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Proposed Improvements to Health Canada's Marihuana Medical Access Program

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Consultation Document

June 17, 2011

Table of Contents

  1. Introduction
  2. How to Comment on this Document
  3. The Improvements under Consideration
  4. How the Proposed Redesigned Program Would Work
    1. Physician-Patient Interaction
    2. Dried Marihuana Production and Distribution
  5. Impact on Current Program Participants Holding an Authorization to Possess Marihuana for Medical Purposes
  6. Impact on Current Program Participants Who Hold a Personal-Use or Designated-Person Production Licence
  7. Opportunity for Those Interested in Becoming a Licensed Commercial Producer

1. Introduction

The Marihuana Medical Access Program (the Program) provides seriously ill Canadians with access to marihuana for medical purposes1. In recent years, a wide range of stakeholders including police and law enforcement, fire officials, physicians, municipalities, and program participants and groups representing their interests, have identified concerns with the current program.

Some of the key concerns raised include:

  • the potential for diversion of marihuana produced for medical purposes to the illicit market;
  • the risk of home invasion due to the presence of large quantities of dried marihuana or marihuana plants;
  • public safety risks, including electrical and fire hazards, stemming from the cultivation of marihuana in homes;
  • public health risks due to the presence of excess mould and poor air quality associated with the cultivation of marihuana plants in homes;
  • the complexity and length of the application process for individuals who wish to obtain an authorization to possess and/or a licence to produce marihuana;
  • the impact of increasing participation in the Program on the efficiency and timeliness of the application and review process;
  • the fact that Health Canada only supplies one strain of dried marihuana; and,
  • the need for more current medical information pertaining to the risks and benefits associated with the use of marihuana for medical purposes, as a means of supporting discussions between physicians and their patients as to whether such treatment is appropriate.

To address these concerns, Health Canada is considering improvements to the Program. The proposed improvements would reduce the risk of abuse and exploitation by criminal elements and keep our children and communities safe.

In this regard, Health Canada would like to hear from Canadians about the improvements under consideration. You are invited to provide comments on this document.

The legalization or decriminalization of marihuana is not part of these changes. Marihuana will continue to be regulated as a controlled substance under the Controlled Drugs and Substances Act (CDSA).

Until any of the proposed improvements to the Program are in place, the process for applying for an authorization to possess and/or a licence to produce marihuana for medical purposes under the Marihuana Medical Access Regulations (MMAR) will remain the same.

2. How to Comment on this Document

The proposed improvements outlined in Sections 3 to 7 of this document represent the foundation of a redesigned program that addresses many of the concerns the Government of Canada has heard about the current program.

If you are interested in providing comments on this document, please do so by July 31, 2011.

  • By Email: consultations-marihuana@hc-sc.gc.ca
  • By Fax: 613-946-4224
  • By Mail: Marihuana Consultations
    Controlled Substances and Tobacco Directorate
    Health Canada
    Mail Room, Federal Records Centre - Bldg 18
    1st Floor, 161 Goldenrod Driveway, Tunney's Pasture
    Ottawa ON K1A 0K9

Please note that Health Canada is committed to reviewing and considering all comments received by July 31, 2011.

3. The Improvements under Consideration

The improvements being considered would not alter the Program's intent to provide seriously ill Canadians with reasonable access to a legal source of marihuana for medical purposes, where conventional treatments are not appropriate and/or have failed to provide necessary relief.

The core of the redesigned Program would be a new, simplified process in which Health Canada no longer receives applications from program participants. A new supply and distribution system for dried marihuana that relies on licensed commercial producers would be established. These licensed commercial producers, who would be inspected and audited by Health Canada so as to ensure that they comply with all applicable regulatory requirements, would be able to cultivate any strain(s) of marihuana they choose. Finally, the production of marihuana for medical purposes by individuals in homes and communities would be phased out.

Individuals wishing to use marihuana for medical purposes would still be required to consult a physician who is licensed to practice medicine in Canada.

4. How the Proposed Redesigned Program Would Work

4.1 Physician-Patient Interaction

  • Health Canada maintains that the determination as to whether the use of marihuana for medical purposes is appropriate for a particular individual is best made through a discussion with their physician. In this regard, Health Canada is proposing to eliminate the categories of conditions or symptoms for which an individual may possess marihuana for medical purposes under the MMAR.
  • Individuals would continue to be required to consult a physician to obtain access to marihuana for medical purposes. Since categories would be eliminated, there would no longer be a requirement for some individuals to obtain the support of a specialist in addition to their primary care physician in order to access marihuana for medical purposes.
  • The existing medical declaration would be replaced by a new document provided by the physician to the individual. Health Canada will consult the medical community on the form this document will take.
  • Individuals would no longer be required to submit information to Health Canada to be authorized to possess dried marihuana. Instead, they would submit their physician's document directly to a licensed commercial producer.
  • Health Canada will establish an Expert Advisory Committee to improve physician access to comprehensive, accurate and up-to-date information on the use of marihuana for medical purposes, thereby facilitating informed decision-making with respect to the use of marihuana for medical purposes.
  • Health Canada would work with the medical community, their provincial/territorial licensing authorities and their associations on the proposed improvements to the program.

4.2 Dried Marihuana Production and Distribution

  • Under the proposed redesigned program, Health Canada would no longer enter into a contract with a commercial entity to supply and distribute dried marihuana and marihuana seeds.
  • The only legal source of dried marihuana would be commercial producers, who would be licensed by Health Canada to produce and distribute dried marihuana. Individuals would purchase their supply of dried marihuana from one of these licensed commercial producers.
  • Personal and designated production would be phased out.
  • In order to be licensed by Health Canada, licensed commercial producers would have to demonstrate compliance with requirements related to, for example, product quality, personnel, record-keeping, safety and security, disposal and reporting, as set out in new proposed regulations. These controls would aim to ensure the quality of the product being purchased by program participants, as well as the security of production sites.
  • Health Canada would establish a comprehensive compliance and enforcement regime for licensed commercial producers, centered on regular audits and inspections.
  • Licensed commercial producers would be required to comply with specific product labelling and packaging requirements. The label and/or the package itself could be one way by which a program participant could demonstrate that their supply of marihuana is legal.
  • Licensed commercial producers would only be permitted to produce marihuana indoors.
  • Licensed commercial producers would be able to produce any strain(s) of marihuana, thus giving individuals greater choice as to which strain(s) they wish to use.
  • Licensed commercial producers would set the price for marihuana for medical purpose.
  • Licensed commercial producers would only be able to send the dried marihuana they cultivate to individuals by registered mail or bonded courier.

5. Impact on Current Program Participants Holding an Authorization to Possess Marihuana for Medical Purposes

With the proposed redesigned Program, there would be no change to the important first step of an individual consulting with their physician in order to obtain access to marihuana for medical purposes. In response to concerns raised by the medical community regarding the clinical use of marihuana, Health Canada is committed to working with the medical community on the identification of reference information that supports appropriate physician-patient consultation on this issue.

Once it has been determined that the use of marihuana for medical purposes is appropriate, the physician would provide the individual with a document.

Individuals would then send the physician's document directly to a licensed commercial producer of their choice. The licensed producer would validate the document from the physician by confirming that the physician is licensed to practice medicine in Canada. The licensed producer would register the individual as a customer and would process the order for a specific amount of dried marihuana. Health Canada would maintain an up-to-date list of licensed producers on its website, and work with the medical community to disseminate this information as widely as possible.

The distribution of dried marihuana by licensed commercial producers to program participants would be by registered mail or bonded courier only.

Participants would no longer receive an authorization to possess or an identification card from Health Canada. Health Canada will consult on how best to establish that an individual is in lawful possession of a legal source of dried marihuana.

6. Impact on Current Program Participants Who Hold a Personal-Use or Designated-Person Production Licence

Within the proposed redesigned Program, only licensed commercial producers will be legally allowed to supply individuals with marihuana for medical purposes. Personal and designated production would be phased out.

That said, as the Government of Canada is committed to ensuring access to an uninterrupted legal source of dried marihuana, it will notify all holders of personal-use and designated-person production licences well in advance of the coming-into-effect of any improvements to the Program. A detailed transition plan will be shared with stakeholders when proposed regulations are pre-published in Canada Gazette, Part I.

7. Opportunity for Those Interested in Becoming a Licensed Commercial Producer

Health Canada is aware that transition to the proposed redesigned Program requires access to an adequate supply of dried marihuana to meet the needs of current and future Program participants. In this regard, Health Canada has identified compliance with requirements relating to the following aspects of production and distribution as being key to obtaining a commercial producer licence:

  • Dried Marihuana Production, Distribution and Disposition
    • indoor production in a non-residential area;
    • physical security standards;
    • product quality standards;
    • packaging and labelling standards; and
    • requirements for the disposal of excess plant material, excess dried marihuana and/or expired dried marihuana.
  • Personnel
    • designation of an individual responsible for managing the production and distribution of dried marihuana; and
    • specific qualifications for all personnel involved in production and distribution.
  • Record-keeping and Reporting
    • requirements to keep records relating to all on-site activities for a set period of time, and the ability to provide set records to Health Canada on request; and
    • requirements for reporting on activities associated with the cultivation of marihuana and the distribution of dried marihuana.
  • Compliance and Enforcement
    • pre-qualification audits and pre-licence inspections; and
    • inspections and/or audits on an ongoing basis.

Annex: The Current Marihuana Medical Access Program

1. Regulation of Marihuana in Canada

Marihuana is included in Schedule II to the Controlled Drugs and Substances Act (CDSA), and as such, is regulated as a controlled substance in Canada. This means that all activities, e.g., possession, possession for the purposes of trafficking, production, importation, exportation, trafficking, and possession for the purposes of exporting, are illegal except as authorized by regulation. Illegal activities associated with marihuana are considered to be criminal offences and are subject to the penalties set out in the CDSA.

2. Program History

In 1999, Health Canada established the Marihuana Medical Access Program (the Program) so as to provide seriously ill Canadians suffering from grave and debilitating illnesses with access to a legal source of dried marihuana for medical purposes. In the original Program, Health Canada authorized individuals to possess marihuana and/or to produce a limited number of plants for medical use through exemptions issued under section 56 of the CDSA.

In July 2000, the Ontario Court of Appeal found fault with the discretionary way in which Health Canada was using Section 56 of the CDSA as the means of granting authorization to possess and/or produce dried marihuana for medical purposes. In response, Health Canada established the Marihuana Medical Access Regulations (MMAR).

The MMAR set out a scheme by which any seriously ill Canadian can, with a declaration from a physician, obtain an authorization to possess and/or a licence to produce dried marihuana for their own personal medical use. The MMAR also provide for an authorized person to designate someone to grow marihuana on their behalf. In 2003, the MMAR were amended to provide for the option for authorized persons to obtain dried marihuana or marihuana seeds for medical purposes by Health Canada. This supply is currently provided under contract by Prairie Plant Systems Inc.

Since 2003, the MMAR have been amended on a number of occasions, so as to streamline the Program, respond to stakeholder concerns and/or address additional court decisions.

3. How the Program Works Now

Eligibility

Under the current Program, individuals suffering from life-threatening or chronic medical conditions must first obtain the support of a licensed medical practitioner who completes a medical declaration stating that dried marihuana is going to be used to alleviate a specific symptom associated with an identified medical condition. The individual then includes this medical declaration in their application for an authorization to possess. To be authorized to possess marihuana, an individual's symptoms and conditions must fall within one of two possible categories:

  • Category 1: any symptom treated as part of compassionate end-of-life care or for symptoms related to specific medical conditions, namely:
    • Severe pain and/or persistent muscle spasms from multiple sclerosis, a spinal cord injury;
    • Severe pain, cachexia, anorexia, weight loss, and/or severe nausea from cancer or HIV/AIDS infection;
    • Severe pain from severe forms of arthritis; or,
    • Seizures from epilepsy.
  • Category 2: a debilitating symptom that is associated with a medical condition or with the medical treatment of that condition, other than those described in Category 1.

Authorization to Possess

If an individual's application meets all of the requirements set out in the MMAR, Health Canada must issue an authorization to possess marihuana for medical purposes to the applicant. The applicant's physician is always notified when an authorization to possess is issued.

Authorized individuals then have three options to obtain a supply of dried marihuana for medical purposes. They can:

  1. Apply for a personal-use production licence authorizing them to grow their own supply of marihuana; or,
  2. Designate someone to produce on their behalf under a designated-person production licence.
  3. Purchase dried marihuana from Health Canada

Licensed Production

As set out above, there are two different types of licences to produce marihuana for medical purposes: personal-use production licences and designated-person production licences. All licences set out specific terms and conditions applicable to the licence, including the maximum amount of marihuana a licence holder may possess at any one time, and the maximum number of plants that are allowed to be in cultivation at any one time.

Footnotes

Footnote 1

For more information about the existing Program and its history, please see the Annex.

Return to footnote 1 referrer