Most Canadian therapeutic cannabis users accessed it outside the legal system | Research

The takeaway

Only 7% of Canadian therapeutic cannabis users accessed it exclusively through authorized sources, with cost, physician reluctance, and program complexity being major barriers.

Read this if you are interested in why medical cannabis access programs often fail to reach the patients they are designed to serve.

Only 7% of therapeutic users accessed cannabis exclusively from authorized sources

What the researchers found

Among 628 current therapeutic cannabis users in Canada, only 7% accessed cannabis exclusively from authorized (legal) sources. The vast majority relied on unauthorized sources despite the existence of a federal access program.

Key barriers included difficulty finding a physician willing to support a program application, high costs of authorized cannabis, and complexity of the application process. Access varied by medical condition and overall health status.

The presence of medical cannabis dispensaries (which were not part of the regulatory regime at the time) was positively associated with access, suggesting these unofficial distribution points were filling a gap left by the formal program. Fewer than 5% of estimated therapeutic cannabis users in Canada were enrolled in the federal program.

Why it matters

When a regulated therapeutic cannabis program exists but only reaches 5% of estimated users, the regulatory framework is failing to serve patients. Understanding the specific barriers to access can inform policy improvements and reduce the harms of unregulated supply.

The numbers in context

628 therapeutic users surveyed. Only 7% accessed exclusively from authorized sources. Fewer than 5% of estimated therapeutic users were enrolled in the federal program. Dispensary presence was positively associated with access.

How the study worked

Cross-sectional survey of 628 current therapeutic cannabis users in Canada. A health services analytical framework examined barriers across five dimensions: accommodation, accessibility, availability, affordability, and acceptability.

What this study cannot tell us

Self-selected survey sample may not represent all therapeutic users. Self-reported data on sources and use patterns. The study captured a specific point in Canadian policy that has since changed significantly with full legalization.

How to read the evidence

Structured cross-sectional survey with a health services framework, though limited by self-selection and pre-legalization timing.

When this study was published

Published in 2014, before Canada's full cannabis legalization in 2018.

The bigger picture

This study captured a moment in Canadian cannabis policy before full legalization in 2018. The barriers identified, particularly physician reluctance and cost, are common across medical cannabis programs worldwide and continue to shape access even in jurisdictions with legal frameworks.

Questions still open

Has full cannabis legalization in Canada resolved the access barriers identified in this study? Do patients fare differently when accessing authorized vs. unauthorized cannabis? How can physician education reduce the barrier of provider reluctance?

Common questions

Why did so few Canadian patients use the legal medical cannabis program?

Major barriers included difficulty finding supportive physicians, high cost of authorized cannabis, and a complex application process. Only about 5% of estimated therapeutic users were enrolled in the federal program.

Where did most therapeutic cannabis users get their cannabis?

The vast majority used unauthorized sources. Medical cannabis dispensaries, which operated outside the formal regulatory framework, were positively associated with patient access.

Read the original research

Barriers to access for Canadians who use cannabis for therapeutic purposes.

The International journal on drug policy, 25(4), 691-9

View on PubMed ↗Publisher’s paper ↗

Citation

Belle-Isle, Lynne; Walsh, Zach; Callaway, Robert; Lucas, Philippe; Capler, Rielle; Kay, Robert; Holtzman, Susan. (2014). Barriers to access for Canadians who use cannabis for therapeutic purposes.. The International journal on drug policy, 25(4), 691-9. https://doi.org/10.1016/j.drugpo.2014.02.009