
Dr. Bonnie Henry [email protected] Chief Medical Officer
Mayor Kennedy Stewart kennedy.stewart@vancouver.ca City of Vancouver
Councilor Adriane Carr [email protected]
Councilor Melissa Degenova [email protected]
Councilor Lisa Dominato [email protected]
* Denotes personal law corporation September 16, 2020 Page 2 of 10
Councilor Pete Fry [email protected]
Councilor Colleen Hardwick [email protected]
Councilor Sarah Kirby-Yung [email protected]
Councilor Jean Swanson [email protected]
Councilor Michael Wiebe [email protected]
Councilor Rebecca Bligh [email protected]
Councilor Christine Boyle [email protected]
Kimberly Holm [email protected] Chief License Inspector and Director of Licensing and Inspections
Inspector Steve Rai Vancouver Police Department [email protected]
Andrew Leung [email protected] Chen and Leung Barristers and Solicitors Legal counsel to the Owners/Landlords
Dear Honourable Ministers, Mr. Premier, Mr. Mayor and City Councilors, Sirs and Madams:
RE: URGENT EMERGENCY Application for licensing to sell/donate cannabis for medical purposes, and conduct research and a s.140 Cannabis Act Ministerial temporary exemption for required licensing modifications to enable The Healing Wave and the Serious Hope Society to continue its Cannabis Substitution Research Program during the Opioid crisis in Vancouver, B.C.
I am writing to you in my capacity as legal counsel assisting Neil Magnuson, the owner operator of The Healing Wave located at 157 E Cordova St in the City of Vancouver in the Province of British Columbia and the related Serious Hope Society that is operating the Cannabis Substitution Project out of that location.
The Healing Wave is a sole proprietorship but the Serious Hope Society, that administers the Cannabis Substitution Project, is a registered BC non-profit and September 16, 2020 Page 3 of 10 attached is a copy of its certificate of incorporation, constitution, list of directors and registered office, a copy of its bylaws and confirmation of incorporation via the BC Registry.
This is an URGENT EMERGENCY application to the Federal Minister of Health for a ‘Temporary Federal Ministerial Exemption’ pursuant to s. 140 of the Cannabis Act with respect to certain provisions of that Act and its regulations, for the following persons, classes of persons, and classes of cannabis as being ‘necessary’ for a medical and scientific purpose and in the public interest in a contributing effort to save lives during the ‘opiate crisis’ in Vancouver B.C., while endeavoring to transition those benefitting from the proposed temporary exemptions into the legal system to whatever greatest extent possible.
Because this application may involve the jurisdiction or at least consideration of other federal ministries to some extent, it is also being copied to the Minister of Justice and those involved specifically in the administration of Health federally such as the Chief Medical Officer Dr. Teresa Tam and representatives involved in the administration of licensing and exemptions under the Cannabis Act and its regulations.
While this application does not involve the jurisdiction of the Province of British Columbia with respect to cannabis distribution for non-medical purposes it is nevertheless being forwarded to the Premier, the Minister of Health and the Attorney General in and for the Province of British Columbia and the Chief Public Health officer Dr. Bonnie Henry as the issue does relate to the wellbeing and health of citizens in the Province of British Columbia and the administration of justice generally in the province and to seek their support for the Project.
It is also being copied to the Mayor and Council of the City of Vancouver seeking their support and City representatives involved in the status of the project's current licensing situation and anticipating that if the federal exemptions are granted there will be further discussions with the City as to the type of license applicable between what is described in the City bylaw as a “cannabis retail store” and a “compassion club” to satisfy the City licensing issue.
Finally, the application is also being forwarded to the landlord via Mr. Leung, his legal counsel, in an effort to persuade them to hold off on any further steps in the eviction process to enable this application to be considered and if approved, to resolve the City licensing issue as the only issue arising in relation to the lease so as to enable the Project to continue to operate at its current location.
The specific licenses, modifications and exemptions applied for are as follows:
1. A personal specific individual exemption for Mr. Neil Magnuson, and his designated volunteers, as the sole proprietor and owner/operator of “ The Healing September 16, 2020 Page 4 of 10
Wave” to enable him to receive, obtain and possess both licit and illicit cannabis in various quantities, forms and strengths for purposes of distribution by way of sale and donation only too registered customers (card holders)of The Healing Wave and/or its research program the Cannabis Substitution Project of the Serious Hope Society by way of a license to possess and sell cannabis for medical purposes (Reg.s.8(5)) and a license for research(Reg.s.8(1(e));
2. A class exemption for all registered customers (card holders) of The Healing Wave as Class A to be able to acquire and possess both licit and illicit cannabis in various forms and quantities as a class described as “medically approved for drug dependency” and in amounts not to exceed 30gms unless otherwise ‘medically approved’ in accordance with the ACMPR for a greater amount up to 150grms as per current regulations;
3. A class exemption for all members of the not for profit Serious Hope Society as Class B to acquire and possess both licit and illicit cannabis in various forms and quantities as part of Class A but also, as a separate Class B encompassing members enrolled in the Society’s research program the Cannabis Substitution Project and in amounts not to exceed 30 grams unless otherwise ‘medically approved’ in accordance with the ACMPR for a greater amount up to 150 grams as per current regulations.
Most importantly, we attach a current specifically strong supportive letter from Dr. Milloy, the Canopy Growth Professor of Cannabis Science, and Assistant professor, Department of Medicine, at the University of British Columbia as well as Research scientist, at the British Columbia Centre on Substance Use, who calls not only for the support and continuance of this Project but its expansion and notes its involvement in saving lives and assisting with his critical research. Dr. Milloy clearly supports this project as needed for both medical and scientific purposes as well as being clearly in the public interest.
Similarly, we have attached a letter of support from Patricia Dribnenki-Pennock a Registered Psychiatric Nurse working in the Vancouver Downtown Eastside that speaks to the value of the project and the need for its continuation for both medical purposes and in the public interest.
In further support and to explain its urgency please see attached Appendices A -E originally attached to the letter to Councilor Bligh at the City of Vancouver, for specific details of the development of this ‘Low barrier access’ project (further to a Vancouver City Council encouraging resolution - App. E) and its history and current operations, the science relied upon (App. C ) and the relevant supportive evidence relied upon from the recent preliminary constitutional law decision of the Alberta Court of Queens’ Bench in R v. Howell (App. D), that is ongoing in relation to sentencing. Also attached is further backgrounder by way of the email threads providing the details of the status of matters with the City of Vancouver and in particular with its Licensing September 16, 2020 Page 5 of 10
Department position that has resulted in the Landlord giving an eviction /termination notice for the end of last month, leaving the Project and its’ patient members on tender hooks as to their ability to access this medically supported project providing a non-lethal pain substitute and helping reduce their chances of dying from street meth or opiates as they have been able to do over the last several years - hence the URGENCY of this matter.
In the past, when based out of VANDU, the Project had the additional support of that community and of the Vancouver City Police and the further support of the VPD is anticipated. We are copying Inspector Rai at the VPD for his information.
It is respectfully submitted that something becomes "necessary" when there is a "greater evil" occurring, such as the ongoing and increasing number of deaths due to the "opiate crisis": https://vancouversun.com/health/the-faces-of-b-c-s-deadly-overdose-crisis-are-young- and-old-male-and-female-rich-and-poor/wcm/f6884f16-64a9-4512-aff2-87a81c8340b5/
The faces of B.C.'s deadly overdose crisis are young and old, male and female, rich and poor and the existing laws do not provide or adequately provide an ability to address the problem and it becomes " necessary" to bend or break or simply not enforce existing laws as a "lesser evil" to help address the "greater evil" while attempting to exhaust all other legal means to transition a contributing solution to the "greater evil" that involves breaking and non-enforcement of the law, into a successful solution and one that is in accordance with the law.
It is respectfully submitted that the “lesser evil” here of breaking or not strictly complying with or not enforcing compliance with existing cannabis laws and its use for medical purposes, falls clearly in principle within the ambit of the recently announced Federal Drug Prosecution Policy: https://www.ppsc-sppc.gc.ca/eng/pub/fpsd-sfpg/fps-sfp/tpd/p5/ch13.html
That while applicable to those controlled drugs falling under the Controlled Drugs and Substances Act (CDSA) that is no longer applicable to cannabis, nevertheless the conduct here involving cannabis that has been legalized to some extent, and involving distribution for a medical purposes and treatment with some planned medical supervision and including some indigenous people, makes the non-prosecution policy ‘principles’ set out below to be equally applicable in principle to this Project.
2020 Public Prosecution Service of Canada Policy
3. Applicable Principles
September 16, 2020 Page 6 of 10
PPSC prosecutors will be guided by the following principles:
1. Resort to a criminal prosecution of the possession of a controlled substance contrary to s. 4(1) CDSA should generally be reserved for the most serious manifestations of the offence (described in paragraph 3 below). 2. In all instances, alternatives to prosecution should be considered unless they are inadequate to address the concerns related to the conduct, including in the following circumstances: a. The possession relates to a substance use disorder. In particular, alternatives to prosecution should be pursued where the offender is enrolled in a drug treatment court program or a course of treatment provided under the supervision of a health professional, including those involving Indigenous culture-based programming, peer counselling, and abstinence-based recovery centres; (emphasis added) b. The offender’s conduct arises from a violation of a bail condition and can be addressed adequately through a judicial referral hearing; c. The offender’s conduct can be adequately addressed through an approved alternative measure or a measure that is consistent with the principles contained in Chapter 3.8 of the PPSC Deskbook governing alternative measures; d. The offender is an Indigenous person and their conduct can be addressed through an Indigenous restorative justice response; or e. The offender’s conduct can be addressed through a restorative justice response.
This Project involves receiving cannabis in various forms and strengths, that has no lethal dose, and endeavoring to assist those not only addicted to potentially lethal drugs but those most at risk, such as the poor, the ashamed, the homeless and the computer illiterate, to name a few, of an overdose from resorting to lethal dose street drugs by substituting cannabis, as supported by international and local science, and with the specific support of the BC Substance Abuse Research Scientist, Dr. Milloy who is very familiar with the project and its necessity.
The Federal Minister of Health's power to exempt persons or classes of persons and cannabis or any class of cannabis in relation to a person from the application of all or any of the provisions of the Cannabis Act and regulations is set out below in section 140 of the Act
Exemption by Minister — persons
140 (1) The Minister may, on any terms and conditions that the Minister considers necessary, by order, exempt any person, or any cannabis or any class of cannabis in relation to a person, from the application of all or any of the September 16, 2020 Page 7 of 10
provisions of this Act or of the regulations if, in the opinion of the Minister, the exemption is necessary for a medical or scientific purpose or is otherwise in the public interest. For greater certainty (1.1) For greater certainty, the Minister may, by order, amend or revoke an order made under subsection (1) or suspend its application in whole or in part. Exemption by Minister — class of persons (2) The Minister may, on any terms and conditions that the Minister considers necessary, by order, exempt any class of persons, or any cannabis or any class of cannabis in relation to any class of persons, from the application of all or any of the provisions of this Act or of the regulations if, in the opinion of the Minister, the exemption is necessary for a medical or scientific purpose or is otherwise in the public interest. Suspension (2.1) The Minister may, by order, suspend, in whole or in part, the application of an order made under subsection (2).
It is respectfully submitted that this application is clearly necessary for medical and scientific purpose, as well as clearly being substantially in the public interest for the following reasons:
1. The target population of the Project are not only addicted and sometimes also suffering from mental health issues but those that are hardest to reach, that are either homeless or living in shelters with, in some cases, no access to computers or Internet or personal telephones and with little or no income or computer literacy. Many are ashamed of their condition and do not wish to have public contact. Some have doctors who prescribe opiates that are covered on the medical plan whereas cannabis is not, and some have doctors who are not prepared to authorize cannabis, but most could not afford current market prices anyway and they fear that having contact with other medical professionals might jeopardize their existing relationship with their doctor and source of opiates. Many have come to be aware of the project as a result of its operation out of the Vancouver Network of Drug Users (VANDU) for several years before it became necessary to establish its own location. Attached video links demonstrates the issues and support amongst the community:
https://www.dropbox.com/s/epw4gk8or63w23r/CSP%20Update%20Collection%2 0-%20Dec%202019%20to%20July%202020%20-%20FINAL.mp4?dl=0
https://pot.tv/video/2020/08/18/truth-hope-change-with-neil-magnuson-ep50/ September 16, 2020 Page 8 of 10
2. It is the hope and expectation of the Project that some of its members will be able and willing to be "medically approved" as required by existing ACMPR legislation under Part 14 of the regulations, or by perhaps an exemption for a lesser approved standard (medically approved for drug dependency) involving initial observations and conversations between willing attending members and a participating Nurse Practitioner or other Healthcare practitioner that at least identifies a drug addiction/dependency or other obvious medical problem that may benefit from the use of Cannabis, so that the member or a designate can produce a licit supply for medical purposes pursuant to Part 14 of Cannabis Act regulations, ACMPR to transition the Projects supply in part into a licit one, among other options. It is hoped that the BC Craft Farmers Co-op (www.bccraftfarmerscoop.com) will be successful in assisting such producers and processors in transitioning into the legal market and being able to sell or at least donate their excess product into at least the medical market, including to particular projects such as this. In addition, the Project will encourage and try to assist other producers, processors and those making high quality edibles and extracts in the legacy/grey/craft markets to similarly so transition their products into the legal market with the ultimate objective that all of the Projects supply becomes legal or licit cannabis, thereby removing the need for any ongoing exemption in that regard.
3. While there is no specific provision for medical dispensaries or storefronts in current federal legislation, there is provision for a license to sell cannabis for medical purposes (with possession), that enables the licensee to display licit cannabis from other LPs and place orders for customers or to produce their own as a micro producer for sale to approved medical patients. An example is the "Completely Cannabis" store in Brockville, Ontario:
https://www.recorder.ca/news/local-news/medical-pot-shop-opens-downtown
Further, the British Columbia Compassion Club Society that has existed in Vancouver since 1997 has an application pending with Health Canada for such a license as a nonprofit to continue to serve its member patients at its commercial drive location. There are others, such as the attached information with respect to an organization called SOLID on Vancouver Island seeking to engage in similar work.
https://www.timescolonist.com/news/local/harm-reduction-group-wants- permission-to-give-free-cannabis-to-opioid-users- 1.24196929?fbclid=IwAR3_96cghCqexX-0ofDuxMXFluh7nC1VN5e-2KWO- g9nQ1vZQRIFiCeXZsc
September 16, 2020 Page 9 of 10
We have also just heard as we were preparing this application that the Provincial Minister of Health, Michael Farnsworth has consulted with his Federal counterpart in support of the Victoria Cannabis Buyers Club, that has also been in operation since in or about 1997, obtaining some sort of exemption from the Cannabis Act to be able to continue supplying cannabis to its member patients in Victoria B.C.:
https://cannabisdigest.ca/province-supports-vcbc-exemption/
The attached excerpts from the Reasons for Judgment in the Howell case and the mostly uncontested evidence indicated on the medical storefront and higher THC requirements supported the finding with respect to the unconstitutionality of the old ACMPR provisions in this regard that are not dissimilar from current Cannabis Act regulations that do not provide for such higher limits or medical storefronts, and support this exemption request in that regard on these issues.
4. Similarly, as indicated above, the limits on the amount of THC that can be contained in edibles and extracts under current legislation in particular are too low and these limits need to be exceeded when dealing with persons addicted to strong substances like the opiates and the Project and its members need to be exempt from those limits. As stated above there is also support for this in the mostly uncontested evidence set out in the Reasons for Judgment excerpts attached from the Howell case in Appendix D.
5. The purpose of this Project is not to make money but to save lives by receiving from many sources all forms of cannabis for distribution to ‘patient’ members of the Project and in time intends to do so with only licit cannabis produced through its members or otherwise, for sale and donation to those persons who can benefit, namely the apparently dependent /addicted to lethal street drugs such as methamphetamine and street opiates, that are the primary cause of the ‘opiate crisis’ deaths that continue to escalate. Its objective is to try and keep the price of the cannabis as low as possible and in particular lower than the street price outside the door for meth or opiates. Some members can afford to contribute and that in turn helps pay the rent and other expenses to keep the project going as an independent place and to meet the "low barrier access" requirements. Attached is a statement of startup costs and estimated average monthly income and expenditures incurred and explained.
6. Once the supply becomes licit then the members involved in the Project will likely need less exemptions and in some cases will no longer need specific personal exemptions if they have access to a legal supply and can stay within possession limits, except perhaps if and while volunteering at The Healing Wave and /or Society .
September 16, 2020 Page 10 of 10
It is respectfully submitted that an urgent temporary exemption should be granted to this project allowing both The Healing Wave and The Serious Hope Society to operate with modified licenses to possess and sell cannabis in various forms and strengths for medical purposes, with possession, and to distribute only to its registered members, not the general public. It is requested that this exemption be granted forthwith so as to enable the Project to proceed as it has been over the last considerable period while discussions continue with representatives of your Ministry and others as necessary with respect to any required terms or conditions as matters evolve. The Project now has over 1250 members at its current location and has been able to expand the Cannabis Substitution Project research program to 206 members with 50 on a waiting list and attempting to add 2 per day as finances and donations permit.
The Project is anxious to continue its work in contributing to the saving of lives in the Downtown Eastside and assisting in whatever way it can to eliminate the ongoing crisis and hopes that the information gathered and the research conducted will ultimately do so and be of great benefit ultimately eliminating the need for its ongoing existence.
May we please hear from you in this regard at your earliest opportunity?
Yours truly,
CONROY & COMPANY Per:
JOHN W. CONROY, Q.C.
Number: S0072698
Societies Act Certificate of Incorporation
SERIOUS HOPE SOCIETY
I Hereby Certify that ~
SERIOUS HOPE SOCIETY was incorporated under the Societies Act on February 6, 2020 at 07:16 PM Pacific Time.
Issued under my hand at Victoria, British Columbia
CAROL PREST REGISTRAR OF COMPANIES PROVINCE OF BRITISH COLUMBIA CANADA
ELECTRONIC CERTIFICATE
CONSTITUTION BC Society • Societies Act
CERTIFIED COPY NAME OF SOCIETY: SERIOUS HOPE SOCIETY Of a document filed with the Province of British Columbia Registrar of Companies Incorporation Number: S0072698 Business Number: 74817 6476 BC0001
CAROL PREST Filed Date and Time: February 6, 2020 07:16 PM Pacific Time
The name of the Society is SERIOUS HOPE SOCIETY
The purposes of the Society are:
• To further, build, collaborate in the development of research around the benifits of cannabis as a viable treatment to combat substance use disorder. • To create community spaces where we can facilitate the treatment of substance use, trauma, and community disconnection with cannabis therapy and connection activities. • To advocate for low cost or no cost varied doses of cannabis to serve as a replacement substance for opioid and stimulant Users engaged in illicit drug use. • To communicate and build the capacity of people and networks whom use cannabis to effect better health outcomes for communities. • To create cannabis awareness materials contributing to public health principles around safety, consumption, and best practices around cannabis use and production. • To produce cannabis edibles in accordance to local food safe standards. • To purchase, sell and/or lease property, equipment and materials deemed necessary to accomplish the society's purpose.
BC Registries and Online Services Incorporation Number S0072698 www.gov.bc.ca/Societies Page 1 of 1
STATEMENT OF DIRECTORS AND REGISTERED OFFICE BC Society • Societies Act
CERTIFIED COPY NAME OF SOCIETY: SERIOUS HOPE SOCIETY Of a document filed with the Province of British Columbia Registrar of Companies Incorporation Number: S0072698 Business Number: 74817 6476 BC0001
CAROL PREST Filed Date and Time: February 6, 2020 07:16 PM Pacific Time
REGISTERED OFFICE ADDRESS INFORMATION
Delivery Address: Mailing Address: 310 - 111 PRINCESS AVE 310 - 111 PRINCESS AVE VANCOUVER BC V6A 0C9 VANCOUVER BC V6A 0C9
DIRECTOR INFORMATION
Last Name, First Name Middle Name: HAY, DEBRA Delivery Address: 1957 13TH AVE E VANCOUVER BC V5N 2C3
Last Name, First Name Middle Name: LEE, SOOK Delivery Address: 310 - 111 PRINCESS AVE VANCOUVER BC V6A 0C9
Last Name, First Name Middle Name: LIVINGSTONE, CHRISTOPHER ANDREW Delivery Address: 310 - 111 PRINCESS AVE VANCOUVER BC V6A 0C9
Last Name, First Name Middle Name: MAGNUSON, NEIL Delivery Address: 310 - 111 PRINCESS AVE VANCOUVER BC V6A 0C9
BC Registries and Online Services Incorporation Number S0072698 www.gov.bc.ca/Societies Page 1 of 2
STATEMENT OF DIRECTORS AND REGISTERED OFFICE BC Society • Societies Act
Last Name, First Name Middle Name: MORGAN, ANDREW Delivery Address: 310 - 111 PRINCESS AVE VANCOUVER BC V6A 0C9
Last Name, First Name Middle Name: MURRAY, JOHN Delivery Address: 310 - 111 PRINCESS AVE VANCOUVER BC V6A 0C9
Last Name, First Name Middle Name: NELSON, JEN Delivery Address: 220 - 376 POWELL ST VANCOUVER BC V6A 1G4
Last Name, First Name Middle Name: YEE, KELCY Delivery Address: 5512 PRENDERGAST RD COURTENAY BC V9J 1P6
BC Registries and Online Services Incorporation Number S0072698 www.gov.bc.ca/Societies Page 2 of 2 Filed Date and Time: February 6, 2020 07:16 PM Pacific Time Society Incorporation Number: S0072698 Model Bylaws (Societies Regulation 2015, Schedule 1)
Bylaws of SERIOUS HOPE SOCIETY (the “Society”)
Bylaws of [insert name of society] ______(the “Society”)
PART 1 – DEFINITIONS AND INTERPRETATION
Definitions
1.1 In these Bylaws:
“Act” means the Societies Act of British Columbia as amended from time to time;
“Board” means the directors of the Society;
“Bylaws” means these Bylaws as altered from time to time.
Definitions in Act apply
1.2 The definitions in the Act apply to these Bylaws.
Conflict with Act or regulations
1.3 If there is a conflict between these Bylaws and the Act or the regulations under the Act, the Act or the regulations, as the case may be, prevail.
PART 2 – MEMBERS
Application for membership
2.1 A person may apply to the Board for membership in the Society, and the person becomes a member on the Board’s acceptance of the application.
Duties of members
2.2 Every member must uphold the constitution of the Society and must comply with these Bylaws.
Amount of membership dues
2.3 The amount of the annual membership dues, if any, must be determined by the Board.
Model Bylaws (Societies Regulation 2015, Schedule 1)
Member not in good standing
2.4 A member is not in good standing if the member fails to pay the member’s annual membership dues, if any, and the member is not in good standing for so long as those dues remain unpaid.
Member not in good standing may not vote
2.5 A voting member who is not in good standing
(a) may not vote at a general meeting, and (b) is deemed not to be a voting member for the purpose of consenting to a resolution of the voting members.
Termination of membership if member not in good standing
2.6 A person’s membership in the Society is terminated if the person is not in good standing for 6 consecutive months.
PART 3 – GENERAL MEETINGS OF MEMBERS
Time and place of general meeting
3.1 A general meeting must be held at the time and place the Board determines.
Ordinary business at general meeting
3.2 At a general meeting, the following business is ordinary business:
(a) adoption of rules of order; (b) consideration of any financial statements of the Society presented to the meeting; (c) consideration of the reports, if any, of the directors or auditor; (d) election or appointment of directors; (e) appointment of an auditor, if any; (f) business arising out of a report of the directors not requiring the passing of a special resolution.
Notice of special business
3.3 A notice of a general meeting must state the nature of any business, other than ordinary business, to be transacted at the meeting in sufficient detail to permit a member receiving the notice to form a reasoned judgment concerning that business.
Model Bylaws (Societies Regulation 2015, Schedule 1)
Chair of general meeting
3.4 The following individual is entitled to preside as the chair of a general meeting:
(a) the individual, if any, appointed by the Board to preside as the chair; (b) if the Board has not appointed an individual to preside as the chair or the individual appointed by the Board is unable to preside as the chair, (i) the president, (ii) the vice-president, if the president is unable to preside as the chair, or (iii) one of the other directors present at the meeting, if both the president and vice-president are unable to preside as the chair.
Alternate chair of general meeting
3.5 If there is no individual entitled under these Bylaws who is able to preside as the chair of a general meeting within 15 minutes from the time set for holding the meeting, the voting members who are present must elect an individual present at the meeting to preside as the chair.
Quorum required
3.6 Business, other than the election of the chair of the meeting and the adjournment or termination of the meeting, must not be transacted at a general meeting unless a quorum of voting members is present.
Quorum for general meetings
3.7 The quorum for the transaction of business at a general meeting is 3 voting members or 10% of the voting members, whichever is greater.
Lack of quorum at commencement of meeting
3.8 If, within 30 minutes from the time set for holding a general meeting, a quorum of voting members is not present,
(a) in the case of a meeting convened on the requisition of members, the meeting is terminated, and (b) in any other case, the meeting stands adjourned to the same day in the next week, at the same time and place, and if, at the continuation of the adjourned meeting, a quorum is not present within 30 minutes from the time set for holding the continuation of
Model Bylaws (Societies Regulation 2015, Schedule 1)
the adjourned meeting, the voting members who are present constitute a quorum for that meeting.
If quorum ceases to be present
3.9 If, at any time during a general meeting, there ceases to be a quorum of voting members present, business then in progress must be suspended until there is a quorum present or until the meeting is adjourned or terminated.
Adjournments by chair
3.10 The chair of a general meeting may, or, if so directed by the voting members at the meeting, must, adjourn the meeting from time to time and from place to place, but no business may be transacted at the continuation of the adjourned meeting other than business left unfinished at the adjourned meeting.
Notice of continuation of adjourned general meeting
3.11 It is not necessary to give notice of a continuation of an adjourned general meeting or of the business to be transacted at a continuation of an adjourned general meeting except that, when a general meeting is adjourned for 30 days or more, notice of the continuation of the adjourned meeting must be given.
Order of business at general meeting
3.12 The order of business at a general meeting is as follows:
(a) elect an individual to chair the meeting, if necessary; (b) determine that there is a quorum; (c) approve the agenda; (d) approve the minutes from the last general meeting; (e) deal with unfinished business from the last general meeting; (f) if the meeting is an annual general meeting, (i) receive the directors’ report on the financial statements of the Society for the previous financial year, and the auditor’s report, if any, on those statements, (ii) receive any other reports of directors’ activities and decisions since the previous annual general meeting, (iii) elect or appoint directors, and (iv) appoint an auditor, if any;
Model Bylaws (Societies Regulation 2015, Schedule 1)
(g) deal with new business, including any matters about which notice has been given to the members in the notice of meeting; (h) terminate the meeting.
Methods of voting
3.13 At a general meeting, voting must be by a show of hands, an oral vote or another method that adequately discloses the intention of the voting members, except that if, before or after such a vote, 2 or more voting members request a secret ballot or a secret ballot is directed by the chair of the meeting, voting must be by a secret ballot.
Announcement of result
3.14 The chair of a general meeting must announce the outcome of each vote and that outcome must be recorded in the minutes of the meeting.
Proxy voting not permitted
3.15 Voting by proxy is not permitted.
Matters decided at general meeting by ordinary resolution
3.16 A matter to be decided at a general meeting must be decided by ordinary resolution unless the matter is required by the Act or these Bylaws to be decided by special resolution or by another resolution having a higher voting threshold than the threshold for an ordinary resolution.
PART 4 – DIRECTORS
Number of directors on Board
4.1 The Society must have no fewer than 3 and no more than 11 directors.
Election or appointment of directors
4.2 At each annual general meeting, the voting members entitled to vote for the election or appointment of directors must elect or appoint the Board.
Directors may fill casual vacancy on Board
4.3 The Board may, at any time, appoint a member as a director to fill a vacancy that arises on the Board as a result of the resignation, death or incapacity of a director during the director’s term of office.
Model Bylaws (Societies Regulation 2015, Schedule 1)
Term of appointment of director filling casual vacancy
4.4 A director appointed by the Board to fill a vacancy ceases to be a director at the end of the unexpired portion of the term of office of the individual whose departure from office created the vacancy.
PART 5 – DIRECTORS’ MEETINGS
Calling directors’ meeting
5.1 A directors’ meeting may be called by the president or by any 2 other directors.
Notice of directors’ meeting
5.2 At least 2 days’ notice of a directors’ meeting must be given unless all the directors agree to a shorter notice period.
Proceedings valid despite omission to give notice
5.3 The accidental omission to give notice of a directors’ meeting to a director, or the non-receipt of a notice by a director, does not invalidate proceedings at the meeting.
Conduct of directors’ meetings
5.4 The directors may regulate their meetings and proceedings as they think fit.
Quorum of directors
5.5 The quorum for the transaction of business at a directors’ meeting is a majority of the directors.
PART 6 – BOARD POSITIONS
Election or appointment to Board positions
6.1 Directors must be elected or appointed to the following Board positions, and a director, other than the president, may hold more than one position:
(a) president; (b) vice-president; (c) secretary; (d) treasurer.
Model Bylaws (Societies Regulation 2015, Schedule 1)
Directors at large
6.2 Directors who are elected or appointed to positions on the Board in addition to the positions described in these Bylaws are elected or appointed as directors at large.
Role of president
6.3 The president is the chair of the Board and is responsible for supervising the other directors in the execution of their duties.
Role of vice-president
6.4 The vice-president is the vice-chair of the Board and is responsible for carrying out the duties of the president if the president is unable to act.
Role of secretary
6.5 The secretary is responsible for doing, or making the necessary arrangements for, the following:
(a) issuing notices of general meetings and directors’ meetings; (b) taking minutes of general meetings and directors’ meetings; (c) keeping the records of the Society in accordance with the Act; (d) conducting the correspondence of the Board; (e) filing the annual report of the Society and making any other filings with the registrar under the Act.
Absence of secretary from meeting
6.6 In the absence of the secretary from a meeting, the Board must appoint another individual to act as secretary at the meeting.
Role of treasurer
6.7 The treasurer is responsible for doing, or making the necessary arrangements for, the following:
(a) receiving and banking monies collected from the members or other sources; (b) keeping accounting records in respect of the Society’s financial transactions; (c) preparing the Society’s financial statements; (d) making the Society’s filings respecting taxes.
Model Bylaws (Societies Regulation 2015, Schedule 1)
PART 7 – REMUNERATION OF DIRECTORS AND SIGNING AUTHORITY
Remuneration of directors
7.1 These Bylaws do not permit the Society to pay to a director remuneration for being a director, but the Society may, subject to the Act, pay remuneration to a director for services provided by the director to the Society in another capacity.
Signing authority
7.2 A contract or other record to be signed by the Society must be signed on behalf of the Society
(a) by the president, together with one other director, (b) if the president is unable to provide a signature, by the vice-president together with one other director, (c) if the president and vice-president are both unable to provide signatures, by any 2 other directors, or (d) in any case, by one or more individuals authorized by the Board to sign the record on behalf of the Society.
Model Bylaws (Societies Regulation 2015, Schedule 1)
September 11, 2020
To whom it might concern,
I am writing in strong support of Mr. Neil Magnuson and the continued operations of his Cannabis Substitution Project/Serious Hope Society. As the University of British Columbia’s inaugural Canopy Growth professor of cannabis science at the University of British Columbia, I am conducting research to evaluate the promise of cannabis to benefically address the ongoing overdose crisis in BC, particularly in Vancouver’s Downtown Eastside. Our preliminary findings indicate that Mr. Magnuson’s project serves an important need for those most at risk of dying from an overdose in the DTES; in my view, closing the project or jeopardizing its operations would only add to the risks faced by his clientele, among the most marginalized and vulnerable of Vancouver’s citizens.
As an epidemiologist, I have researched life-saving interventions for people who use drugs—such as Insite, North America’s first supervised injection facility—for almost 15 years. Driven by the contamination of the illicit drug supply with fentanyl, a powerful opioid painkiller, the ongoing overdose crisis disproportionately claims the lives of people living with addiction or chronic pain. Using data gathered through regular interviews with more than 3,000 people at high risk of overdose in Vancouver, my research group has found evidence that cannabis might lower the risk of overdose by helping people stay on treatment for substance use disorder, avoiding high-risk drug use practices like injecting illicit opioids, and substituting for illicit opioids to treat chronic pain. For example, in a recent study published in the journal Addiction, we found that among people starting medication-based treatment for opioid use disorder, those using cannabis every day were 21% more likely to stay in treatment for at least six months, a key measure of treatment success. Similarly, among people at high risk of overdose living with chronic pain, those using cannabis every day were 50% less likely to use illicit opioids every day, a driving risk for overdose. In a separate analysis, we found that people at high risk of overdose using cannabis primarily for pain relief were far less likely to suffer an overdose.
Unfortunately, many people at high risk of overdose in the DTES do not have meaningful and equitable access to the medical cannabis they need through the legal medical or recreational cannabis systems. Higher cost, the lack of retail outlets in the DTES, and the need for identification are some of the barriers that combine to put legal cannabis out of reach. By distributing high-quality cannabis at no cost to vulnerable and marginalized people in the DTES, Mr. Magnuson’s project fills an important gap. Without his service, I am confident that some of his clientele would be forced to turn to
BC Centre on Substance Use 400-1045 Howe St Vancouver BC V6Z 2A9 www.bccsu.ca opioids from the fentanyl-contaminated drug supply to treat their chronic pain or address withdrawal, with potentially fatal results.
Beyond the important work being done by Mr. Magnuson’s Cannabis Substitution Project, I should also note he is making important contributions to my research into the risks/benefits of cannabis use among people at high risk of overdose. He shared his experiences and perspectives as a featured speaker at last year’s research symposium on cannabis hosted by the University of British Columbia’s Faculty of Medicine and Canopy Growth. He is also serving on the advisory board for the Generalizable Experiments into Medical Marijuana and Addiction (GEMMA), a program of ground- breaking controlled trials to test the potential of cannabis to improve the health and wellbeing of people living with substance use disorders. This research is supported by arms’ length gifts to the university from Canopy Growth—one of the world’s largest producers of legal cannabis—and the Government of British Columbia’s Ministry of Mental Health and Addictions. A motion passed by the Vancouver City Council affirmed their support for my research into medical cannabis to address the overdose crisis; my research has been covered by local (The Tyee, Global BC, CBC Vancouver), national (the Globe and Mail, the National Post, CBC Radio) and international (CNN, the Daily Mail) media.
As the overdose crisis reaches its fifth year with an ever-increasing toll of preventable deaths, it is clear that more life-saving interventions must be put in place. The preliminary evidence gathered by my research group documents how many people at highest risk of overdose use medical cannabis to avoid exposure to the fentanyl-contaminated drug supply. By providing a no-cost source of medical cannabis, Mr. Magnuson’s project fills a crucial need for many at risk of overdose and should be protected, supported, and expanded.
Please do not hesitate to contact me with any questions or concerns about our research into cannabis or my support of Mr. Magnuson and the Cannabis Substitution Project/Serious Hope Society.
Sincerely,
M-J Milloy, PhD Canopy Growth professor of cannabis science, Assistant professor, Department of Medicine, University of British Columbia Research scientist, British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, Canada, V6Z 2A9
September 10, 2020 RE: The Cannabis Substitution Project Neil Magnuson 157E Cordova Street, Vancouver, British Columbia
To Whom it May Concern;
I am a Registered Psychiatric Nurse who has worked in the Downtown East Side for a number of years. As such, I have had the opportunity to see and hear the benefits of the Cannabis Substitution Project from numerous individuals in the DTES community. Clients report the free edibles program has provided relief for insomnia, pain, anxiety, substance use withdrawal and cravings. Some report that they use the edibles recreationally and for relaxation.
We are currently experiencing the worst numbers for overdose deaths right now. We need readily accessible safer substances for folks so that they remain safe, supported, and alive. The Cannabis Substitution Project not only provides that, but provides a low barrier space for individuals to access for substances that are affordable (free), therapeutic, and recreational, as well as a space to build connections and support within the DTES community.
There is substantial evidence to establish the benefits of cannabis as harm reduction and therapeutic for individuals using opioids. Please refer to this journal article published in the International Journal of Drug Policy for further: https://www.sciencedirect.com/science/article/abs/pii/S0955395920300785
Please allow the Cannabis Substitution Project on 157E Cordova Street to remain open for our DTES community.
Sincerely,
Patricia Dribnenki-Pennock
Registered Psychiatric Nurse
DTES Community, Vancouver, BC
Appendix A The Healing Wave and how it operates
1. The person attending the store must register by providing a name and nothing more and is then given a number and a card. Most of the attendees are persons who were attending at the prior VANDU location and are known to Mr. Magnuson and the volunteers. Consistent with “low barrier access” and trying to reach the hard to reach, they are not required to provide any other information at that time to become a member. It is suspected that approximately 25% are using fake names. Many are homeless or living in shelters of one kind or another and often their addiction or related illnesses, physical and/or mental, are apparent. However, there is also a group of functional addicts who have jobs and are simply ashamed of their addiction and continue to seek anonymity. Approximately 700 have people signed up since the store opened. 2. The supply comes from local trusted sources (currently 10 to 12 donors) that have been supplying them over the last three years with no problems. Baked goods are by donation or commissioned and comply with food safe procedures. High concentrations of THC in edibles and extracts by necessity exceed the Cannabis regulation discrete unit and container limits because such high concentrations are required and requiring the purchase or donation of 2500 packages instead of one is more practical and economical and less wasteful. Several other sources have expressed an interest in making donations to this harm reduction project and efforts are ongoing to transition to these suppliers into the illicit market. 3. The store has a full range of high quality cannabis products from creams to suppositories to flowers and extracts at comparably very low prices, including $1 per cannabis joint, and flower buds from $2.50 to $6 per gram compared to $14 at other places and full gram cartridges at $35 as well as capsules with 50 mg of CBD for $2.00 each. The plan is to reduce the prices further when able with the objective of making sure that the prices are lower than street prices for the opiates and other drugs being sold outside on the street nearby. 4. The store is divided into two parts, namely the Healing Wave and the Cannabis Substitution Project of the Serious Hope Society,(that has its own Facebook page) and that currently has 206 persons that signed up initially with the Project directly and were accepted into that Project. It is currently capped at that number for economic reasons and there are many others on a waiting list. Meanwhile some 700 persons have signed up with The Healing Wave since its opening including many that are members of the Project. Healing Wave members are simply eligible to low barrier access at the store, with some on the waiting list to get into the Project when it can expand. Currently, the store donates more than 20% of its minimal net profits to the Cannabis Substitution Project. The Healing Wave pays the rent and donates space to the Project and pays the ‘volunteers’ $110 per 8 hours for service when training them to work the store/dispensary and they share in some of the profits in type of symbiotic relationship. A ‘community’ store with social, medicinal and research purpose associated to an individual who is assuming liability for all aspects of the operation while limiting any liability of the Serious Hope Society and its Project, bearing in mind the nature of the grey market and efforts to transition.
Appendix B The Cannabis Substitution Project of the Serious Hope Society and how it operates
The Cannabis Substitution Project operates as follows:
1. Members in the CS Project are required to initially fill out an entry form and questionnaire based on the form used by SOLID a Federal study out of Victoria that includes ones age, years of drug use, length of time in the program, experience with cannabis and how it affects their drug use etc. (see below).
2. Members get to choose up to 420 mg every four days, so approximately 80,000 mg is being distributed every four days. All of it has been tested in-house or otherwise, and there have been no problems of any kind. All members are encouraged to inform their doctors of their participation. Some of them indicate that they have their doctors support.
3. Each time they pick up 420 mg, they must fill out another ongoing questionnaire asking what they’re using it for, what their dosages, how often they use it, and if there are other benefits or problems etc. (see below);
4. There is a plan to try and involve having a Nurse Practitioner available for those who are prepared to seek medical approval or assistance. However, it is recognized that many have been prescribed opiates by their doctors and because they have been cut off or simply want more and do not want their doctors or any others to know what they are doing so will not want to do that fearing issues with their doctor etc. If some become officially ’medically approved this could also facilitate a legal supply for some and maybe more through the BC Craft Farmers Co-Op (www.bccraftfarmerscoop.com).
5. It is hoped that there will be some evaluation of the information obtained from the questionnaires by researchers such as Dr. Milloy and others to assess effectiveness and any other ways and means to address the problem in the target population. INITIAL INTAKE FORM
CSP Members Health Status Sheet
Date:
Card Number:
Age:
Gender:
Years of drug use:
1. What has been your experience using Cannabis?
2. How has your other drug use changed since being in the program? (e.g. using more or less types of substances, (withdrawal) physical, mental).
3. What other changes did you notice? (e.g. changes in eating, sleeping, pain mgmt.) FOLLOW UP QUESTIONNAIRE
(completed every 4 days)
1. What are you using Cannabis for?
2. What dose works the best?
3. How long in between doses?
4. Any problems or other benefits? Appendix C Relationship Between Cannabis (Marijuana) and Opioids
“Something that actually works”: Cannabis use among young people in the context of street entrenchment https://dx.plos.org/10.1371/journal.pone.0236243
Cannabis access is associated with reduced rates of opioid use and abuse, opioid-related hospitalizations, opioid-related traffic fatalities, opioid-related drug treatment admissions, and opioid-related overdose deaths
“This review found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by MC [medical cannabis] users, compared to people with no additional use of MC. There was 64–75% reduction in opioid dosage for MC users and complete stoppage of opioid use for chronic non-cancer pain by 32–59.3% of MC users, when compared to patients without additional use of MC. … Given the current opioid epidemic in the USA and medical cannabis’s recognized analgesic properties, MC could serve as a viable option to achieve opioid dosage reduction in managing non-cancer chronic pain.” Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review, Systematic Reviews, 2020 “The aim of this study was to evaluate the short-term and long-term effects of plant-based medical cannabis (MC) on outcomes of interest related to pain, quality of life, tolerability, and opioid medication use in a large cohort of chronic pain patients using medical cannabis over the course of one year. … Medical cannabis treatment was associated with improvements in pain severity and interference. … In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses. … Taken together, the results of this study add to the cumulative evidence in support of plant-based MC as a safe and effective treatment option and potential opioid substitute or augmentation therapy for the management of chronic pain symptomatology and quality of life.” Medical cannabis for the management of pain and quality of life in chronic pain patients: A prospective observational study, Pain Medicine, 2020 “In this study, we observed an association between state-level legalization of medical cannabis and opioid prescribing by orthopedic surgeons in the Medicare Part D cohort. We found that overall opioid prescribing by orthopedic surgeons in this cohort was reduced in states permitting patient access to medical cannabis, compared with those who do not. … On examination of prescription data of different opioid classes, we found that prescriptions for hydrocodone, the most commonly prescribed opioid medication, by orthopedic surgeons had a statistically significant negative association with state MCLs.” State medical cannabis laws associated with reduction in opioid prescriptions by orthopedic surgeons in Medicare Part D cohort, Journal of the American Academy of Orthopedic Surgeons, 2020 “We examined the association between the legalization of recreational marijuana and prescription opioid distribution in Colorado. Utah and Maryland, two states that had not legalized recreational marijuana, were selected for comparison. … There was a larger reduction from 2012 to 2017 in Colorado (-31.5%) than the other states. Colorado had a significantly greater decrease in codeine and oxymorphone than the comparison states.” Prescription opioid distribution after the legalization of recreational marijuana in Colorado, International Journal of Environmental Research and Public Health, 2020 A team of investigators affiliated with the John Hopkins School of Medicine assessed whether or not cannabis availability would hypothetically influence pain patients demand for prescription opioids. One hundred and fifty-five subjects with recent experience using both opioids and cannabis for pain management participated in the survey. Authors reported, “[O]ur demand analyses suggests the availability of cannabis decreased opioid consumption (intensity) and increased the degree to which opioid consumption was influenced by opioid price (elasticity).” They concluded, “These results suggest cannabis may confer an opioid-sparing effect in this population.” Evaluating the co-use of opioids and cannabis for pain among current users using hypothetical purchase tasks, Journal of Psychopharmacology, 2020 “Our study found that the addition of MMJ (medical marijuana) to [cancer pain] patients’ palliative care regimen withstood the development of tolerance and reduced the rate of opioid use, over a significantly longer follow-up period than patients solely utilizing opioids. … MMJ(+) improved oncology patients’ ESAS scores [a measurement of pain, nausea, and anxiety) despite opioid dose reductions and should be considered a viable adjuvant therapy for palliative management.” The efficacy of medical marijuana in the treatment of cancer-related pain, Journal of Palliative Medicine, 2020 “This matched cohort study included patients who were admitted with a traumatic injury. … There were 66 patients included: 33 cases and 33 matched controls. Dronabinol [oral synthetic THC] was initiated 55 hours from admission. Cases and controls were well matched. Cases had a significant reduction in opioid consumption with adjunctive dronabinol while opioid consumption was unchanged for controls. This resulted in a ninefold greater reduction in opioid consumption for cases versus controls. … The addition of dronabinol resulted in reduced opioid consumption, … suggesting a beneficial opioid-sparing effect of dronabinol in acutely painful conditions. … Because our study showed that the opioid-sparing effect of dronabinol may be greatest in patients who use marijuana, use of dronabinol adjunctively may benefit nearly half of [Colorado’s] population.” Matched pilot study examining cannabis-based dronabinol for acute pain following traumatic injury, Trauma Surgery & Acute Care, 2020 “The evidence reported here presents the most accurate picture of the effect of cannabis access laws on prescription opioid use to date and can therefore inform the ongoing state and national debates over the legality of cannabis as well as other policy options to combat the opioid epidemic. Our analysis of a comprehensive national database on a diverse set of measures of opioid use provides an estimate of the overall net impact of cannabis laws. … In general, we find evidence that both RCLs (recreational cannabis laws) and MCLs (medical cannabis laws) decrease opioid prescribing. … Thus, the evidence presented here suggests that cannabis access laws could be a useful tool in combatting the prescription opioid epidemic. While our data do not allow us to test this potential mechanism explicitly, our results are consistent with a substitution of cannabis for prescription opioids in the treatment of pain.” The impact of cannabis access laws on opioid prescribing, Journal of Health Economics, 2019 “We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain. … We observed an independent negative association between frequent cannabis use and frequent illicit opioid use among PWUD with chronic pain. … We found that people who used cannabis every day had about 50% lower odds of using illicit opioids every day compared to cannabis non-users.” Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis, PLOS One “Results provide evidence that MMLs may be effective at reducing opioid reliance as survey respondents living in states with medical cannabis legislation are much less apt to report using opioid analgesics than people living in states without such laws.” “The effects of cannabis laws on opioid use, International Journal of Drug Policy, 2019 “An initial sample of 131 patients was recruited from a private pain management center’s investigative population. Ninety-seven patients completed the 8-week study. The primary inclusion criteria included patients between 30 and 65 years old with chronic pain who have been on opioids for at least 1 year. Data were collected at three different time points: baseline, 4, and 8 weeks. … Over half of chronic pain patients (53%) reduced or eliminated their opioids within 8 weeks after adding CBD-rich hemp extract to their regimens. Almost all CBD users (94%) reported quality of life improvements.” Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study, Postgraduate Medicine, 2019 “[S]ubstitution of marijuana for opioids, which included a substantial degree of opioid discontinuation (~20 percent), was common. Our findings are consistent with prior surveys of American and Canadian marijuana users in which substitution of marijuana for opioids was prevalent due to better symptom management and fewer adverse and withdrawal effects.” Substitution of marijuana for opioids in a national survey of US adults, PLOS One “The objective of this study was to determine if the use of medical cannabis affects the amount of opioids and benzodiazepines used by patients on a daily basis. … Over the course of this 6-month retrospective study, patients using medical cannabis for intractable pain experienced a significant reduction in the number of MMEs (daily milligram morphine equivalents) available to use for pain control.” Medical cannabis: Effects on opioid and benzodiazepines requirements for pain control, The Annals of Pharmacotherapy, 2019 “Using a dataset of approximately 800,000 urine drug test results collected from pain management patients of a time from of multiple years, creatinine corrected opioid levels were evaluated to determine if the presence of the primary marijuana marker 11-nor-carboxy-tetrahydrocannabinol (THC-COOH) was associated with statistical differences in excreted opioid concentrations. Results & conclusion: For each of the opioids investigated (codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, fentanyl and buprenorphine), marijuana use was associated with statistically significant lower urinary opiate levels than in samples without indicators of marijuana use.” Reduced urinary opioid levels from pain management patients associated with marijuana use, Pain Management, 2019 “We examine the association between opioid prescription patterns in privately insured adults and changes in state cannabis laws among five age groups (18–25, 26–35 36–45, 46–55 and 56–64 years). … [I]n states which implemented medical cannabis use laws (but not other categories of cannabis liberalization laws), lower rates of opioid prescription were seen in the younger age cohorts (18–25, 26–35, 36–45 and 46–54 years).” Association between cannabis laws and opioid prescriptions among privately insured adults in the US, Preventive Medicine, 2019 “A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006– 2014. … In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use.” Impact of medical marijuana legalization on opioid use, chronic opioid use, and high risk opioid use, Journal of General Internal Medicine, 2019 “In this research, we have examined the effect of MML laws and the presence of active legal dispensaries on CDC age-adjusted opioid overdose death rates over the years 1999-2015. Our results suggest that states with active legal dispensaries see a drop in opioid death rates over time. … Overall, this research provides evidence that states with MMLs may see a decline in opioid overdose death rates if they enact legal dispensaries.” Medical marijuana laws and their effect on opioid-related morality, Economics Bulletin, 2019 “A retrospective cohort was evaluated to understand the pattern of care and QOL (quality of life) outcomes with MC (medical cannabis) use across rural multidisciplinary practices in New Mexico. … A total of 133 patients were identified between Jan 2017 – May 2017. … Pain score improved in 80% of patients with cancer and in 75% of non-cancer patients. … MC use led to ODR (opioid dose reduction) in 41% of all patients.” Opioid dose reduction and pain control with medical cannabis, Journal of Clinical Oncology, 2018 “Analyzing a dataset of over 1.3 billion individual opioid prescriptions between 2011 and 2017, which were aggregated to the individual provider-year level, we find that recreational and medical cannabis access laws reduce the number of morphine milligram equivalents prescribed each year by 6.9 and 6.1 percent, respectively. These laws also reduce the total days supply of opioids prescribed, the total number of patients receiving opioids, and the probability a provider prescribes any opioids net of any offsetting effects.” The impact of cannabis access laws on opioid prescribing, University of Alabama Legal Studies Research Paper No. 3266629, 2018 “[S]tudies demonstrate that when patients replace their opioid prescriptions with medical cannabis, they find its pain relief to side effect profile superior to opioids. Additionally, there has been a significant reduction in opioid-related mortality and morbidity since cannabis has become legally available. … As the world continues to face the opioid epidemic, research into alternatives to opioids for pain relief needs to be prioritized. There is significant evidence that cannabis, and synthetic cannabinoid receptor agonists, may provide patients with a way to reduce their opioid use. With this in mind, there is a foreseeable future of both legalized cannabis and synthetic cannabinoid receptor agonists to help mitigate the burden of opioid-based analgesic regimens.” Perspectives on cannabis as a substitute for opioid analgesics, Pain Management, 2019 “This study examined whether statewide medical cannabis legalization was associated with reduction in opioids received by Medicaid enrollees. …For Schedule III opioid prescriptions, medical cannabis legalization was associated with a 29.6 percent reduction in number of prescriptions, 29.9 percent reduction in dosage, and 28.8 percent reduction in related Medicaid spending. … Statewide medical cannabis legalization appears to have been associated with reductions in both prescriptions and dosages of Schedule III (but not Schedule II) opioids received by Medicaid enrollees in the US. … It was estimated that, if all the states had legalized medical cannabis by 2014, Medicaid annual spending on opioid prescriptions would be reduced by 17.8 million dollars.” Medical cannabis legalization and opioid prescriptions: Evidence of US Medicaid enrollees during 1993-2014, Addiction, 2018 “Using a unique data set of medical cannabis dispensaries combined with county-level mortality data, we estimate the effect of dispensaries operating in a county on the number of overdose deaths. … [W]ithin MCL (medical cannabis law)-adopting states, counties with dispensaries experience six percent to eight percent fewer opioid-related deaths among non-Hispanic white men, while mortality due to heroin overdose declines by more than ten percent. … Extrapolating our results implies that, for every 100,000 non-Hispanic white men, 10 fewer opioid-induced fatalities would have occurred between 2009 and 2015 if dispensaries were present and operating in every county within each MCL state.” The effect of medical cannabis dispensaries on opioid and heroin overdose mortality, SSRN white paper, 2018 “[T]he most common prescription medications replaced by medicinal cannabis in this study were opiates/opioids in a large percentage within every pain group, up to 72.8% of patients in the chronic pain as primary illness group. … This is notable given the well-described “opioid-sparing effect” of cannabinoids and growing abundance of literature suggesting that cannabis may help in weaning from these medications and perhaps providing a means of combating the opioid epidemic.” Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort, The Journal of Headache and Pain, 2018 “We found no evidence to support the concern that recreational marijuana legalization increased opioid prescriptions received by Medicaid enrollees. Instead, there was some evidence in some model specifications that the legalization might be associated with reduction in Schedule III opioids in states that implemented legalization.” Recreational marijuana legalization and prescription opioids received by Medicaid enrollees, Drug and Alcohol Dependence, 2018 “[T]he use of Trokie® lozenges is associated with a self-reported pain reduction in chronic, non- cancer pain patients. … [T]he proportion of participants reducing or discontinuing opiate analgesics was … 84 percent, similar to what has been previously found in a study based on patient self-reports.” Self-reported effectiveness and safety of Trokie lozenges: A standardized formulation for the buccal delivery of cannabis extracts, Frontiers in Neuroscience, 2018 Investigators assessed opioid use patterns in a cohort of 573 patients registered with Health Canada to access medical cannabis products. Among those patients who acknowledged using opioids upon enrollment in the trial, 51 percent reported ceasing their opiate use within six-months. “The high rate of cannabis use for the treatment of chronic pain — and subsequent substitution for opioids — suggests that cannabis may play a harm-reduction role in the ongoing opioid dependence and overdose crisis While the cannabis substitution effect for prescription drugs has been identified and assessed via cross-sectional and population-level research, this study provides a granular individual- level perspective of cannabis substitution for prescription drugs and associated improvement in quality of life over time.” Preliminary data from the largest national longitudinal medical cannabis patient study in Canada, May 1, 2018 “This cross-sectional study used a quasi-experimental difference-in-differences design comparing opioid prescribing trends between states that started to implement medical and adult-use marijuana laws between 2011 and 2016 and the remaining states. This population-based study across the United States included all Medicaid fee-for-service and managed care enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose. … State implementation of medical marijuana laws was associated with a 5.88% lower rate of opioid prescribing. Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38% lower rate of opioid prescribing. … [T]he further reductions in opioid prescribing associated with the newly implemented adult-use marijuana laws suggest that there were individuals beyond the reach of medical marijuana laws who may also benefit from using marijuana in lieu of opioids. Our finding that the lower opioid prescribing rates associated with adult-use marijuana laws were pronounced in Schedule II opioids, further suggest that reaching these individuals may have greater potential to reduce the adverse consequences, such as opioid use disorder and overdose.” Association of medical and adult-use marijuana laws with opioid prescribing for Medicaid enrollees, JAMA Internal Medicine, 2018 “Between August 1 – December 31, 2016 a total of 2290 patients were enrolled in the program under the qualifying condition of intractable pain; 45 of these patients were previously enrolled in the program under an additional qualifying condition. This report focuses on the 2245 patients who were certified for intractable pain and enrolled in the program for the first time during this interval. … A large proportion (58%) of patients on other pain medications when they started taking medical cannabis were able to reduce their use of these meds according to health care practitioner survey results. Opioid medications were reduced for 38% of patients (nearly 60% of these reduced at least one opioid by ≥50%), benzodiazepines were reduced for 3%, and other pain medications were reduced for 22%. If only the 353 patients (60.2%, based on medication list in first Patient Self- Evaluation) known to be taking opioid medications at baseline are included, 62.6% (221/353) were able to reduce or eliminate opioid usage after six months.” Minnesota Department of Health, Intractable Pain Patients in the Minnesota Medical Cannabis Program: Experience of Enrollees During the First Five Months, 2018 “To gauge how effective medical marijuana was at managing chronic pain and reducing opioid use, researchers surveyed 138 medical marijuana users with an anonymous 20-question survey focusing on how often they used the marijuana. … When patients were asked if they were able to curb their use of other painkillers after starting medical marijuana, 18 percent reported decreasing their use ‘moderately,’ 20 percent ‘extremely’ and 27 percent ‘completely’.” Older Adults’ Use of Medical Marijuana for Chronic Pain: A Multisite Community-Based Survey, Data presented at the 2018 annual meeting of the American Geriatrics Society, May 2018 “We find fairly strong and consistent evidence using difference-in-differences and event study methods that states providing legal access to marijuana through dispensaries reduce deaths due to opioid overdoses. … We provide complementary evidence that dispensary provisions lower treatment admissions for addiction to pain medications. … In short, our findings that legally protected and operating medical marijuana dispensaries reduce opioid-related harms suggests that some individuals may be substituting towards marijuana, reducing the quantity of opioids they consume or forgoing initiation of opiates altogether. … At a minimum, however, our results suggest a potential overlooked positive effect of medical marijuana laws that support meaningful retail sales.” Do medical marijuana laws reduce addictions and deaths related to pain killers? Journal of Health Economics, 2018 “During the study period, 2736 patients above 65 years of age began cannabis treatment and answered the initial questionnaire. The mean age was 74.5 ± 7.5 years. The most common indications for cannabis treatment were pain (66.6%) and cancer (60.8%). After six months of treatment, 93.7% of the respondents reported improvement in their condition and the reported pain level was reduced from a median of 8 on a scale of 0-10 to a median of 4. … After six months, 18.1% stopped using opioid analgesics or reduced their dose. … Cannabis use may decrease the use of other prescription medicines, including opioids.” Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly, European Journal of Internal Medicine, 2018 “We used an interrupted time-series design (2000-2015) to compare changes in level and slope of monthly opioid-related deaths before and after Colorado stores began selling recreational cannabis. … Colorado’s legalization of recreational cannabis sales and use resulted in a 0.7 deaths per month reduction in opioid-related deaths. This reduction represents a reversal of the upward trend in opioid-related deaths in Colorado.” Recreational cannabis legalization and opioid-related deaths in Colorado, 2000-2015, American Journal of Public Health, 2017 University of New Mexico investigators assessed opioid prescription use patterns over a 21-month period in 37 pain patients enrolled in the state’s medicinal cannabis program compared to 29 non- enrolled patients. Compared to non-users, medical cannabis enrollees “were more likely either to reduce daily opioid prescription dosages between the beginning and end of the sample period (83.8 percent versus 44.8 percent) or to cease filling opioid prescriptions altogether (40.5 percent versus 3.4 percent).” Enrollees were also more likely to report an improved quality of life. “The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.” Association between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study, PLOS One, 2017 “This paper uses a unique marijuana dispensary dataset to exploit within- and across-state variation in dispensary openings to estimate the effect increased access to marijuana has on narcotic-related admissions to treatment facilities and drug-induced mortalities. [It] finds that core-based statistical areas (CBSAs) with dispensary openings experience a 20 percentage point relative decrease in painkiller treatment admissions over the first two years of dispensary operations … [and] provides suggestive evidence that dispensary operations negatively affect drug-induced mortality rates.” The effects of marijuana dispensaries on adverse opioid outcomes. SSRN Working Paper, 2017 “Medical marijuana policies were significantly associated with reduced opioid pain reliever-related hospitalizations but had no associations with marijuana-related hospitalizations. … Medical marijuana legalization was associated with 23% (p=0.008) and 13% (p=0.025) reductions in hospitalizations related to opioid dependence or abuse and OPR overdose, respectively; lagged effects were observed after policy implementation.” Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever, Drug and Alcohol Dependence, 2017 “[The] review of the current literature suggests states that implement medical cannabis policies could reduce prescription opioid medication associated mortality, improve pain management, and significantly reduce health care costs.” The use of cannabis in response to the opioid crisis: A review of the literature, Nursing Outlook, 2017 Among patients with a musculoskeletal injury who acknowledged having used cannabis to assist in recuperating from injury over the past six months, 90 percent said that it was effective at reducing their pain. Eighty-one percent said that the use of cannabis reduced their intake of opioids. “[I]n the subset of patients who used marijuana during their recovery, a majority indicated that it helped alleviate symptoms of pain and reduced their level of opioid intake.” Perceptions of the use of medical marijuana in the treatment of pain following musculoskeletal trauma, Journal of Orthopaedic Trauma, 2017 “State-specific estimates indicated a reduction in opioid positivity for most states after implementation of an operational MML. … Operational MMLs are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose.” State medical marijuana laws and the prevalence of opioids detected among fatally injured drivers, American Journal of Public Health, 2016 “The current study assessed the impact of 3 months of medical marijuana treatment on executive function, exploring whether MMJ patients would experience improvement in cognitive functioning, perhaps related to primary symptom alleviation. … Results suggest that in general, MMJ patients experienced some improvement on measures of executive functioning. … Patients also indicated moderate improvements in clinical state, including reduced sleep disturbance, decreased symptoms of depression, attenuated impulsivity, and positive changes in some aspects of quality of life. Additionally, patients reported a notable decrease in their use of conventional pharmaceutical agents from baseline, with opiate use declining more than 42%.” A pilot study assessing the impact of medical marijuana on executive function, Frontiers in Pharmacology, 2016 “Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP (chronic pain) patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications.” Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain, Journal of Pain, 2016 “The treatment of chronic pain with medicinal cannabis in this open-label, prospective cohort resulted in improved pain and functional outcomes, and a significant reduction in opioid use. … Opioid consumption at follow-up decreased by 44%.” The Effect of Medicinal Cannabis on Pain and Quality-of-Life Outcomes in Chronic Pain: A Prospective Open- label Study, The Clinical Journal of Pain, 2016 “Using both standard differences-in-differences models as well as synthetic control models, we find that states permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.” Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?, NBER Working Paper No. 21345, 2015 “Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time.” Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010, JAMA Internal Medicine, 2014
Cannabis access is associated with reductions in overall prescription drug activity
“Medical marijuana laws (MMLs) can impact marijuana and opioid use, but the relationship between MMLs and other drugs, such as prescription stimulants, remains unexamined. … We pooled 2015- 2017 National Survey on Drug Use and Health data for adults (n = 126 463), and used survey- weighted multinomial logistic regression to estimate odds of past-year (a) medical prescription stimulant use, (b) non-medical prescription stimulant use and (c) non-medical versus medical stimulant use. We stratified by gender, adjusted for sociodemographic characteristics, and tested the interaction between MML state residence and sexual identity. … Medical prescription stimulant use was lower in MCL states versus non-MCL states for heterosexual men (3.7% versus 4.6%) and women (4.2% versus 5.7%). Bisexual men’s medical stimulant use prevalence was 4.2% in MCL states versus 9.9% in non-MCL states: among women, it was 7.3% versus 8.6%. Among bisexual men, non-medical prescription stimulant use was 5.6% in MCL states versus 8.1% in non-MCL states; for bisexual women it was 6.0% versus 7.9%. … The ‘spillover’ effect of MCL enactment on the use of substances besides cannabis should be explicitly tested in future studies.” Medical marijuana laws and medical and non-medical prescription stimulant use among a nationally representative sample of US adults: Potential spillover effects by sexual identity and gender, International Journal of Drug Policy, 2020 “This study seeks to understand whether people substitute between recreational cannabis and conventional over-the-counter (OTC) sleep medications. … We measured annually-differenced market shares for sleep aids as a portion of the overall OTC medication market, thus accounting for store-level demand shifts in OTC medication markets and seasonality, and used the monthly changes in stores’ sleep aid market share to control for short-term trends. … For the first time, we show a statistically significant negative association between recreational access to cannabis and OTC sleep aid sales, suggesting that at least some recreational purchasers are using cannabis for therapeutic rather than recreational purposes … [O]ur results indicate that enough individuals are switching from OTC sleep aids to recreational cannabis that we can identify a statistically significant reduction in the market share growth of OTC sleep aids in conjunction with access to recreational cannabis using.” Using recreational cannabis to treat insomnia: Evidence from over-the-counter sleep aid sales in Colorado, Complimentary Therapies in Medicine, 2019 “A retrospective analysis was performed on a cohort of 146 medical cannabis patients who reported benzodiazepine use at initiation of cannabis therapy. … After completing an average 2-month prescription course of medical cannabis, 30.1% of patients had discontinued benzodiazepines.” Reduction of benzodiazepine use in patients prescribed medical cannabis, Cannabis and cannabinoid Research, 2019 “We report results from an ongoing, online survey of medical cannabis users with chronic pain nationwide about how cannabis affects pain management, health, and pain medication use. … Consistent with other observational studies, approximately 80% reported substituting cannabis for traditional pain medications (53% for opioids, 22% for benzodiazepines), citing fewer side effects and better symptom management as their rationale for doing so.” Pills to pot: Observational analyses of cannabis substitution among medical cannabis users with chronic pain, Journal of Pain, 2019 “Findings from this systematic review show that MMLs are associated with a modest reduction in opioid prescriptions. Specifically, implementation of MMLs (medical marijuana laws) is associated with a 7% reduction in opioid prescriptions.” State marijuana laws and opioid overdose mortality, Injury Epidemiology, 2019 “This longitudinal analysis of Medicare PartD found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened. … Combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids.” Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population, JAMA Internal Medicine, 2018
“This was a retrospective, mirror-image study that investigated medical cannabis’ effectiveness in patients suffering from chronic pain associated with qualifying conditions for MC in New York State. … After 3 months treatment, MC improved quality of life, reduced pain and opioid use, and lead to cost savings. … These results are consistent with previous reports demonstrating MC’s effectiveness in neuropathic pain.” Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis, Mental Health Clinician, 2018 “We conducted a pragmatic historical cohort study to measure the effect of enrollment in a state- authorized United States’ Medical Cannabis Program (MCP) on scheduled II-V drug prescription patterns. … Our pragmatic preliminary study found that enrollment in the NM MCP was associated with significant reductions in scheduled II-V prescription drug activity and associated use of conventional pharmacies and prescribing providers. … 34% of the MCP patients cease to exhibit any evidence of scheduled drug consumption and an additional 36% reduce the number of prescriptions filled for scheduled drugs by the last 6 months of our sample period. … In conclusion, a shift from prescriptions for other scheduled drugs to cannabis may result in less frequent interactions with our conventional healthcare system, and potentially improved patient health.” Effects of legal access to cannabis on Schedule II-V prescriptions, Journal of Post-Acute and Long-Term Care Medicine, 2017 “Using the variations across state MMLs between 1996 and 2014 of Medical Expenditure Panel Survey (MEPS) this paper estimates the effects of MMLs on prescription drug utilization, with a focus on opioids. I find that MMLs lead to a $2.47 decrease in per person prescribed opioid spending among young adults (ages 18-39) over a year. Most of this decrease results from the intensive margin of use and MML states that allow home cultivation experience even larger decreases.” The effects of medical marijuana laws on prescribed opioids and other prescription drugs, SSRN Working Paper, 2017 “Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007-14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied. If all states had had a medical marijuana law in 2014, we estimated that total savings for fee-for-service Medicaid could have been $1.01 billion.” Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees, Health Affairs, 2017 “Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. National overall reductions in Medicare program and enrollee spending when states implemented medical marijuana laws were estimated to be $165.2 million per year in 2013.” Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D, Health Affairs, 2016
The adjunctive use of cannabis augments the analgesic properties of opioids
“In this exploratory CEA (cost effective analysis) of smoked cannabis for neuropathic pain, we found augmentation of standard therapy agents for neuropathic pain with smoked cannabis to be cost- effective over the short- and long-term. … Judicious use of medicinal cannabis alongside standard therapy agents may be particularly beneficial to patients with refractory pain and to active cannabis users.” A cost-effective model for adjunctive smoked cannabis in the treatment of chronic neuropathic pain, Cannabis and Cannabinoid Research, 2019 “The reduction of opioid dosing when used in combination with cannabis/cannabinoids reduces side effects and allows for easier detoxification and weaning due to less of a tolerance and withdrawal from opiates, and rekindling of opiate analgesia after prior dosages have worn off. Because of the cannabis-opioid synergistic interactions as suggested by available data, cannabis has been suggested as a tool in the opioid detoxification and weaning process. …. Unfortunately, most chronic pain management programs have rules and “opioid contracts” mandating patients to be free of cannabis/cannabinoid use for enrollment and ongoing treatment. Given the abundance of evidence- based medicine and research on cannabinoid-opioid synergy, these policies seem quite outdated and should be re-evaluated. Patients using cannabis/cannabinoids may inadvertently be assisting their own detox and weaning from opiates. Chronic pain management programs should harness this potential benefit within their treatment program and use it to their patients’ advantage.” Medicinal properties of cannabinoids, terpenes, and flavonoids in cannabis, and benefits in migraine, headache and pain: An update on current evidence and cannabis science, Headache, 2018
“This double-blind, placebo-controlled, within-subject study determined if cannabis enhances the analgesic effects of low dose oxycodone using a validated experimental model of pain and its effects on abuse liability. … Although active cannabis and 2.5 mg oxycodone alone failed to elicit analgesia, combined they increased pain threshold and tolerance. … Smoked cannabis combined with an ineffective analgesic dose of oxycodone produced analgesia comparable to an effective opioid analgesic dose without significantly increasing cannabis’s abuse liability.” Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability, Neuropsychopharmacology, 2018 “[T]hese clinical and pre-clinical data suggest that analgesic synergy produced by coadministered cannabis and opioids could be harnessed to achieve clinically relevant pain relief at doses that would normally be subanalgesic. This strategy could have significant impacts on the opioid epidemic, given that it could entirely prevent two of the hallmarks of opioid misuse: dose escalation and physical dependence.” Emerging evidence for cannabis’ role in opioid use disorder, Cannabis and Cannabinoid Research, 2018 “Twenty-one individuals with chronic pain, on a regimen of twice-daily doses of sustained-release morphine or oxycodone were enrolled in the study and admitted for a 5-day inpatient stay. Participants were asked to inhale vaporized cannabis in the evening of day 1, three times a day on days 2-4, and in the morning of day 5. … The extent of chronic pain was also assessed daily. … Pain was significantly decreased after the addition of vaporized cannabis. We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.” Cannabinoid-opioid interaction in chronic pain, Clinical Pharmacology and Therapeutics, 2011
Patients often use cannabis as a substitute for other controlled substances, including prescription medications, alcohol, and tobacco
“Among our subjects, over 90 percent of CU [cannabis users] and PU [past users] reported “a little” or “great” relief from symptoms with MC [medical cannabis] and 61.20 percent claimed that MC had allowed them to reduce or discontinue use of other medications.” Utilization of medicinal cannabis for pain by individuals with spinal cord injury, Spinal Cord Series and Cases, 2020 “RCLs (recreational cannabis laws) and, to a lesser extent, MCLs (medical cannabis laws) reduce the total days supply of NSAIDs, the number of different patients to whom providers prescribe NSAIDs, and the likelihood that a provider prescribes any NSAIDs.” The impact of cannabis access laws on opioid prescribing, Journal of Health Economics, 2019 “Participants [in the study] were 93 US military veterans and members of the Santa Cruz Veterans’ Alliance (SCVA). … The majority of participants reported that they use cannabis as a substitute for other licit and illicit substances. … [P]articipants reported a high degree of substitution behavior, particularly for alcohol. … [N]early half the sample reported substituting cannabis for prescription medications. … The current study also confirms the findings of previous studies that have documented a trend in substitution behavior, where cannabis is substituted for other drugs, which, if associated with reduced harm, could be beneficial for overall health.” A cross-sectional examination of choice and behavior of veterans with access to free medicinal cannabis, The American Journal of Drug and Alcohol Abuse, 2019 “The aim of the study was to investigate the characteristics, safety, and effectiveness of medical cannabis therapy for fibromyalgia. … Most patients ceased, reduced, or at least did not change the dosage of their chronic drugs for fibromyalgia while receiving medical cannabis. At six months, 28 out of 126 patients (22.2%) stopped or reduced their dosage of opioids, and 24 out of 118 (20.3%) reduced their dosage of benzodiazepines. … Considering the low rates of addiction and serious adverse effects (especially compared to opioids), cannabis therapy should be considered to ease the symptom burden among those fibromyalgia patients who are not responding to standard care.” The safety and efficacy of medical cannabis in fibromyalgia, Journal of Clinical Medicine, 2019
“The current study collected narrative information about use of marijuana for medical purposes from medical marijuana card holders in Rhode Island. … Of the 25 participants in this investigation, … 7 participants reported that they were able to cut back on their medications, and 12 reported that they were able to completely stop taking other prescription medications once they started using marijuana for medical purposes.” Marijuana as a substitute for prescription medications: A qualitative study, Substance Use & Misuse, 2019 “The objective of this study was to determine if the use of medical cannabis affects the amount of opioids and benzodiazepines used by patients on a daily basis. … All available daily milligram morphine equivalents (MMEs) and daily diazepam equivalents (DEs) were calculated at baseline and at 3 and 6 months. … Over the course of this 6-month retrospective study, patients using medical cannabis for intractable pain may have expe- rienced a significant reduction in the average MME available for pain control. A non–statistically significant difference in average benzodiazepine dose was observed. The results of this study add to the currently mixed body of evidence suggesting that medical cannabis may be effective for treating pain.” Medical cannabis: effects on opioid and benzodiazepine requirements for pain control, Annals of Pharmacotherapy, 2019 “A retrospective chart review of 77 patients diagnosed with multiple sclerosis participating in treatment with medical cannabis for symptom management was conducted. … Subjective improvement endorsed by patients was extensive, with alleviation of symptomatology seen most in pain (71%), spasticity (43%), and sleep (42%). In addition, 34% of patients were able to decrease and discontinue other medications including opioids, stimulants, and benzodiazepines, indicative of symptom improvement.” Multiple Sclerosis and use of medical cannabis: A retrospective review evaluating symptom outcomes, Neurology, 2019 “We report results from an ongoing, online survey of medical cannabis users with chronic pain nationwide about how cannabis affects pain management, health, and pain medication use. … 1,321 participants completed the survey. Consistent with other observational studies, ~80% reported substituting cannabis for traditional pain medications (53% for opioids, 22% for benzodiazepines), citing fewer side effects and better symptom management as their rationale for doing so.” Pills to pot: observational analyses of cannabis substitution among medical cannabis users with chronic pain, The Journal of Pain, 2019 “[T]he purpose of this study was to examine the prevalence of cannabis for medicinal purposes (CMP) use for anxiety symptoms. … Overall, 2032 completed responses with a verified user number were collected. Of the total sample, 888 (43.7%) reported CMP authorization to treat anxiety symptoms and completed all psychometric screening instruments. … Nearly half (49%) reported replacing a non-psychiatric (53.7%) or psychiatric medication (46.3%) prescribed to them by their physician with CMP.” Cannabis use behaviors and prevalence of anxiety and depressive symptoms in a cohort of Canadian medicinal cannabis users, Journal of Psychiatric Research, 2019 “A 239-question cross-sectional survey was sent out via email in January 2017 to gather comprehensive information on cannabis use from Canadian medical cannabis patients registered with a federally authorized licensed cannabis producer, resulting in 2032 complete surveys. … The most commonly cited substitution was for prescription drugs (69.1%; n = 953), followed by alcohol (44.5%; n = 515), tobacco (31.1%; n = 406), and illicit substances (26.6%; n = 136). … Of the 610 mentions of opioid medications, participants self-reported they stopped using 59.3% completely (100% substitution) (n = 362), and a further 18.4% reduced their use by 75% (n = 112). … Of the 515 respondents who substituted cannabis for alcohol, 30.9% suggested they stopped using it completely (100%) (n = 159), and 36.7% reported reducing by at least 75% (n = 189). … Of the 406 participants who substituted cannabis for tobacco, 50.7% say they stopped using it completely (100% substitution) (n = 206), and 13.8% reported reducing their use by 75% (n = 56).” Medical cannabis patterns of use and substitution for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances; results from a cross-sectional survey of authorized patients, Harm Reduction Journal, 2019 “A retrospective analysis was performed on a cohort of 146 medical cannabis patients (average age 47 years, 61% female, 54% reporting prior use of cannabis) who reported benzodiazepine use at initiation of cannabis therapy. … After completing an average 2-month prescription course of medical cannabis, 30.1% of patients had discontinued benzodiazepines. At a follow-up after two prescriptions, 65 total patients (44.5%) had discontinued benzodiazepines. At the final follow-up period after three medical cannabis prescription courses, 66 total patients (45.2%) had discontinued benzodiazepine use, showing a stable cessation rate over an average of 6 months. … Patients initiated on medical cannabis therapy showed significant benzodiazepine discontinuation rates after their first follow-up visit to their medical cannabis prescriber, and continued to show significant discontinuation rates thereafter.” Reduction of benzodiazepine use in patients prescribed medical cannabis, Cannabis and Cannabinoid Research, 2019 “The research team administered brief hard copy surveys to 450 adults attending an annual public event advocating for cannabis law reform. … Medical cannabis users reported a greater degree of use of medical cannabis and a greater degree of trust in medical cannabis compared to mainstream healthcare. In comparison to pharmaceutical drugs, medical cannabis users rated cannabis better on effectiveness, side effects, safety, addictiveness, availability, and cost. Due to the medical use of cannabis, 42% stopped taking a pharmaceutical drug and 38% used less of a pharmaceutical drug.” Medical cannabis users’ comparisons between medical cannabis and mainstream medicine, Journal of Psychoactive Drugs, 2019 “The aim of this study is to characterize the epidemiology of cancer patients receiving medical cannabis treatment and describe the safety and efficacy of this therapy. … We analyzed the data routinely collected as part of the treatment program of 2970 cancer patients treated with medical cannabis between 2015 and 2017. … A total of 1013 patients responded to the medication chapter before and during treatment. At intake these patients took together 3982 regularly used drugs (medications they take regularly). 35.1% reported a decreased in their drugs consumption, mainly in the following families: other analgesics and antipyretics, hypnotics and sedatives, corticosteroids and opioids. Opioids, for example, was the most prevalent drug consumed by 344 patients (33.9%) at intake, 36% of them stopped taking opioids [and] 9.9% decreased [their] dose.” Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer, European Journal of Internal Medicine, 2018 “31 patients were involved in an observational cross-over study. The patients were screened, treated with 3 months of Standardized Analgesic Therapy (SAT): 5 mg of oxycodone hydrochloride equivalent to 4.5 mg oxycodone and 2.5 mg naloxone hydrochloride twice a day and duloxetine 30 mg once a day. Following 3 months of these therapies, the patients could opt for MCT (medical cannabis therapy) and were treated for a minimum of 6 months. … The majority of patients elected during MCT to decrease or discontinue pharmaceutical analgesic consumption.” Effect of adding medical cannabis treatment to analgesic treatment in patients with low back pain related to fibromyalgia: An observational cross-over single center study, Clinical and Experimental Rheumatology, 2018 “We explored patterns of use of cigarette, alcohol, and illicit drugs in HIV-infected people with chronic pain who were prescribed opioid analgesics. … In multivariate analyses, only cannabis use was significantly associated with lower odds of prescribed opioid analgesic use. Our data suggest that new medical cannabis legislation might reduce the need for opioid analgesics for pain management, which could help to address adverse events associated with opioid analgesic use.” Cannabis use is associated with lower odds of prescription opioid analgesic use among HIV-infected individuals with chronic pain, Substance Abuse & Misuse, 2018 “[O]ur results indicate that MC (medical cannabis) may be used intentionally to taper off prescription medications. These findings align with previous research that has reported substitution or alternative use of cannabis for prescription pain medications dues to concerns regarding addiction and better side-effect and symptom management, as well as complementary use to help manage side-effects of prescription medication.” Preferences for medical marijuana over prescription medications among persons living with chronic conditions, The Journal of Alternative and Complementary Care, 2017 Among patients with a musculoskeletal injury who acknowledged having used cannabis to assist in recuperating from injury over the past six months, 90 percent said that it was effective at reducing their pain. Eighty-one percent said that the use of cannabis reduced their intake of opioids. “[I]n the subset of patients who used marijuana during their recovery, a majority indicated that it helped alleviate symptoms of pain and reduced their level of opioid intake.” Perceptions of the use of medical marijuana in the treatment of pain following musculoskeletal trauma, Journal of Orthopaedic Trauma, 2017 “[F]indings on cannabis substitution effect and the biological mechanisms behind it strongly suggest that cannabis could play a role in reducing the public health impacts of prescription and non- prescription opioids. … The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to consider the implementation and assessment of cannabis- based interventions in the opioid crisis.” Rationale for cannabis-based interventions in the opioid overdose crisis, Harm Reduction Journal, 2017 An estimated two out of three medical marijuana patients substitute cannabis in place of opioids, according 2017 survey data compiled by Aclara Research, a Chicago-based consulting firm. Specifically, 67 percent of respondents reported that they ceased their use of opioids after initiating cannabis therapy. Twenty-nine percent of respondents said that they reduced their use of opioids. Aclara Research, Cannabis, Prescription Drugs, and Opioid Usage: Study Highlights, 2017 “The largest survey on cannabidiol or CBD usage to date found that women were more likely than men to use CBD and once they started using it, were likely to drop their traditional medicine. … Forty- two percent of the CBD users said they had stopped using traditional medications like Tylenol pain relievers or prescription drugs like Vicodin and had switched to using cannabis instead.” Survey: Nearly half of people who use cannabidiol products stop taking traditional medicine, Forbes.com, 2017 “Ninety-seven percent of the sample ‘strongly agreed/agreed’ that they are able to decrease the amount of opioids they consume when they also use cannabis. … In addition, 80% of patients reported that cannabis by itself was more effective than their opioids. … Supporting the results of previous research, this study can conclude that medical cannabis patients report successfully using cannabis along with or as a substitute for opioid-based pain medication.” Cannabis as a substitute for opioid-based pain medication: patient self-report, Cannabis and Cannabinoid Research, 2017 “Among respondents that regularly used opioids, over three-quarters (76.7%) indicated that they reduced their use since they started medical cannabis. This was significantly ( p < 0.0001) greater than the patients that reduced their use of antidepressants (37.6%) or alcohol (42.0%). Approximately two-thirds of patients decreased their use of anti-anxiety (71.8%), migraine (66.7%), and sleep (65.2%) medications following medical cannabis.” Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep, Journal of Psychopharmacology, 2017 “Findings include high self-reported use of cannabis as a substitute for prescription drugs (63%), particularly pharmaceutical opioids (30%), benzodiazepines (16%), and antidepressants (12%). Patients also reported substituting cannabis for alcohol (25%), cigarettes/tobacco (12%), and illicit drugs (3%).” Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients, International Journal of Drug Policy, 2017 “These patient-reported outcomes support prior research that individuals are using cannabis as a substitute for prescription drugs, particularly, narcotics/opioids, and independent of whether they identify themselves as medical or non-medical users. This is especially true if they suffer from pain, anxiety and depression.” Cannabis as a substitute for prescription drugs – a cross-sectional study, Journal of Pain Research, 2017 “Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances. … The finding that cannabis was substituted for all three classes of substances suggests that the medical use of cannabis may play a harm reduction role in the context of use of these substances, and may have implications for abstinence-based substance use treatment approaches.” Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors, Drug and Alcohol Review, 2015 “Participants were 367 patients recruited from four medical cannabis dispensaries located throughout Arizona. … Patients reported using medical cannabis to treat a variety of conditions. … [P]atients reported using other medications less frequently when using cannabis. This is consistent with findings from other studies.” Medical cannabis in Arizona: Patient characteristics, perceptions, and impressions of medical cannabis legalization. Journal of Psychoactive Drugs, 2015
Chronic pain patients are less likely to abuse medicinal cannabis as compared to opioids
“Generally, rates of problematic use of MC (medicinal cannabis) among MC users seem lower than rates of problematic use of opioids among those prescribed opioids,” Problematic use of prescription opioids and medicinal cannabis among patients suffering from chronic pain, Pain Medicine, 2016
Chronic pain patients are less likely to become depressed using medical cannabis
“Prevalence of depression among patients in the OP (opioids), MM (medical marijuana) and OPMM groups was 57.1%, 22.3% and 51.4%, respectively and rates of anxiety were 48.4%, 21.5% and 38.7%, respectively. … Levels of depression and anxiety are higher among chronic pain patients receiving prescription opioids compared to those receiving MM. Findings should be taken into consideration when deciding on the most appropriate treatment modality for chronic pain, particularly among those at risk for depression and anxiety.” Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana, Journal of Affective Disorders, 2017
Cannabis use is associated with greater rates of opioid use treatment retention and may mitigate opioid-related cravings
“Many chronic pain patients are prescribed opioids at doses exceeding the current Guideline. Tapering the dose can be difficult, as patients fear a return to a state of overwhelming pain. Several factors can increase the likelihood of success: the patient’s readiness for change, psychological support, pharmacological support and careful monitoring. This pilot study addressed these four factors. Six hundred patients took part. Each was taking daily opioid doses ranging from 90-240 mg morphine equivalent dose (MED). All indicated they were prepared to reduce their opioid dose. Over a six-month period, opioid doses were tapered according to individual needs, usually 10% every 1-2 weeks. … After 6 months, 156 patients (26%) had ceased taking opioids. An additional 329 patients (55%) had reduced their opioid use by an average of 30%. … Medical cannabis provided pharmacological support throughout the tapering process … [and] was very helpful to many patients. … The positive results justify further investigation. A pilot study of a medical cannabis – opioid reduction program, American Journal of Psychiatry and Neuroscience, 2019 “This exploratory double-blind randomized placebo-controlled trial assessed the acute (1 hour, 2 hours, and 24 hours), short-term (3 consecutive days), and protracted (7 days after the last of three consecutive daily administrations) effects of CBD administration (400 or 800 mg, once daily for 3 consecutive days) on drug cue–induced craving and anxiety in drug-abstinent individuals with heroin use disorder. … Acute CBD administration, in contrast to placebo, significantly reduced both craving and anxiety induced by the presentation of salient drug cues compared with neutral cues. CBD also showed significant protracted effects on these measures 7 days after the final short-term (3-day) CBD exposure. In addition, CBD reduced the drug cue–induced physiological measures of heart rate and salivary cortisol levels. There were no significant effects on cognition, and there were no serious adverse effects. CBD’s potential to reduce cue-induced craving and anxiety provides a strong basis for further investigation of this phytocannabinoid as a treatment option for opioid use disorder.” Cannabidiol for the reduction of cue-induced craving and anxiety in drug-abstinent individuals with heroin use disorder: A double-blind randomized placebo controlled trial, in The American Journal of Psychiatry , 2019
“The evidence summarized in this article demonstrates the potential cannabis has to ease opioid withdrawal symptoms, reduce opioid consumption, ameliorate opioid cravings, prevent opioid relapse, improve OUD treatment retention, and reduce overdose deaths. … Adjunct cannabis use alongside current treatment strategies could help to improve the number of individuals engaging in OUD treatment, as well as increase treatment retention rates.”
Emerging evidence for cannabis’ role in opioid use disorder, Cannabis and Cannabinoid Research, 2018 “The present study found that individuals initiating OAT (opioid agonist treatment) were approximately 21% more likely to be retained in treatment at 6 months if they reported ≥ daily use of cannabis. This finding persisted after adjustment for a range of confounders, including high-intensity concurrent use of other substances and relevant social-structural exposures (e.g. homelessness). … Given the well-known mortality risk reduction benefit of sustained engagement in OAT, findings from the present study alongside prior research evidence support the urgent need for clinical research to evaluate the therapeutic potential of cannabinoids as adjunctive treatment to OAT to address the escalating opioid-overdose epidemic.” High-intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis, Addiction, 2018 “Significant research efforts are still necessary to evaluate fully the development of CBD as a potential therapy for addiction disorders. To date, the evidence appears to at least support a potential beneficial treatment for opioid abuse. The fact that patients with substance use disorders often present with various psychiatric and medical symptoms that are reduced by CBD — symptoms such as anxiety, mood symptoms, insomnia, and pain — also suggests that CBD might be beneficial for treating opioid-dependent individuals. Currently most medications for opioid abuse directly target the endogenous opioid system. CBD could thus offer a novel line of research medication that indirectly regulate neural systems modulating opioid-related behavior, thus helping to reduce side effects normally associated with current opioid substitution treatment strategies.”
Early phase in the development of cannabidiol as a treatment for addiction: Opioid relapse takes center stage, Neurotherapeutics, 2015 “Opioid dependent participants were randomized to receive dronabinol 30mg/d (n=40) or placebo (n=20), under double-blind conditions, while they underwent inpatient detoxification and naltrexone induction. … The severity of opioid withdrawal during inpatient phase was lower in the dronabinol group relative to placebo group. … Post hoc analysis showed that the 32% of participants who smoked marijuana regularly during the outpatient phase had significantly lower ratings of insomnia and anxiety and were more likely to complete the 8-week trial. Dronabinol reduced the severity of opiate withdrawal during acute detoxification. … Participants who elected to smoke marijuana during the trial were more likely to complete treatment.” The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone, Drug and Alcohol Dependence, 2015 “The present study replicates a previous surprising finding that intermittent cannabis use is associated with improved retention in naltrexone treatment among opioid dependent patients, while both abstinence from cannabis and regular cannabis use during naltrexone treatment are associated with high dropout. … These findings are of interest, because they suggest the hypothesis that moderate cannabis use may be exerting a beneficial pharmacological effect improving the tolerability of naltrexone in the early weeks after induction, and that cannabinoid agonists might have promise for improving the effectiveness of naltrexone treatment for opioid dependence.”
Intermittent marijuana use is associated with improved retention in naltrexone treatment for opiate- dependence, American Journal of Addictions, 2009 “Intermittent use of nonopiate drugs is common during outpatient treatment for opiate dependence and may be a favorable prognostic indicator. This may support a “harm reduction” approach as opposed to a strict abstinence-oriented approach. Further research is needed to identify the optimal therapeutic stance toward other drug use during treatment for opiate dependence.”
Concurrent substance use and outcome in combined behavioral and naltrexone therapy for opiate dependence, The American Journal of Drug and Alcohol Abuse, 2009
Cannabis as a non- lethal substitute for opiate use to prevent deaths in the opiate crisis
Attached is a recent April 2019 approved article from the Journal of Psychiatric Drugs that shows that numerous medical patients are reducing their prescriptions for opiates and sleep medications substituting cannabis instead. The paper, entitled “Use of cannabis to relieve pain and promote sleep by customers at an adult use dispensary,” assessed marijuana use trends among 1,000 adult use customers in Colorado.
Seventy-four percent of those surveyed said that they consumed cannabis to promote sleep, while 65 percent reported using cannabis to alleviate pain. Among those respondents with a history of taking prescription sleep aids, 83 percent reported either reducing or ceasing their use of those medicines. Among those respondents with a history of consuming prescription opioids, 88 percent reported mitigating or stopping their use.
The findings are similar to those of prior longitudinal trials similarly finding that prescription drug use declines — specifically the use of opioids, anti-anxiety medications, and sleep aids — following subjects’ enrollment in medical cannabis access programs. Paul Armentano of NORML USA, highlights several of these trials in his Hill op-ed, “Clarifying some of the mixed messages surrounding cannabis and opioids.” (https://thehill.com/opinion/healthcare/448154-clarifying-some-of-the-mixed-messages- surrounding-cannabis-and-opioids#bottom-story-socials)
The full text of the new study, which is lead authored by Marcus Bachhuber (lead author of the 2014 JAMA study here: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1898878) is attached.
2019_Retail_consu mers_substitute.pdf
NORML’s blog on the study is here: https://blog.norml.org/2019/07/02/study-adult-use-retail-customers-frequently-substitute- cannabis-for-opioids-other-prescription-drugs/.
Some examples of media coverage of the study, with Mr. Armentano’s comments, appear here:
UPI: https://www.upi.com/Health_News/2019/07/02/Marijuana-replacing-opioids-sleep-aids-for-many-study- finds/6441562093057/
HealthDay/WebMD: https://consumer.healthday.com/public-health-information-30/marijuana-news-759/for-many-pot-is- now-an-alternative-to-opioids-or-sleep-meds-748018.html
MarijuanaMoment: https://www.marijuanamoment.net/recreational-marijuana-store-customers-consume-to-help-pain-and- sleep-study-finds/
US News and World report: https://www.usnews.com/news/health-news/articles/2019-07-02/for-many-pot-is-now-an- alternative-to-opioids-or-sleep-meds
The reduction in patient opiate overuse is particularly important in our current “opiate crisis” where Vancouver appears to be central. There now exists gold standard , ‘double blind placebo based’ study, that support that cannabis is one of the most effective “exit strategy drugs” to get people off opiates (see for example http://www.ncbi.nlm.nih.gov/pubmed/30684198). There is an urgent need for the continued existence of this not for profit compassionate medical cannabis club to continue in the City of Vancouver to try and at least continue to contribute to trying to meet that urgent need. Our physicians need to learn to prescribe more cannabis and less opiates for chronic pain and those on the street or at home who are already addicted need to be encouraged to consider the use of cannabis as a ‘stepping stone’ to help them in a direction away from their addiction. The Serious Hope Society through its Cannabis Substitution Program is proving such “reasonable access” for these patients and have done so for a long time and on a ‘low barrier’ basis as they are mostly homeless or living in assisted housing with no cell phones or computers or online access etc
Study: Cannabis Associated with Reduced Opioid Use, Prolonged Benefits in Pain Patients BY NORML
POSTED ON JUNE 19, 2020 “Taken together, the results of this study add to the cumulative evidence in support of plant-based MC (medical cannabis) as a safe and effective treatment option and potential opioid substitute or augmentation therapy for the management of chronic pain symptomatology and quality of life.”
Study: Adult Use Marijuana Laws Associated With Reduced Use Of Opioids The enactment of state laws regulating the use of marijuana by adults is associated with a reduction in the use of schedule III opioid drugs among Medicaid enrollees.
Study: Cannabis Lozenge Associated With Reduced Opioid Use Patients who consume plant-derived cannabis extracts in the form of an oral lozenge report reductions in chronic pain and opioid use.
Study: Medical Cannabis Access Associated With Significant Reduction In Prescription Opioid Use The enactment of medical cannabis access laws is associated with significant reductions in prescription opioid use among Medicaid enrollees.
LEGALIZATION Study: Medical Cannabis Access Associated With Significant Reduction In Prescription Opioid Use BY PAUL ARMENTANO, NORML DEPUTY DIRECTOR
POSTED ON JULY 11, 2018 The enactment of medical cannabis access laws is associated with significant reductions in prescription opioid use among Medicaid enrollees, according to just-published data in the journal Addiction. Authors reported, “For Schedule III opioid prescriptions, medical cannabis legalization was associated with a 29.6 percent reduction in number of prescriptions, 29.9 percent reduction in dosage, and 28.8 percent reduction in related Medicaid spending.”
ACTIVISM
Kentucky NORML: Cannabis Access Associated with Reduced Rates of Opioid Use and Abuse BY NORML
POSTED ON JUNE 22, 2018 KY NORML is passionate about education. And with the opioid epidemic consuming our state, we feel that it is our duty to share valuable information regarding the relationship between cannabis and opioids.
Canada: Patients Dramatically Reduce Their Opioid Use Following Cannabis Access Pain patients enrolled in Canada’s legal medical cannabis access program significantly reduce their use of opioids over the long-term…
Study: Broad Access To Cannabis Dispensaries Lowers Opioid Abuse State laws permitting a large percentage of patients to readily access medical cannabis dispensaries are associated with reductions in opioid-related treatment admissions and mortality…
Study: Colorado’s Adult Use Cannabis Access Law Associated With Reductions In Opioid Deaths BY PAUL ARMENTANO, NORML DEPUTY DIRECTOR
POSTED ON OCTOBER 13, 2017 Retail cannabis distribution in Colorado is associated with a reduction in opioid-related mortality, according to data published online ahead of print in The American Journal of Public Health. Authors reported: “Colorado’s legalization of recreational cannabis sales and use resulted in a 0.7 deaths per month reduction in opioid- related deaths. This reduction represents a reversal of the upward trend in opioid-related deaths in Colorado.”
Study: Medical Cannabis Associated With Improved Cognitive Performance, Reduced Opioid Use Medical cannabis administration is associated with improved cognitive performance and lower levels of prescription drug use.
SCIENCE Study: Medical Cannabis Use Associated With Improved Cognitive Performance, Reduced Use Of Opioids BY PAUL ARMENTANO, NORML DEPUTY DIRECTOR
POSTED ON NOVEMBER 14, 2016 Medical cannabis administration is associated with improved cognitive performance and lower levels of prescription drug use, according to longitudinal data published online in the journal Frontiers in Pharmacology.
Study: Marijuana Use Associated With Decreased Symptoms Of Opiate Withdrawal In Subjects Undergoing Methadone Treatment Philadelphia, PA: The use of cannabis is associated with mitigated symptoms of opiate withdrawal in…
SCIENCE Study: Marijuana Use Associated With Decreased Symptoms Of Opiate Withdrawal In Methadone Maintenance Treatment Subjects BY PAUL ARMENTANO, NORML DEPUTY DIRECTOR
POSTED ON JULY 16, 2013 Cannabis consumption is associated with mitigated symptoms of opiate withdrawal in subjects undergoing methadone maintenance treatment, according to the findings of a new study published online in The American Journal on Addictions. “[I]ncreased cannabis use was found to be associated with lower severity of [opiate] withdrawal in a subset of the sample with available chart data,” authors wrote. “These results suggested a potential role for cannabis in the reduction of withdrawal severity during methadone induction.”
SCIENCE Study: Cannabis Is A “Potential Exit Drug To Problematic Substance Use” BY PAUL ARMENTANO, NORML DEPUTY DIRECTOR
POSTED ON DECEMBER 20, 2012 Three quarters of medical cannabis consumers report using it as a substitute for prescription drugs,…
Increased Access To Therapeutic Cannabis Likely To Reduce Patients’ Use Of Opiates, Other Addictive Drugs Victoria, British Columbia: Regulating cannabis access would provide patients with an effective treatment for chronic…
Wider Use Of Cannabis Therapy Could Reduce Prescription Pain Drug Deaths "Physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of…
Appendix D R v. Howell 2020 ABQB 385 excerpts from RFJ regarding homeless issue and opiate substitution Facts
[7] The underlying facts for this application are generally not in dispute. I will deal with contested evidence where it is necessary for the purpose of these applications, but do not intend to deal with the evidence in any great detail. These applications turn mainly on the law.
[8] In support of the Constitutional Challenge, Mr. Howell filed a number of affidavits. His own affidavit affirmed April 15, 2019 sets out most of the relevant facts and issues, as well as his own use of cannabis for medical purposes.
[9] Lisa Kirkman affirmed an affidavit on April 15, 2019. Her affidavit describes herself and her son as “patients” of Mr. Howell, and outlines their medical issues, the failure of conventional medicine to help them, their use of medical marihuana, the difficulties they have encountered finding a reliable source both as to availability and cost, and the benefits they have received from cannabis extracts supplied to them by Mr. Howell.
[10] Dr. David Rosenbloom’s affidavit was sworn April 11, 2019. Dr. Rosenbloom is an expert in pharmacy and pharmacology, the effect of delayed access to drugs including medical cannabis, and the purchase of drugs.
[11] An affidavit from Dr. Stephen Gaetz sworn June 21, 2019 was filed. Dr. Gaetz is an expert in “homelessness, precarious housing, matters related to homelessness and precarious housing, and services for those of modest means.”
[12] Sarah Wilkinson’s affidavit affirmed June 25, 2019 describes her daughter’s struggle with Ohtahara syndrome, the ineffectiveness of “traditional therapies,” and the benefits her daughter has received from cannabis use. Ms. Wilkinson is Mr. Howell’s partner. She also describes her health issues and the benefits she has received from Mr. Howell’s products.
[13] Dr. Jokubas Ziburkus swore an affidavit on April 11, 2019. He is an expert in “endocannabinoid system, endocannabinoids, phytocannabinoids, cannabis plants and products, and the pre-clinical research on medical cannabis.” He filed a second affidavit sworn June 26, 2019.
[14] An affidavit from Dr. Carolina Landolt sworn April 15 was also filed. Dr. Landolt is an expert in cannabis, medical cannabis patient access, and the management of chronic complex problems in both patient and out-patient settings.
[15] Mr. Howell also filed an affidavit from Harrison Jordan sworn April 15, 2019. Mr. Jordan is a lawyer and says he has “personal knowledge of information related to Canadian licensed producers of medical cannabis, their pricing of cannabis as well changes to pricing and policies of these licensed producers over time.” The thrust of his evidence is to outline problems with the legal medical cannabis system.
[16] In response, the Crown filed an affidavit from Todd Cain, affirmed October 1, 2019. Mr. Cain is the Director General of the Licensing and Medical Access Directorate of the Controlled Substances and Cannabis Branch of Health Canada. Mr. Cain’s affidavit describes Health Canada’s regulatory framework. He reviewed all of Health Canada’s records relating to Mr. Howell, and stated that Mr. Howell “was not authorized under Part 1 of the ACMPR to operate any type of commercial enterprise regarding cannabis.” He also states that Mr. Howell: . . . has only ever been authorized to produce cannabis for medical purposes on behalf of one person. This authorization was valid from July 28, 2017 until January 26, 2018. He was not authorized to possess, cultivate, produce, sell, provide, ship, deliver, distribute or transport cannabis for any other individuals.
[17] Mr. Cain also states that Mr. Howell’s activities “were carried out completely outside the regulatory regime designed to protect patients and the Canadian public.”
[18] Before the application, it was agreed that questioning of Dr. Ziburkus, Dr. Landolt, Eric Nash and Mr. Cain would be done by way of video link. At the application itself, Mr. Howell testified in chief and was then cross-examined. The Crown did not cross-examine Ms. Kirkman, Ms. Wilkinson, Mr. Jordan, Dr. Rosenbloom, or Dr. Gaetz on their affidavits.
Summary of Experts Eric Nash
[124] Mr. Nash provided an affidavit he swore on April 12, 2019. His opinions are based on his experience with Health Canada’s regulatory framework for the medicinal use, production, distribution and sale of cannabis and access to medical cannabis.
[125] Mr. Nash has extensive experience in the medical marihuana field, having been co-owner and principal of two medical cannabis-based businesses. From 2002 to 2014, he cultivated, distributed and sold cannabis for medical purposes to patients authorized by Health Canada as chief operating officer of a federally-licensed producer. That company had applied to become an LP in August 2013 and was issued a “Ready to Build” approval on February 24, 2014.
[126] His report relies to some extent on the testimony of a medical cannabis expert in the Allard, as well as his discussions and interviews with a large number of people. His opinions include that:
1. Some 700,000 Canadians use cannabis for medicinal purposes; 2. Some 60,000 Canadians have Personal use Production licences;
3. The price charged by Licensed Producers is based primarily on what the market will bear;
4. The current high cost is based on years of black-market prices;
5. Personal use production is “the best option for patients in securing an affordable, safe and consistent supply to meet their therapeutic needs”;
6. People who are unable for reasons of housing restrictions, health issues and other considerations require a designated grower to assist them; and
7. Designated growers can satisfy the individual patient’s needs, including consistency of product, strains and requirements such as the absence of pesticides and herbicides, although the primary benefit is financial.
[127] Mr. Nash estimated the cost of medical cannabis from licensed producers at $10.00 per gram, contrasted with $1.29 per gram or less for self-production or production by a designated grower.
[128] His affidavit speaks of him having spoken to “several hundred licensed patients and authorized growers” which has given him significant knowledge and insight into the marihuana access programs, patients, supply issues and the medical cannabis industry in Canada.
[129] He references recommendations made to Health Canada by the Canadian AIDS Society calling for lifting restrictions on designated producers, including the limits on the number of personal and designated growers per site.
[130] Mr. Nash says that in his opinion, “the MMAR, the MMPR and the ACMPR limit access for medical purposes by presenting significant barriers to many Canadians who benefit from using cannabis therapeutically by making commercially grown and sold cannabis as a medical product unaffordable”. He extends his opinion to the new Cannabis Regulations.
[131] Mr. Nash says that the barriers to access to medical marihuana through LPs include the requirement of many LPs that payment be by credit card or bank transfer (when many patients do not have such means of payment available); that many LPs operate only through the mail such that patients without a fixed address may have difficulties obtaining deliveries; that shipping costs are very expensive and in some cases prohibitively so; the scarcity of medical professionals prepared to prescribe cannabis; that shipping can damage the product; that the supply of various strains or hybrids may be interrupted and is inconsistent; that switching suppliers is time- consuming and often results in interruptions in supply; products are sometimes recalled or contaminated; and that LPs cannot distribute or sell cannabis edibles or concentrates other than diluted cannabis oil.
[132] He opines that Health Canada “has failed to address patient needs by supplying a range of safe and efficacious cannabis-based products to Canadian Medical patients.” He says that from his experience, “a very large percentage of Canadian patients are consistently denied legal access to medical cannabis due to prohibitive cost and unaffordability, administrative delays, inability to find a doctor to sign for legal access, continued stigma and prejudice towards the use of medical cannabis, and a myriad of regulatory burdens placed onto patients, doctors and legal home cultivators.”
[133] Mr. Nash gave evidence by video conference. His expertise to offer opinion evidence on the use, production and sale of medical marihuana was confirmed. He described growing marihuana as labourious and technically challenging but not particularly difficult. It is “tricky but forgiving”.
[134] He was cross-examined as to the basis for his beliefs and opinions, and confirmed that he had kept no records of these conversations by way of statistics or graphs. Issues like patients being denied authorizations come from the patients themselves, as do the anecdotal stories of difficulties finding a producer and people enquiring of him whether costs can be covered under “PharmaCare” (British Columbia’s subsidized prescription program).
[135] Mr. Nash did not differentiate between authorized or unauthorized medical marihuana users, or delve into the financial concerns expressed by people he spoke to. He referenced the time frame of 2002 to 2016 with respect to these various conversations. He expressed the view that since doctors prescribe marihuana, it should be paid for by health programs.
[136] The emphasis on his evidence related to the affordability of medical marihuana through LPs and the difficulty many people experience accessing medical marihuana through LPs. Dr. Carolina Landolt
[137] Dr. Landolt was qualified as an expert in cannabis, medical cannabis patient access and the management of complex chronic pain problems in patient and out- patient settings. She is an internal medicine specialist, as well as a rheumatologist. Her affidavit sworn April 15, 2019 describes a number of concerns about the medical marihuana system under the ACMPRs and previous regulations. She had been asked a number of questions by Defence Counsel, which were answered in her affidavit.
a) What role does trial and error play for a medical cannabis patient seeking medical cannabis that is effective for their condition [138] Her response described how not all cannabis strains have the same effects for a given patient such that strain selection is a “highly individualized and iterative process”. She said that initiating medical cannabis is a “gradual process which can require multiple iterations for many reasons including establishing the optimal method of consumption (and) correct dose…”.
b) In early 2017 and generally, how long did it take for the medical cannabis patients to receive cannabis from licensed producers? How long did it take for a medical cannabis patient to obtain a medical document and register with a licensed producer? And if a medical cannabis patient wanted to switch to a different licensed producer what would be required?
[139] Dr. Landolt described the various processes involved and problems created from fall 2015 to early 2017 by limited availability of various strains and products, limited supplies, successful strains being discontinued, short supply of oils, and delays with registration processes. She described registration delays of up to weeks. Switching suppliers was so time consuming that many patients were reluctant to change suppliers even if there were supply or quality problems.
c) What is important for various patients?
[140] Dr. Landolt dealt with patient classes who seemed to benefit most from medical marihuana, including those suffering from chronic pain, sleep disruption, fatigue, inflammatory bowel disease such as IBD, Crohn’s Disease and ulcerative colitis, seizure disorders such as epilepsy, and endometriosis.
[141] She also discussed the benefits from extracts such as oils, and problems encountered because of limitations on the amount of THC concentrations. Dr. Landolt also provided information on communications between patients and LPs, and difficulties caused by the general use of online ordering from LPs. She says that the need for computer access causes difficulties for patients with limited financial means, those with less formal education, older patients, disabled patients, and patients for whom English is a second language.
[142] Dr. Landolt notes that cannabis is the only medication that is exclusively purchased online without the benefit of a physical store. She also referenced privacy concerns expressed by some of her patients who had to share personal information with LPs. Dr. David Rosenbloom
[143] Dr. Rosenbloom’s affidavit of April 11, 2019 deals with pharmacy and pharmacology, the effect of delayed access to drugs and the purchase of drugs. His expertise was acknowledged. He was not cross-examined at the hearing.
[144] As with Dr. Landolt, he was asked a number of questions by Defence Counsel and his affidavit serves as his expert report. [145] Dr. Rosenbloom provided information on the importance of accessing medical cannabis on an uninterrupted and on-demand basis for pain patients, gastro-intestinal patients, autistic patients, ADD patients, Tourette’s patients, OCD patients, PTSD patients, patients with severe menstrual cramping, and children with severe seizure. He commented on studies which have found that cannabis users vs opiate users are less likely to experience respiratory depression and that cannabis use is associated with decreased opiate use. If access to cannabis is interrupted, that might push patients into using opioids.
[146] Inflammatory bowel disease patients may be unable to control their symptoms without cannabis and require hospitalization. Failure to take cannabis for seizure disorders could lead to a recurrence of seizures and could lead to a potentially fatal condition.
[147] With other conditions, Dr. Rosenbloom said that without cannabis, the patient’s symptoms would recur. He contrasted patient confidence in pharmacists (which is very high) to patient confidence in drug manufacturers (which is very low), noting that medical cannabis is purchased directly from the manufacturer. Dr. Jokubas Ziburkus
[148] Dr. Ziburkus was qualified as an expert in the endocannabinoid system, endocannabinoids, phytocannabinoids, cannabis plants and products, and the pre- clinical and clinical research on medical cannabis. His expert report is contained in his affidavits sworn April 15, 2019 and June 26, 2019.
[149] His evidence focused on the history of cannabis use for medicinal purposes, and technical aspects of extracting medicinal ingredients from the cannabis plant. Dr. Ziburkus notes that cannabis dosing “can be easier to achieve using cannabis oils, topical preparations, and even vaporizer ‘pens’.”
[150] Dr. Ziburkus says that high concentrations and inhalation may be necessary in diseases that have acute onset of conditions, such as migraines or seizures. These high concentrations can be potentially lifesaving. He described a number of studies involving cancer pain patients, tremors in Parkinson’s disease, and muscle spasms that affect the diaphragm. All of these demonstrated the benefits of high concentrations of THC.
[151] Dr. Ziburkus opines that “cannabis is safer than coffee” and that cannabis has the highest safety ratio of any common illicit substance such as heroin, alcohol or methamphetamine. It is also the least addictive of any scheduled drugs. He says there are zero reported overdose deaths from cannabis use.
[152] He also notes the difficulties some patients have taking cannabis oil because of the limit on THC potency. Some patients have difficulty swallowing, for others the carrier oils may be too caloric, and with others, absorption may be a difficulty. [153] Dr. Ziburkus describes “full spectrum CO2 extraction” and the potential use of neutral cannabinoid forms such as THCA.
[154] He describes the benefits of medical marihuana with patients suffering from autism, pain, gastro-intestinal issues, seizure disorders, ADHD, Tourette’s, OCD and PTSD.
[155] Dr. Ziburkus was cross-examined on his work with cannabis, including his involvement with a cannabis production company. He acknowledged that he was no longer researching, but was working to promote medical marihuana. He noted that social reform appears to be happening faster that scientific research.
[156] He emphasized that the medically beneficial substances in the cannabis plant are the components that do not cause the high or psychotropic effect. Much of the scientific work is to remove those elements, which cause concerns for medical practitioners, especially with children.
[157] Crown counsel asked a number of questions about safety issues, vaping, children ingesting edibles, addiction, and brain development. Dr. Ziburkus opined that benefits from the use of medical cannabis clearly outweighed any risks. Harrison Jordan
[158] Mr. Jordan is an Ontario lawyer. His affidavit of April 15, 2019 is based on his personal knowledge of information related to Canadian licensed producers of medical cannabis, their pricing of cannabis, as well as changes to pricing and policies.
[159] He conducted research of LPs relating to shipping times, same day deliveries, strain availability, oil availability, and minimum purchase orders in effect around March 24, 2017. His findings from this research described how the mail order medical cannabis system operated at the time in a step by step way:
1. The patient must obtain a medical document from a licensed medical practitioner following a visit with that practitioner;
2. The patient must then send the medical document to an LP;
3. To obtain medical cannabis from a second or third LP, a new medical document from a licensed medical practitioner must to be obtained for each new LP and sent to that LP;
4. Patients could purchase dried cannabis, cannabis oil or capsules if available, at a quantity of no more than 30 times their daily limit; and
5. Medical cannabis could only be delivered to the patient’s residence or to the prescribing medical practitioner’s office.
[160] Mr. Jordan then described a number of problems with the system, including: 1. Delays caused by the time taken by the patient to find a medical practitioner willing to prescribe cannabis, getting in to see that medical practitioner, and getting the necessary medical document;
2. Delays caused between the patient sending the medical document to a LP, the LP verifying the medical document with the patient and the doctor, and then registering the document with Health Canada;
3. Delays in switching LPs, which required going back to the medical practitioner;
4. Limited availability because there were only 39 LPs in Canada, 26 of whom were licensed for production and sale, and only 16 of whom were selling cannabis oil products;
5. Limited availability as some of the LPs were showing “out of stock” for some products on their websites;
6. Limited availability of cannabis oil and small container sizes;
7. Limited information on extraction methods;
8. Unavailability of oil other than in edible form;
9. High prices caused by minimum order requirements, taxation and shipping costs;
10. Limited “compassionate” pricing programs;
11. Shipping problems and shipping times; and
12. Shortages in recreational cannabis supplies as an alternate source. Stephen Gaetz
[161] Dr. Gaetz was qualified as an expert in homelessness, precarious housing, matters related to homelessness and precarious housing, and services for those of modest means.
[162] His affidavit sworn June 21, 2019 provides his report. He described the income available to Albertans in March 2014 under the Alberta Income and Employment Supports program, as well as under the Assured Income for the Severely Handicapped program. Dr. Gaetz also provided statistics on homelessness and “precarious” housing (not affordable, over-crowded or substandard).
[163] Dr. Gaetz’s affidavit includes statistics on the prevalence of disabilities among the homeless and those living in precarious housing. He also provided information on the increased likelihood that such persons would not have credit cards, or a bank account, or access to computers. For people living in shelters, there may be limitations on their ability to smoke. Dr. Gaetz described the difficulties such persons have in getting mail
[164] His affidavit also provided information on the incidence of domestic violence in Canada, and that domestic violence often forces victims and family members into shelters and homelessness.
[165] Dr. Gaetz was not cross-examined.
Todd Cain
[166] Mr. Cain’s affidavit affirmed October 1, 2019 was submitted on behalf of the Crown. His evidence was presented as fact evidence. Mr. Cain is the Director General of the Licensing and Medical Access Directorate of the Controlled Substances and Cannabis Branch of Health Canada. His duties in that capacity include managing the licensing, registration and client service functions under the Cannabis Act and its regulations. Before the regulations under the CDSA were repealed, he had similar responsibilities under the ACMPRs. Prior to his present position, Mr. Cain was the Director General of Organization and Launch Directorate of the Cannabis Legalization and Regulation Branch at Health Canada.
[167] His affidavit describes the history of the legalization of medical marihuana in Canada and the progression of regulations from the MMAR 2001, MMAR 2003, MMPR, the ACMPR, and the Cannabis Regulations.
[168] He discusses the Government purpose behind the various regulations and the changes made as a result of the various court decisions that struck down portions of them.
[169] Mr. Cain discusses the changes from the MMAR and MMPR regimes to the ACMPR, which were in effect at the time Mr. Howell was charged. He describes the process for individuals to access medical marihuana from an LP. He notes that the ACMPR allowed for the production and possession of cannabis oil and not just dried marihuana.
[170] From the Health Canada records available to him, Mr. Cain says that as of March 2017 there were 374 health care practitioners in Alberta who had prescribed medical marihuana. There were 2,695 health care practitioners who had done so in Canada.
[171] He described the process to become an LP and the rationale for the requirements necessary to become licensed. Applicants were required to provide detailed descriptions of the physical security measures for the site, how records will be kept, quality assurance procedures, notices to local authorities, and a floor plan of the site. Applicants were required to pass security clearance. Licensing could be refused if there was false or misleading information in the application, if information was received that the applicant had been involved in the “diversion of a controlled substance”, if there would likely be a risk to public health, safety or security, including diversion, or for security clearance purposes.
[172] Good production practices were required to be followed relating to cleanliness of the facility, employment of skilled personnel, testing practices and procedures, and ensuring the quality of the product (being free from unacceptable solvents and residues).
[173] Mr. Cain’s affidavit discusses the growth of LPs since they began under the MMPR in 2013. He describes the “vast list of offerings and strains” available in 2017 from the then 12 LPs. Mr. Cain also discusses the services offered by the LPs to make medical marihuana available. He notes that while shipments were to be delivered to the patient’s ordinary place of residence, they could also go to the individual’s health care practitioner or even shelters and other organizations providing social services to the individual.
[174] Mr. Cain describes measures taken by some LPs to assist financially disadvantaged patients, as well as payment options including pre-paid credit cards and money orders.
[175] He says that Health Canada’s data shows that the system under the ACMPR has met the demand, based on key indicators such as the number of shipments, the number of client registrations and the amount of inventory.
[176] Mr. Cain notes that in May 2017, Health Canada streamlined the application process for issuing production licences to increase production of medical cannabis, and that within 12 months, an additional 61 commercial licences had been issued.
[177] He states that “past inventory levels show that licensed producers held sufficient inventory to meet the demand for cannabis for medical purposes.” LPs were supplying 201,398 patients in the first quarter of 2017-2018, which grew to 354,538 patients by the fourth quarter of 2018-2019.
[178] Health Canada’s figures show that the average cost of medical marihuana from LPs was $9.17 per gram of dried cannabis, compared to $8.84 on the black market.
[179] Mr. Cain says the average daily dose per registered user was 2.3 grams.
[180] Based on those averages, he says that the “average monthly cost of cannabis for medical purposes would be approximately $660.24.”
[181] Mr. Cain also provides information about licensing under the ACMPRs for personal production, including production by designated producers. Under the application process, individuals could get registration certificates allowing them to obtain cannabis from an LP while they waited for their first crop to mature, or in the event of a crop failure. From Health Canada’s records, in June 2017 there were 6,797 individuals with active and valid registrations allowing them to produce cannabis for themselves or to obtain cannabis from a designated person.
[182] Mr. Cain explains the restrictions on registrations per person as well as per production site. These were introduced to provide for “some control on the size of cannabis for medical purposes production operations and to reduce the risk of diversion to the illicit market and other risks to public safety.” The change of the number of people a designated grower could grow for following Hitzig (1 to 2) and the change to the number of registrations per site following Beren (3 to 4) were intended to preserve the intent of the regime, which was “to permit the production of small quantities of cannabis and was not intended to regulate large production operations.”
[183] The prohibition against derivatives prior to the ACMPRs was safety related because of the potential impact of highly concentrated products and accidental consumption by children. Over-intoxication was also a concern. Under the ACMPR, derivatives were permitted as long as they were not created using organic compounds that were highly flammable, explosive, or toxic. CO2 extraction was generally permitted.
[184] Concentrations of THC were limited to 30 mg per mL and the content of capsules was limited to 10 mg, because higher concentrations have not been shown by Health Canada testing to be consistent with a therapeutic effect without undue risk to the patient’s health, and to reduce the risk of overconsumption.
[185] His review of Mr. Howell’s licensing applications shows:
1. An application on October 30, 2013 on behalf of Canruderal Inc to become an LP;
2. Applications in April and May 2014 that were refused; and
3. A new application received July 14, 2014 which remains on hold because Mr. Howell has not taken steps to migrate his application to Health Canada’s online system and to provide information required under the Cannabis Act.
[186] Mr. Cain says that from his review of Health Canada’s records, Mr. Howell has never held a commercial cannabis production licence under the MMPR or the ACMPR.
[187] Mr. Cain provided a second affidavit, sworn October 17, 2019 providing information on the ability of persons requiring cannabis for medical purposes outside of the parameters of the ACMPR. He notes that such person could apply to the Minister for an authorized individual discretionary exemption pursuant to section 56 of the CDSA. Health Canada records indicate that from June 2016 to March 2017 28 such exemptions were issued, including exemptions relating to the importation of specialized cannabis products.
Conclusions on the evidence
[231] Most of the evidence put forward by the Defence was unchallenged by the Crown. Some of it, such as the fact that homeless people may have difficulties getting deliveries to their residence, or some doctors may not be comfortable having marihuana sent to their offices for homeless patients, or that people with limited financial resources may have difficulty purchasing medical marihuana at the cost estimated by either Mr. Nash or Mr. Cain, are matters that the Court can take judicial notice of (see, R v Spence, 2005 SCC 71).
[238] The totality of the evidence leads me to a number of fact findings. I will focus mainly on the ACMPR and the period from April 2016 when Mr. Howell began to supply marihuana to Lisa Kirkman to March 2017 when he was charged. I make the following fact findings:
1) the medical marihuana system under the ACMPRs did not result in a perfect system of economic, efficient and consistent supply of medical marihuana to patients;
2) Health Canada had been responsive to concerns about the effectiveness of the earlier medical marihuana regulations and made sincere efforts to make them constitutionally valid;
3) Marihuana provides health benefits to many people, sometimes life-changing benefits;
4) For some persons, the health benefits depend on the strain of marihuana, the manner of dosage (smoking, vaping, ingesting, topical application) and the concentration of THC in the product they use;
5) For persons with complicated medical issues, persons who require a consistent source of the type of marihuana they require, and for people who require specialized products such as high concentration oil or extracts, personal production is the most economical way of sourcing the marihuana they need;
6) LPs do not adequately serve the homeless (because of issues including the residential delivery requirements, on-line registration and purchasing, the need for computer access, the lack of computer skills, the lack of fluency in English or French, and payment requirements (such as bank accounts and credit cards));
7) Medical marihuana accessed through LPs is expensive and beyond the financial means of many people requiring medical marihuana;
8) Where personal production is an option, many people are unable to grow marihuana themselves because of disabilities, skills, finances, and a site the can use;
9) While the designated grower provisions are intended to address this issue, there are people who are unable (for a variety of reasons, including lack of family and friends, remote locations, and finances) to find a designated grower;
10) Some people had difficulty finding a medical practitioner willing to prescribe medical marihuana in general;
11) Some people experienced delays in getting an access permit because of waiting times to see a medical practitioner;
12) Some people experienced delays in the registration process with Health Canada;
13) Some people experienced delays in the registration process with LPs;
14) Some people experienced problems with LPs because of a lack of choice of products, unavailability of the products they needed, delays in changing LPs;
15) Some people have no legal access to the products that benefit them the most, such as high concentration THC oil and extracts;
16) Mr. Howell began growing large quantities of marihuana without any proper licensing;
17) Mr. Howell’s production practices were consistent with the Health Canada requirements respecting quality control and quality assurance and he was producing good quality marihuana and extracts;
18) Mr. Howell began to supply marihuana to Sarah Wilkinson and her daughter and to Lisa Kirkman and her son, not being their registered designated grower; 19) None of Ms. Wilkinson, her daughter, Ms. Kirkman or her son, had an authorization to possess medical marihuana under the ACMPR during the period April 2016 to March 2017; and
20) Production of high concentrate cannabis oil and extracts by Mr. Howell was not authorized under the ACMPR.
[245] The system under the ACMPR to obtain medical marihuana from an LP fails to provide a timely, reliable source of affordable medical cannabis of the nature required by some people. Interruptions to access to the needed medical cannabis can result in serious impacts on some persons, including returning to the use of opiates, as well as exacerbation of existing conditions.
[246] Second, according to Mr. Howell, cooperative growing should not be prohibited, as the prohibition provides a significant barrier to access to medical cannabis for many people. In his view, Hitzig, Sfetkopoulos, Beren and Allard all support the constitutionality of medical cooperative growing. 259] The Crown notes that the ACMPRs do not prohibit a cooperative marihuana growing operation as the ACMPR does not mandate any particular business structure. The Crown says that Mr. Howell did not need to apply for an LP to personally supply marihuana to as many as 8 people if he joined with three other designated growers.
[290] I am also satisfied from the evidence of Mr. Howell, Ms. Wilkinson, Ms. Kirkman, and Dr. Ziburkus that concentrations of higher than 30 mg/mL THC in cannabis oil or extracts can provide superior results than less potent concentrations in some patients.
[291] There was no evidence put forward on behalf of the Crown as to why high concentrations such as those described by Mr. Howell for use by Ms. Wilkinson and her daughter, and by Ms. Kirkman and her son, or by Dr. Ziburkus, are impermissible. Dr. Ziburkus says in his affidavit: ...Quick access to high concentrations of THC, such as in shatter which can reach 80-90% THC, can be potentially lifesaving in the cases of sever epilepsies and life-threatening seizures.
[292] There was no evidence to the contrary.
[293] My conclusion is that both liberty and security of the person are impacted by the limitation on THC concentration [298] Dr. Goetz’s evidence is uncontradicted in this case that the home delivery requirement denies access to the homeless. There was evidence that many medical practitioners will not allow their offices to be the mailing address for medical marihuana prescribed for their patients. That also denies access to homeless patients of those patients. While shelters may be used, there is evidence (and I can also take judicial notice) that there are many people living “rough,” many people who do not like shelters or social service agencies because of restrictions on drug and alcohol use. There is no evidence before me as to why medically-prescribed marihuana should not be as available to patients as with other prescription drugs
333] The access regime under the ACMPR still required on-line ordering from LPs. That creates difficulties for people without computers or access to computers. But there are free computers in many public locations like libraries. There are numerous social service agencies set up to help the homeless and people without the skills or language capabilities to complete applications for disadvantaged people. People with the disadvantages and disabilities described in the Defence evidence have the same difficulties access basic human needs
336] I do see a difficulty with the requirement that medical marihuana from an LP must be shipped to a residential address (or doctor’s office or shelter). I am not aware that prescription drugs, including narcotics, are similarly restricted in how a pharmacist can get them into the hands of the patient. That was a problem flagged and identified in the evidence relating to homeless people and people with precarious housing.
[337] With the exception of restricting delivery of medical marihuana by LPs to the patient’s residence, or health care practitioner, or to a shelter, I do not see the other problems with access identified in the evidence as constituting such an unreasonable barrier to access as to constitute a section 7 violation.
[345] Here, there was no reason or justification articulated by the Crown in these proceedings as to why the home delivery restriction was considered necessary. If pharmacists can mail out prescribed narcotics to post office boxes or business addresses, what is the rationale for prohibiting regulated medical marihuana from being distributed in a similar fashion.
[346] My conclusion is that the delivery restrictions in the ACMPRs are arbitrary. That said, this finding may not influence LPs as to how they choose to get their products into the hands of their customers. Like having retail outlets, it is likely beyond governmental power to dictate to a private enterprise how many outlets it must have. The marketplace generally makes those determinations, but for local zoning restrictions [348] That may not be the kind of cooperative that the Defence contemplates, but there would appear to be no reason under the ACMPR prohibiting charitably- minded people from applying to become LPs. They would have the ability to sell their products at the prices they choose, and presumably could find legitimate ways of employing many of their customers who are medical cannabis users to work for the LP in some capacity. Cannabis as an Alternative to Opiates and More Dangerous Drugs on the Downtown Eastside
WHEREAS
1. In 2015, following several days of Public Hearings, Vancouver City Council approved licensing rules for medical-cannabis dispensaries, including the creation of an exclusion zone in the Downtown Eastside where marijuana sales are prohibited except for sites with a property line on Hastings Street or Main Street;
2. The City’s intention in creating an exclusion zone in the Downtown Eastside in 2015 was to limit the proximity of dispensaries to youth and vulnerable populations;
3. On October 17, 2018, the federal Cannabis Act came into effect, making recreational cannabis legal in Canada;
4. Prior to the October 17, 2018, legalization of cannabis in Canada, i.e., in June 2018, the federal government passed the bill to legalize recreational cannabis in Canada, leading the provincial governments – including B.C. – to implement new regulations for cannabis businesses to operate, and leading the City of Vancouver to update its Zoning and Development and License by-laws to ensure that Vancouver cannabis retailers operate in adherence to all regulations;
5. On December 20, 2018, a Special Meeting of Vancouver City Council was held for the purpose of receiving a report from the Mayor’s Overdose Emergency Task Force and to consider recommendations for immediate action on the overdose crisis – recommendations Council unanimously supported;
6. On April 14, 2019, the City of Vancouver marked “the 1090th day since B.C. declared the increase in overdose deaths as a public health emergency” by declaring that the City would “fly the city’s flag at half-mast on this day each year until B.C.’s provincial health officer rescinds the current state of public health emergency.”;
7. Since April 14, 2016, more than 3,600 people have lost their lives to overdose in B.C., with more than 1,000 of these deaths occurring in Vancouver, driven by an increasingly toxic, unregulated drug supply that is contaminated by fentanyl, carfentanil, and other contaminants;
8. Recent scientific findings have raised the possibility that cannabis might have a beneficial role to play in the overdose crisis, with preliminary evidence linking cannabis to reductions in the risk of experiencing drug-related harms, notably Standing Committee of Council on City Finance and Services Minutes, June 26 and 27, 2019 21 through research conducted by UBC Professor M-J Milloy which showed that among 2,500 hard drug users in the Downtown Eastside, cannabis helped 20 per cent to stay with treatment after a six-month period;
9. Vancouver City Council and the City of Vancouver generally support the exploration of studies related to the opioid overdose crisis facing the city and the role of cannabis in potentially addressing the situation, including two related actions in the Mayor’s Emergency Overdose Task Force currently underway;
10. The CBC quotes Dr. Keith Ahamad, Medical Director for the Regional Addiction Program at Vancouver Coastal Health, an addiction medicine clinician at St. Paul’s Hospital, and a clinical researcher with the B.C. Centres on Substance Use, as stating that the Downtown Eastside exclusion zone makes no sense from a public health point of view and that the City’s “… current drug policy… is obviously not working and actually worsening harm. It’s literally bad drug policy.”;
11. Health workers, addiction experts, and others working on the frontlines of the Downtown Eastside have reported that the situation on the Downtown Eastside has become much more dire since 2015, and have suggested that the exclusion zone created by the City of Vancouver in 2015 has only served to further stigmatize the Downtown Eastside instead of protecting its vulnerable population, leaving people at the epicentre of the opioid crisis with no low-cost, legal options if they want to use cannabis as an alternative to more dangerous drugs;
12. High Hopes Social Enterprise (HHSE), an organization that seeks to increase the general well-being of the DTES community and support the sustainability and resilience of its community and residents, has identified a need to enable lowcost, legal cannabis options on the Downtown Eastside for the most vulnerable people situated at the epicentre of the opioid crisis, people who may want to use cannabis as an alternative to more dangerous drugs but cannot afford market retail prices as stipulated by the province; 13. The Vancouver Overdose Prevention Society and High Hopes Social Enterprise (HHSE) make note of support for low-cost, legal cannabis options on the Downtown Eastside (potentially on the model of a community cannabis store with a social enterprise and research focus), from, among others:
• Professor Evan Wood, MD, PhD, FRCPC, ABAM Dip, FASAM; Professor of Medicine, UBC; Canada Research Chair in Inner City Medicine; Director, British Columbia Centre on Substance Use; and Executive Director of the British Columbia Centre on Substance Use (BCCSU);
• Professor M-J Milloy, PhD, Canopy Growth professor of cannabis science, Assistant professor, Department of Medicine, University of British Columbia; Research scientist, British Columbia Centre on Substance Use; New Investigator, Canadian Institutes of Health Research; Scholar, Michael Smith Foundation for Health Research; and
• Dr. Mark Tyndall, Executive Medical Director BC Centre for Disease Control;
14. All cannabis retail stores require a Provincial licence to operate and are regulated and enforced by the BC Liquor and Cannabis Regulation Branch under the Cannabis Control and Licensing Act; 15. There are currently four cannabis retail locations in the Downtown Eastside with approved Development Permits, all of which will be eligible and expected to apply for a provincial cannabis retail licence to operate as legal cannabis stores:
• 529 E Hastings Street (Hastings and Jackson St); • 151 E Hastings Street (Hastings between Main and Columbia); • 369 Columbia Street (Hastings and Columbia); and • 231 Abbott Street (Abbott and Cordova);
16. In order for the four cannabis retail locations noted above, all of which have received Development Permits from the City, to proceed to the license application phase with the provincial government, they will be required to close with no guarantee that they will be granted a license or any clear indication as to the timeframe for any license that may ultimately be issued, leaving the Downtown Eastside without any retail cannabis locations for those who may wish to use cannabis as an alternative to more dangerous drugs;
17. Despite the legalization of recreational marijuana in Canada, and regulatory structures in place provincially and at the City of Vancouver, there does not appear to be a regulatory option available that would enable low-cost, legal cannabis (potentially on the model of a community cannabis store with a social enterprise and research focus) for the Downtown Eastside and its most vulnerable residents who may want to use cannabis as an alternative to opiates and more dangerous drugs; and
18. The City of Vancouver’s recent April 14, 2019 News Release (“Vancouver mourns the lives lost to overdose on third-year anniversary of B.C.’s public health emergency”) states: “The City is committed to addressing the issues that further exacerbate the struggles around substance use. A comprehensive approach to illicit substance use including prevention, harm reduction and treatment, will save so many lives. We call upon health professionals, all levels of government, and the public to join us in advocating for a safe drug supply, in Vancouver and elsewhere in Canada, to protect residents and prevent any more unnecessary deaths”.
THEREFORE BE IT RESOLVED
A. THAT Vancouver City Council direct staff to make recommendations to Council with respect to Section 11 of the City of Vancouver Zoning and Development By-law with proposals on how this zoning by-law could be amended to allow well-considered exceptions to the City’s current prohibition on Cannabis Stores in the Downtown Eastside exclusion zone, consistent with the City’s commitment to a comprehensive approach to illicit substance use, including prevention, harm reduction;
FURTHER THAT Vancouver City Council direct staff to engage with the Liquor and Cannabis Regulation Branch (LCRB) to indicate Vancouver City Council’s interest to address unintended aspects of the City’s current Zoning and Development By-law as it pertains to facilitating well-considered exceptions to Standing Committee of Council on City Finance and Services Minutes, June 26 and 27, 2019 23 the City’s Zoning and Development By-law in relation to cannabis Stores in the city, as well as engagement around the province’s regulatory processes for licensing cannabis retail stores; and
FURTHER THAT Vancouver city council direct staff to engage with VANDU and people who use drugs to consider what kinds of laws are best for implementing their needs around cannabis.
B. THAT Vancouver City Council direct staff to make recommendations to Council with respect to regulatory options and potential pathways that could enable lowcost, legal, medicinal cannabis options for the Downtown Eastside (potentially on the model of a community cannabis store or compassion club with a social enterprise, medicinal, and research focus; consistent with Health Canada’s Access to Cannabis for Medical Purposes Regulations) for those people who may want to use cannabis as an alternative to opiates and more dangerous drugs but cannot afford the market retail prices stipulated by provincial regulations for a cannabis retail store, as well as enabling and supporting ongoing research and data collection into the potential relationship and benefits of cannabis on the reduction of opioid use, associated harms and overdoses.
C. THAT the Mayor on behalf of Council write to The Honourable Ginette Petitpas Taylor, Minister of Health expressing an interest in supporting a clinical research program to supply and study medicinal cannabis as an alternative to opiates and more dangerous drugs on the Downtown Eastside, pursuant to Mayor’s Overdose Emergency Task Force and Recommendations for Immediate Action on the Overdose Crisis, item F. Secure Space for a Clean Supply project. From: John Conroy To: Bligh, Rebecca Cc: Danielle Lukiv; Conor Doherty; Neil Magnuson Subject: RE:The Healing Wave and the Serious Hope Society Cannabis Substitution Project Date: Monday, August 31, 2020 12:10:17 PM
Thanks Rebecca,
I am including a link to interviews conducted with the many addicted persons and patients attending and dependent upon The Healing Wave and Serious Hope Society Cannabis Substitution Project to address their opiate addiction issues. These are some of the people who will suffer if the project is shut down as well as all the hard to reach and those who are too ashamed to be on camera. https://www.dropbox.com/s/el1bza0wmzztroe/CSP%20Update%20Collection%20- %20Dec%202019%20to%20July%202020.mp4?dl=0
Also, a link to a recent article indicating Health Canada has approved a storefront (medical sales only) in Brockville Ontario and the article indicates there are now 3 in Canada. The BC Compassion Club Society application is still in process. https://www.recorder.ca/news/local-news/medical-pot-shop-opens-downtown
This is the federal license the Healing Wave and/or the Serious Hope Society will need to obtain together with a legal supply hopefully via the BC Craft Co-Op and with a Nurse Practitioner on staff but there are and will still be difficulties reaching the target group who are ashamed, getting opiates from their doctors and paid for by MSP or other insurance (still rare) or have gone to the street because their doctor cut them off and /or insurance won’t cover, to name just a few of the ongoing barriers to reaching this particular group. Low barrier will need special exemptions to reach this group at least initially.
Hopefully licensing (and Landlord)will hold off and see the benefits of this project continuing as a lesser evil(no license) while endeavoring to save lives(the greater evil) while we continue, openly instead of underground, to try all legal means to bring the Project into a legal situation.
Please let me know if you need anything further from the Society, to assist your efforts,
John
John W. Conroy QC Conroy & Company Barrister & Solicitor 2459 Pauline Street Abbotsford, B.C. Canada V2S 3S1 Webpage: www.johnconroy.com Email: [email protected] Tel: (604) 852 5110 Fax: (604)859 3361
From: Bligh, Rebecca
Hi there John,
Following a number of conversations I have had with staff last week, I feel I can provide an update on the work City staff have done in speaking with senior government about the Healing Wave’s situation, in advance of a formal reply from staff.
According to staff, their conversations with provincial regulators did not provide a framework for a licensing exemption that would apply to the Healing Wave and Cannabis Substitution Project. Furthermore, the federal government has no plans to reopen the Cannabis Act for a review until 2023, and therefore any dialogue regarding amending any of it’s regulations or limits is a non-starter. From the City’s perspective, our local bylaw framework follows the federal led cannabis strategy, and therefore staff don’t see a path forward for action on their part.
The main issue for the City is that the Healing Wave’s new location is a storefront out of which is sold illegal cannabis, and that therefore the City is unable to enact a licensing exemption under law.
I appreciate that Neil and the Healing Wave were encouraged by my motion to move to a permanent location in advance of working with the City, but since staff is yet to report back on my motion and recommend any action the City can take, it technically remains an illegal occupation of the space, and unfortunately there don’t seem to be any avenues that staff have identified to make an exemption. Though this is disappointing, I hope over the coming weeks to continue to work with staff to ensure that the medical service the Cannabis Substitution Project provides is valued as a priority. Staff have planned an update to Council on their work for the motion in November, but for now any regulatory changes in the immediate future remain uncertain.
I am pleased to see that the Healing Wave’s situation has been brought to the immediate attention of the City, and at present, I have not heard of any immediate plans of enforcement from our City office. I will be following further action by the City closely as staff send their formal response, and I look forward to your response and feedback.
Rebecca
Councillor Rebecca Bligh CITY OF VANCOUVER 453 W. 12 Ave., Vancouver, BC V5Y 1V4 E: [email protected] P:604-873-7249 Twitter @rebeccaleebligh
Assistant Sarah Basi E: [email protected] T: 604-871-6712
From: John Conroy [mailto:[email protected]] Sent: Tuesday, August 25, 2020 3:57 PM To: Neil Magnuson; Bligh, Rebecca; Conor Doherty Cc: Danielle Lukiv Subject: [EXT] RE: FW: Magnuson Letter to Councillor Bligh
City of Vancouver security warning: Do not click on links or open attachments unless you were expecting the email and know the content is safe.
Thank you very much John
From: Neil Magnuson
Thank you!
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From: Bligh, Rebecca
Just heard back from staff, there is a meeting with the province and licensing tomorrow. I expect to hear an update after that. Worst case we can use a letter from me that is advocating for the landlord to stand down while we navigate this process, best case the letter can come from the city.
More to follow when we hear back from staff.
Rebecca
Councillor Rebecca Bligh CITY OF VANCOUVER 453 W. 12 Ave., Vancouver, BC V5Y 1V4 E: [email protected] P:604-873-7249 Twitter @rebeccaleebligh
Assistant Sarah Basi E: [email protected] T: 604-871-6712
From: Neil Magnuson [mailto:[email protected]] Sent: Tuesday, August 25, 2020 2:33 PM To: John Conroy; Conor Doherty Cc: Bligh, Rebecca; Danielle Lukiv Subject: [EXT] Re: FW: Magnuson Letter to Councillor Bligh
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Just met with the landlord, they still have not heard from the city. He suggested that perhaps you could communicate to him the conversation you had with coucelor Bligh and her comments regarding not moving against them or us while we navigate licences.
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From: John Conroy
Conor, If you sent me anything last week, I did not receive it. Hoping to get something before this Friday that we can share with the Landlords and their lawyer. Looking forward to hearing from you. John
John W. Conroy QC Conroy & Company Barrister & Solicitor 2459 Pauline Street Abbotsford, B.C. Canada V2S 3S1 Webpage: www.johnconroy.com [johnconroy.com] Email: [email protected] Tel: (604) 852 5110 Fax: (604)859 3361
From: Conor Doherty
Hi there John,
Thank you for your letter and your various relevant documents, which will be extremely helpful in our advocacy on this issue. As an update, I will be writing a letter with Cllr. Bligh to staff, inquiring as to any current plans to enforce the eviction notice or licensing issue, and request whether any enforcement measures can be delayed while your legal advice and work with the federal and provincial government is pending. The letter will highlight the specifics of the Serious Hope Society and Healing Wave's current situation, with the hope that we will be able to receive a favourable response from staff that allows your operations to continue as you work with senior government to resolve the licensing discrepancies.
Feel free to forward on any follow up or questions you may have! We will make sure to have this letter sent out by end of day tomorrow, and will make sure you are CC'd.
All the best,
Conor Doherty.
On Fri, Aug 14, 2020 at 4:13 PM John Conroy
John W. Conroy QC Conroy & Company Barrister & Solicitor 2459 Pauline Street Abbotsford, B.C. Canada V2S 3S1 Webpage: www.johnconroy.com [johnconroy.com] Email: [email protected] Tel: (604) 852 5110 Fax: (604)859 3361
-- Conor Doherty M 778 886 6902 From: John Conroy To: Bligh, Rebecca Cc: Neil Magnuson; Danielle Lukiv Subject: RE: EVICTION of the Healing Wave and Cannabis Substitution Project Date: Thursday, September 10, 2020 4:41:15 PM Attachments: Edibles Program.docx
Thanks Rebecca,
Copying Neil and suggest he show the landlord your email, so they see something is in the works. I am attaching a supportive letter from a Registered Psychiatric Nurse familiar with the Project that confirms it is saving lives and I hope to have something from Dr. Milloy soon as well and will forward. I have also spoken to the proprietor of the Completely Cannabis medical store in Brockville Ontario and have confirmed it has a Federal license to sell cannabis for medical purposes (no provincial rec license) and has a micro production license so is setting up to produce their own that authorized ACMPR patients will be able to purchase as legal cannabis. He can also obtain (but keep separate from the micro product by having 2 vaults at considerable cost) samples from existing LP's that patients come in and get advice about and can be ordered for them from the LP. This is the type of license but with some modifications by federal s.140 exemptions that the Healing Wave will apply for like the BC Compassion Club pending application. Hoping to hear from you again soon,
John
John W. Conroy QC Conroy & Company Barrister & Solicitor 2459 Pauline Street Abbotsford, B.C. Canada V2S 3S1 Webpage: www.johnconroy.com Email: [email protected] Tel: (604) 852 5110 Fax: (604)859 3361
-----Original Message----- From: Bligh, Rebecca
Hi John,
I have been in touch with Kathryn and Sadhu and asked them both to speak with the City licensing office in order that you receive a statement as soon as possible on the current situation. Kathryn is out of the office at the moment, but I have sent a follow up to Sadhu emphasizing the urgency. I am fully supportive of your efforts and appreciate your frustrations given a potential impending eviction, and will work further with them both to ensure you have the most up to date information. I will also be drafting and sending a formal letter of support to staff on this issue that The Healing Wave and others in the community have been facing.
Best,
Rebecca. Rebecca Bligh Councillor, City of Vancouver
Sent from my iPad ______From: John Conroy [[email protected]] Sent: September 8, 2020 2:03 PM To: Bligh, Rebecca; Conor Doherty Cc: Danielle Lukiv; Neil Magnuson Subject: [EXT] RE: EVICTION of the Healing Wave and Cannabis Substitution Project
City of Vancouver security warning: Do not click on links or open attachments unless you were expecting the email and know the content is safe. ______May we please have a reply to this as soon as possible. As you know the Landlord has terminated the lease effective August 31st,2020 simply because of the City Licensing letter and position and no other. The tenant is now overholding and the Landlord visited again today and says they promised the City they would do this and says he has to be out in a couple of days unless we get something from the City to his lawyer. I attached the letter from the law firm and eviction notice to you in my last email to you. Is the Licensing department prepared to hold off on enforcement while we endeavor to transition this life saving project, through the federal and then City legal requirements and to advise the Landlord accordingly? We urgently need something from the City that says it will temporarily hold off on licensing enforcement while the project is transitioning.
John W. Conroy QC Conroy & Company Barrister & Solicitor 2459 Pauline Street Abbotsford, B.C. Canada V2S 3S1 Webpage: www.johnconroy.com [johnconroy.com]
From: John Conroy Sent: Thursday, September 03, 2020 4:09 PM To: 'Bligh, Rebecca'
Dear Councillor Bligh and Conor Doherty,
I regret to advise that I have just received a text from Neil Magnuson indicating that his landlord just came and met with him and said that his lawyer is going to go to court to get a court order on Monday to evict them, unless they hear from the City before that they are going to or are prepared to hold off on enforcement while we try to obtain the federal license. So we need to get a letter from someone, if at all possible ASAP!
It sounds like the staff have misunderstood the situation as the review of the Cannabis Act is set for October 2021 and not 2023 and what we will be seeking is not dependent upon that review. We are seeking Federal licenses to sell medical cannabis only and with a license to do research and development and to and with the member/patients only and with a Federal temporary s. 140 exemption from certain aspects of the licensing and distribution requirements due to the nature of the clientele including their homelessness, medical and mental health issues and poverty and the nature of the high-end products required in fighting the opiate and meth crisis.
Apparently, the federal government has licensed three such medical storefronts, according to the article I sent you the other day and I am looking into those circumstances.
The province has no role to play as this is not a retail store distributing cannabis for recreational or social purposes.
If we get the federal license and exemption then the City will have a role to play in licensing hopefully as a form of Compassion Club but at least a Medical store that may require a new definition under the City by law.
This Project is helping prevent people from dying. If they are evicted there is going to be an outcry by at least 1000 patients and their supporters. Not having a City license is surely a minor transgression or evil compared to the evils that will befall those who lose access to a non-lethal product in substitution for a lethal product.
May we please hear from you before Monday that the City is willing to hold off on licensing enforcement and certainly not blame the landlord or hold him to any former promises to evict so long as we are making a genuine effort to transition this unique altruistic not for profit effort that is indisputably assisting in reducing the number of deaths in the opiate crisis in the Downtown Eastside of Vancouver that have been happening in greater numbers than Covid!
Where are the City’s priorities?
John W. Conroy QC Conroy & Company Barrister & Solicitor 2459 Pauline Street Abbotsford, B.C. Canada V2S 3S1 Webpage: www.johnconroy.com [johnconroy.com]
From: Bligh, Rebecca
Hi there John, Following a number of conversations I have had with staff last week, I feel I can provide an update on the work City staff have done in speaking with senior government about the Healing Wave’s situation, in advance of a formal reply from staff.
According to staff, their conversations with provincial regulators did not provide a framework for a licensing exemption that would apply to the Healing Wave and Cannabis Substitution Project. Furthermore, the federal government has no plans to reopen the Cannabis Act for a review until 2023, and therefore any dialogue regarding amending any of it’s regulations or limits is a non-starter. From the City’s perspective, our local bylaw framework follows the federal led cannabis strategy, and therefore staff don’t see a path forward for action on their part.
The main issue for the City is that the Healing Wave’s new location is a storefront out of which is sold illegal cannabis, and that therefore the City is unable to enact a licensing exemption under law.
I appreciate that Neil and the Healing Wave were encouraged by my motion to move to a permanent location in advance of working with the City, but since staff is yet to report back on my motion and recommend any action the City can take, it technically remains an illegal occupation of the space, and unfortunately there don’t seem to be any avenues that staff have identified to make an exemption. Though this is disappointing, I hope over the coming weeks to continue to work with staff to ensure that the medical service the Cannabis Substitution Project provides is valued as a priority. Staff have planned an update to Council on their work for the motion in November, but for now any regulatory changes in the immediate future remain uncertain.
I am pleased to see that the Healing Wave’s situation has been brought to the immediate attention of the City, and at present, I have not heard of any immediate plans of enforcement from our City office. I will be following further action by the City closely as staff send their formal response, and I look forward to your response and feedback.
Rebecca
Councillor Rebecca Bligh CITY OF VANCOUVER 453 W. 12 Ave., Vancouver, BC V5Y 1V4 E: [email protected]
Assistant Sarah Basi E: [email protected]
From: John Conroy [mailto:[email protected]] Sent: Tuesday, August 25, 2020 3:57 PM To: Neil Magnuson; Bligh, Rebecca; Conor Doherty Cc: Danielle Lukiv Subject: [EXT] RE: FW: Magnuson Letter to Councillor Bligh
City of Vancouver security warning: Do not click on links or open attachments unless you were expecting the email and know the content is safe. ______Thank you very much John
From: Neil Magnuson
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______From: Bligh, Rebecca
Just heard back from staff, there is a meeting with the province and licensing tomorrow. I expect to hear an update after that. Worst case we can use a letter from me that is advocating for the landlord to stand down while we navigate this process, best case the letter can come from the city.
More to follow when we hear back from staff.
Rebecca
Councillor Rebecca Bligh CITY OF VANCOUVER 453 W. 12 Ave., Vancouver, BC V5Y 1V4
E: [email protected]
Twitter @rebeccaleebligh
Assistant
Sarah Basi
E: [email protected]
From: Neil Magnuson [mailto:[email protected]] Sent: Tuesday, August 25, 2020 2:33 PM To: John Conroy; Conor Doherty Cc: Bligh, Rebecca; Danielle Lukiv Subject: [EXT] Re: FW: Magnuson Letter to Councillor Bligh
City of Vancouver security warning: Do not click on links or open attachments unless you were expecting the email and know the content is safe.
______
Just met with the landlord, they still have not heard from the city.
He suggested that perhaps you could communicate to him the conversation you had with coucelor Bligh and her comments regarding not moving against them or us while we navigate licences.
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______
From: John Conroy
Conor,
If you sent me anything last week, I did not receive it.
Hoping to get something before this Friday that we can share with the Landlords and their lawyer.
Looking forward to hearing from you.
John
John W. Conroy QC
Conroy & Company
Barrister & Solicitor
2459 Pauline Street
Abbotsford, B.C.
Canada
V2S 3S1 Webpage: www.johnconroy.com [johnconroy.com]
Email: [email protected]
Tel: (604) 852 5110
Fax: (604)859 3361
From: Conor Doherty
Hi there John,
Thank you for your letter and your various relevant documents, which will be extremely helpful in our advocacy on this issue.
As an update, I will be writing a letter with Cllr. Bligh to staff, inquiring as to any current plans to enforce the eviction notice or licensing issue, and request whether any enforcement measures can be delayed while your legal advice and work with the federal and provincial government is pending. The letter will highlight the specifics of the Serious Hope Society and Healing Wave's current situation, with the hope that we will be able to receive a favourable response from staff that allows your operations to continue as you work with senior government to resolve the licensing discrepancies.
Feel free to forward on any follow up or questions you may have! We will make sure to have this letter sent out by end of day tomorrow, and will make sure you are CC'd.
All the best,
Conor Doherty.
On Fri, Aug 14, 2020 at 4:13 PM John Conroy
Councillor Bligh and Conor Doherty, Attached is my formal letter about the project and numerous appendices that I hope are self-explanatory.
Looking forward to hearing from you particularly about the eviction situation.
John
John W. Conroy QC
Conroy & Company
Barrister & Solicitor
2459 Pauline Street
Abbotsford, B.C.
Canada
V2S 3S1
Webpage: www.johnconroy.com [johnconroy.com]
Email: [email protected]
Tel: (604) 852 5110
Fax: (604)859 3361
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Conor Doherty
M 778 886 6902 INITIAL STARTUP COSTS
Counters 3,000 Chairs 500 Tables 700 3 Refrigerators and 1 Freezer 1,600 Door Locks 150 Kitchen Appliances 200 Bathroom Supplies 75 Office Equipment, Computer, Printer etc. 1,600 Security Cameras 750 Display Jars etc. 150 Purchasing Supplies, Scales, Bags, etc. 700 Shelving Units 500 Fans 200 Printing - cards, signs etc. 900
Total: $11,025
MONTHLY EXPENSES
Rent 2,000 Hydro 200 Wi-Fi / Internet 100 Compensation for “volunteers” 13,000 Packaging needs 200 Cleaning supplies 120 Management compensation, transportation, lodging, etc. 9,500
Total: $25,120
Footnote #1: The $13,000 is based on 5 people per day at $110 per person (8 hours) and 25 working days per month. The "management compensation" is the money paid to Neil Magnusson and one main designated assistant in the amount of $180 each per day covering their services and expenses.
Footnote #2; The overall objective is to keep the costs down for the members while making sure the expenses and other costs are covered to run the Project. Whenever possible to do so, the prices to the members will be lowered as the Project continues and is able to do so. There have been minimal profits after costs to date, but it is expected that there will be an increase over time with increased volume in donations, supply and demand for non-lethal Cannabis as a substitute for lethal street drugs.