Why Canada's approach to cannabis research is flawed

Nina (not her real name) was just 16 when she began smoking crack cocaine with her boyfriend of the time. It was 2010, and they would drive around for hours in their neighbourhood — Pickering, a suburb east of Toronto — drinking and blasting music, before finding a quiet parking lot to smoke up. Sometimes, they would have friends join them, and other drugs would be involved — cocaine, weed, methamphetamines. Nights would turn into mornings, much to the distress of Nina’s parents.

“I used to ignore their calls, and figure I would deal with it later on,” she said, shaking her head at the memory. Nina, now 23 and a Political Science major at Ryerson University admits that her crack habit got “out of hand” in her late teenage years, costing her friendships, and setting her education back by years. “My friends are either in their first real job or in masters programs and I’m only in second year at Ryerson. But it’s alright, at least I fixed sh*t you know?”

By “fixed”, Nina is referring to how she successfully weaned herself off crack by using cannabis. “It was mostly for my anxiety and to get myself to go to sleep at night, and you know, I had broken up with my guy by then so I guess it made it easier to not have that access to crack. I needed something else to get high with.”

There is no conclusive evidence that cannabis helps beat a crack addiction. In fact, the bulk of existing medical evidence about cannabis paints the drug as one that is addictive, causes confusion, an impaired ability to remember, paranoia, delusions, hallucinations, and can apparently even increase one’s risk of a heart attack. Health Canada’s official claim about individuals who use cannabis is that they can develop a “cannabis use disorder, which at its extreme can result in addiction.”

Indeed, the recent packaging and labelling requirements from Health Canada ahead of legalization this year makes it compulsory for licensed weed producers to clearly display one of six rather alarmist, even disputable warnings on their packaging. Among them: “Up to 1 in 2 people who use cannabis daily will become addicted” and “harmful chemicals found in tobacco smoke are also found in cannabis smoke”.

“We already know cannabis is being used therapeutically by Canadians, outside the doctor-patient relationship. It’s being used for substance abuse, addiction, harm reduction, chronic pain, epilepsy… I could go on,” says M.J Milloy, a research scientist with the British Columbia Centre on Substance Use (BCCSU) who studies the effects of cannabis on patients living with HIV/AIDS or addiction.

“Unfortunately, there is a need for further funding for cannabis research that is just not being met right now.”

A hefty price tag

In January 2018, the federal government committed $1.4 million for 14 research projects, that will be based in hospitals and universities across the country on the effects of legalizing recreational marijuana. This follows up on an initial round of funding for catalyst grants worth one million dollars dispensed by the Canadian Institute of Health Research to study the impact of cannabis on driving, workplace usage, youth and pregnancy outcomes. Prior to 2017 however, cannabis research was simply not a priority of the CIHR — an arm of the government that determines what specific research projects to commit money towards.

Milloy argues that the amount of money committed by the government is not nearly enough to truly understand the benefits and harms of cannabis. “Unfortunately when it comes to research with humans, the price tag is quite substantial. I’m currently running a five-year study of 1,000 people, and it is costing us more than $3 million,” Milloy told VICE Money.

“The investment the government has made is obviously welcome, but they have to do more to generate the kind of evidence I think is needed to inform how Canadians use cannabis both medically and non-medically as well.”

In its final report released November 2016, the federal Task Force on Cannabis Legalization and Regulation called on the government to “promote and support clinical research on the use of cannabis and cannabinoids for medical purposes.”

The report also noted that the lack of research has placed physicians in a “difficult position” when it comes to prescribing cannabis as a medical drug. Indeed, years after medical cannabis was made legal in Canada, the Canadian Medical Association still preserves its conservative stance on weed, recognizing that some individuals suffering from “chronic disease” may obtain “relief” with cannabis, but emphasizing the “insufficient evidence” on the risks and benefits of cannabis use.

“In a way, I understand the CMA’s position,” says Mark Ware, Vice Chair of the Task Force and one of the foremost pain management experts in the country, whose own research at McGill University involves evaluating the use of cannabis for medical purposes. “I think we are living in a world where medicines have been developed by the process of regulating the product by clinical trials and by having evidence in that sort of pharmaceutical model. So if you accept that position as being the gold standard, I understand why they would think that cannabis does not meet that standard,” he told VICE Money.

It is, in a way, a catch-22 scenario. “Physicians are saying that they don’t have the scientific evidence to tell their patients how cannabis can be used. But we don’t have the money to find that conclusive evidence,” says Milloy.

Minimizing harm, maximizing benefits

Perhaps then, it boils down to what kind of cannabis research the government wants to be seen funding.

“There are two goals in cannabis research — minimizing the harm of cannabis consumption, and maximizing the benefits of cannabis consumption. Right now the emphasis is on minimizing harm,” says Jonathan Page, co-founder and CEO of Anandia Labs a cannabis biotechnology company that has partnered up with the University of British Columbia to conduct medical research on the marijuana plant.

“There’s a still a stigma around researching cannabis in the medical community. From the government’s perspective, they have gone out on a limb with legalization so they’re going to have to put funding behind a risk mitigation strategy so as to not seen to be encouraging cannabis consumption,” Page told VICE Money over the phone from Vancouver.

But for the private sector “minimizing harm” has been a lesser part of the equation since 2013, when the Canadian government implemented the Marihuana for Medical Purposes Regulations (MMPR), a legal medical weed regime that morphed into the Access to Cannabis for Medical Purposes Regulations in 2016.

That industry is now worth close to a billion dollars. There are almost 80 licensed weed producers across the country, 235,000 registered patients and over 10,000 physicians who have at some point prescribed medical marijuana to their patients. Although there are no official statistics, it is estimated that thousands of Canadians who are not officially registered as medical marijuana patients use weed and other cannabidiol (CBD) products (the non-psychoactive component of weed) experimentally, for therapeutic reasons. South of the border, the CBD industry is growing in popularity — a recent report by the consulting firm Brightfield Group projects that it will be a billion dollar market by 2020.

“Governments shouldn’t be funding everything. I do not think that is realistic nor do I think that is appropriate,” says Ware. “Given the size and capital of the private sector I think that are various players in the cannabis field who should step up and support research.”

Big Weed and cannabis research

Ware is presumably referring to the biggest licensed weed producers in the country — Canopy Growth Corporation, Aphria, Aurora, Medreleaf and Tilray. Combined, they have a market value of $20 billion, and with legalization merely months away, that figure will undoubtedly increase.

But to date, the amount of money that these companies have actually committed to clinical trials and observational studies that could potentially produce substantive evidence on the medical benefits of cannabis has been limited. There is an argument to be made that the incentive of industry to fund cannabis research is simply not there, because they already have a great product to sell in its original form.

“We’re already allowed to sell cannabis to patients, and soon to everyone. A lot of companies don’t have the motivation to invest money and go through the time consuming, incredibly expensive process of funding clinical research,” says Phillipe Lucas, Vice-President of Patient Research and Advocacy at Tilray, a B.C.-based licensed weed producer.

For its part, Tilray is funding two clinical trials in Canada — first to determine the “tolerability and efficacy of cannabinoids in children with Dravet Syndrome”, a form of epilepsy amongst infants and children, and a second co-study with the University of British Columbia involving the use of cannabis for PTSD in Canadian military veterans, law enforcement officers and sexual assault survivors.

That second partnership, says Lucas was a $400,000 investment by the company, a substantial amount considering the small scale of public funding. But Tilray is gunning to become the premier medical cannabis company in the country, possibly even the world — one can infer that the investment fits into its long term business strategy.

“The benefit of private funding is that it doesn’t have to go through the long grant cycle of the CIHR, where you might only get your money every few years. But having said that, we ultimately do not have the kind of resources that the government does.”

Scientists like Lucas and Milloy both believe those resources are particularly crucial in the addictions field.

Milloy is currently conducting an observational study of 1,100 people with HIV infections in the Downtown East Side of Vancouver who are using cannabis therapeutically. “We were the first to identify how cannabis could reduce the viral load of patients living with HIV.”

More recently, Milloy identified a group of crack cocaine users who, much like Nina, were successfully using cannabis to reduce the frequency of crack cocaine consumption. “People have been doing this on their own accord for years,” he says.

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Recreational cannabis is set to become legal in Canada in September, although no specific date has been set. The Liberal government continues to hammer home its key priorities — protect Canada’s youth and eliminate the black market, all of which are arguably important goals.

The issue is, legalization will undoubtedly bring in a slew of new cannabis users, intent on trying weed for the first time, or experimenting with different quantities, strains and products on the market. And the science just hasn’t caught up.

“Once the penalties are removed, once the social stigmas are relaxed and once people can go down to their local store and buy cannabis, you’re going to see a lot of people out there experimenting,” says Milloy. “And that’s problematic only for the reason that we have not done the research to tell people what to do with cannabis, and how to do it.”

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