Among one of the concerns regarding medical marijuana are the potential barriers to the use of this medication. In places, medical marijuana is still not legal, but even in places where it is, like Canada, there are still challenges that present themselves. While my experience is limited to Canada, I find that a lot of the barriers that exist remain the same. If you have experiences you would like to share, please feel free to include them in the comments.
Knowledge – Patient’s
One of the first and biggest barriers to medical marijuana is a lack of information as to how to go about getting a prescription. It used to be that you had to fill out a large complicated set of forms to be submitted to Health Canada. The application would then be handled by some bureaucratic process at which point you would be approved or denied.
In March 2014 the rules changed. Now, instead of filling out a Health Canada form, you fill out a form directly with your choice of dispensary. The Health Canada website provides you with a list of licensed dispensaries, and most of them have their forms available online.
The forms include two parts: personal information, and doctor prescription.
The prescription form has to be filled out by a medical doctor, and includes dosage information as well as the doctor’s office information.
The forms are mailed to the dispensary, which confirms that the doctor who filled out the prescription is properly licensed, and you become a registered patient.
Knowledge – Doctor’s
While patients are uninformed, so too are doctors. When I was first looking for a prescription, I asked my GI for it. He said no. I was surprised since he actually seemed supportive of my occasional use.
Over the next few months, whenever marijuana came up with other doctors like those at the ER, they recommended that I get a prescription. I was torn, doctors seemed supportive of the idea, but yet I seemed unable to get a prescription. Finally, I decided to bring it up with my GI again and ask why he was unwilling to give me one.
It turned out that my doctor was under the impression that a condition had to be fatal in order to allow for the use of medical marijuana. Even though he thought that pot would be beneficial for me, he believed he wasn’t allowed to prescribe it for me.
Other doctors are unaware of the current available research. I had one ER doctor believe that marijuana was counter-indicated for Crohn’s even though Crohn’s is one of the few conditions that have had studies confirming the benefit of marijuana.
Patients are not the only people being fed misinformation about medical marijuana. Doctors are just as likely to have mistaken ideas about its use, its addictive properties, and so forth. The new rule changes make doctors the gatekeepers to prescriptions, but no efforts have been made to properly educate them. This leaves it up to patients to educate them or find a sympathetic doctor.
Even those patients who are more knowledgeable in the effects and use of marijuana may find it difficult to find a sympathetic doctor. It is counterintuitive to most patients to push their doctors for explanations. Since there is the fear of being labeled a drug seeker, patients might also worry about seeming over-eager about the acquisition of a prescription.
Availability
As per the new rules, you have to register with a dispensary. While it appears that Health Canada allows you to register with two at once, most dispensaries themselves insist on being your only provider. As a result, patients are dependent on the strains available at one dispensary. This limits a patient’s ability to find the strains that work best for them.
If the dispensary runs out of the strains that work, the patient might find themselves without their meds for however long it takes for a new working strain to be available.
Other places where marijuana is legal work with a prescription system where you have a card and can bring it to different dispensaries.
Legality
In many places in North America, as well as the rest of the world, marijuana is still illegal. Medical users are sometimes forced to go to dealers to meet their needs. This is true of people on chemotherapy looking for relief, as well as people who use for other medical reasons.
For some people, medical marijuana is one of the only things that helps with their conditions. It can be a matter of desperation if the difference is living in constant pain. This creates an added risk to being able to take your medication. For the people who use it to control mental health conditions, the need to have access to your medication can be even more essential. Imagine for example those who use the uplifting effects to control their suicidal tendencies?
Although nominally legal in certain states, until recently Federal agents would continue to raid “legal” grow-ops, since it continued to be federally illegal. This creates a further difficult situation for people who have reason to be particularly careful about adherence to federal laws when they contradict with state laws: such as those who are in the midst of a citizenship application or those working for the federal government.
Questionable legality may also create problems at workplaces that do drug testing.
Portability
Another barrier is portability. Since the legality of marijuana is different from place to place, you might not be able to have access to your medication when you travel. This can make things like visiting family difficult. Within the US, legality can change from state to state, and while in Canada it is federally approved across the provinces, those with reason to travel to the US are not allowed to cross the border with their medication.
This may seem reasonable at first because of medical marijuana’s questionable legal status, but consider that this is not true of any other medication. At need one can arrange to bring any other prescription with them and even have it filled if needed at pharmacies in the US.
Similarly, it can be difficult to know where it is safe to take your meds. Pain and symptoms strike anywhere. For example, if your difficulty is with pain due to eating, eating out might be difficult. If you are visiting friends you might be unable to take the pain medication with you. Smoking in public is awkward. If people think you are smoking tobacco you run the risk of being verbally assaulted for your choice. If they realize you are smoking pot, you run the risk of having the police called on you, being yelled at, being threatened, and so forth.
What’s more, the rules regulating where a patient is allowed to smoke are unclear. On the one hand, a patient should be able to medicate within reason, anywhere that they are able to go. Due to the air-contaminant nature of smoking marijuana, at the very least medical marijuana patients should be able to medicate wherever cigarettes are allowed.
Despite this being the case, there is some suggestion that the prescription only applies to private residences. This in turn means that people who cannot smoke in certain places such as their parent’s or friend’s, they may have difficulty finding a legal place to medicate. This adds an additional constriction to people trying to decide whether they should go out and suffer through pain or stay in to be able to medicate.
Shaming
The threats fall into a category that serves as the biggest repellant to medical marijuana use: shaming. This comes in many varieties, but consistently is listed as the biggest barrier experienced by medical users.
Shaming comes in a bunch of different varieties. There are the “concerned and caring” shamers, the fear-mongers, the naturalists, the religiously motivated, and so on. The people who engage in this behaviour may fall into various categories even in one conversation.
Medical marijuana users, whether they have a prescription or not, are made to feel ashamed. We are portrayed in media as being slow-witted, and conservative news paints us as being violent criminals. Many of us have to contend with disapproving relatives who condescendingly explain to us everything that is wrong with us for deciding to treat our pain. Or who use misinformation to try and convince us that what we are doing is wrong, even in the face of overwhelming evidence to the contrary.
Medical marijuana users are often accused of faking the severity of our pain. We are expected to perform pain, more so that chronic pain patients already are. We will have people questioning us, and questioning whether we are really in pain. Or whether the pain is really bad enough to require such drastic measures.
Even among less-scientifically illiterate religions that encourage proper medical care, the use of medical marijuana is characterized as being a sin. The more conservative religions create the risk of being shunned.
Of course, often times, when people are questioned about their objections to marijuana, you discover that actually, their disagreement seems to center on most painkillers. Just the act of treating pain is seen as an act of weakness, instead of the necessity it really it.
As a result, patients can find it difficult to take their medication. Those who live in apartments have to be careful to not let the distinctive smell bother their neighbours. They run the risk of having disapproving landlords pointlessly hassle them or even threaten eviction.
Staying with family can create a need to hide your use, or create awkward situations when you have to medicate. Patients can find themselves being cornered and lectured while they are medicating or shortly afterwards. They might be forbidden from taking the medication on the property and be forced to go elsewhere if they need to address their symptoms because of this ongoing lack of acceptance of marijuana as medication rather than recreation.
In deference to their parents or friend’s discomfort, some patients are able to go a certain time without their medication. Those for whom use is sparing, or who also have access to other medications that can help treat their symptoms. Other patients, myself among them, might have medical marijuana as the only prescription for their symptoms, and being separated from their medication for a significant period of time could mean greater hardship.
Money
Since it is a relatively new drug many insurance companies don’t cover prescription marijuana as of yet. Even the provincial coverage available to those on government benefits does not cover medical marijuana. Many of the people relying on medical marijuana are people who have fairly severe disabilities. Many are struggling financially as a result of these illnesses, so the added financial burden of having to pay for this uncovered prescription can be particularly difficult.
For example, I am on ODSP which provides me with some prescription coverage, however Marijuana itself is not at this time covered. My dispensary averages about $10 per gram, and the standard prescriptions is 1 gram per day. This means that for a full month’s prescription I would have to find $300 to spare. So far I’ve been able to average significantly less than that, but some months are more difficult than others. Because the majority of my money comes from Disability, I have to budget very carefully. After covering my monthly bills, there isn’t always a lot of money left behind to cover groceries and other expenses, so even cutting my prescription in half for a cost of $150 is quite a big chunk of the money I have.
What makes it more difficult is when dispensaries have a minimum order, some of as much as $100. Being forced to go without pain medication can mean more than more pain. It can cost you money as well if you find yourself eating out more because pain is draining you of energy. It can mean a trip to the hospital and even an admission.
Ultimately all of the barriers come from the same source: misinformation piled on underlying social culture of ableism.
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