Sunday, 29 January 2017

Ten Reasons Why Mail-Order Cannabis Is Unacceptable


Do you ever run out of your medication?  For most Canadians, it's a simple trip to the pharmacy. Some pharmacies even deliver to your door.  But for the 75,000+ Canadians taking part in the ACMPR, running out of their meds is a lot more difficult to fix.

Legal Cannabis only comes in the mail from one of the 33+ Licensed Cannabis producers these days. On the surface and for many patients, this suits them just fine.  But if you're one of the other normal Canadians, there are more negatives to mail-order than there are positives.  At the very least we deserve both mail order and storefronts too.

This is the top ten reasons why I feel that mail-order medicine is unacceptable and not access:

10)  Credit/technology Requirements

Mail order Cannabis requires certain payment methods that only a portion of the Canadian citizenry are able to possess these days.  Credit isn't free and never has been.  Mail-order means that good ol' cash cannot be used.  If we really want to dissolve street level sales who do accept cash, you'll have to give us storefronts where cash can be used.

The notion that every Canadian has access to credit is coupled here with another asinine assumption, that being that every one of us has internet access.  Yes, you can place an order over the telephone, but that doesn't mean that sales clerk is going to be able to tell you what each strain does or whether it would work for you.  And, I've heard horror stories of patients being told they must order online through the producer web site.  Kinda like how bank tellers try to convince you to use the ATM machine next time.

9)  Credit Card payment wait times:

Credit Card:  those of us who carry a balance must time the purchase of our medicine correctly.  Five day payment clearing period + two day delivery means a lot of us are doing without because of credit processing times.  Not good enough.

Pre-Paid Credit:  I bought one of these once because I couldn't wait for my credit payment to clear. What a shock when I realized that it's a 2-day activation period.  I guess I was expected to do without my antidepressant for those 2 days + the 2 days it took to be delivered.

Certified Check:  It's like every single step in this process MUST profit someone.  I have to pay to certify a check?  Yep.  Then you have to wait for snail-mail to deliver it, and then delivery to take place.  So ridiculous.

Imagine if you had to certify a cheque in order to buy your Lipitor or your Cymbalta.  Crazy eh?

8)  Delivery times

For the average price of $10, patients in the ACMPR can be sure their doctor-prescribed Cannabis gets to them by Purolator or Canada Post within 2-3 business days.  And that's fine if you've planned properly.  But if you run out before your Cannabis is delivered, what do you do?  Can you imagine if you had a seizure disorder or were going through Chemotherapy while you waited for this corporate-run delivery service to get you your meds?  Tick-tock as you suffer.

7)  Questionable delivery personnel

I've been legal since May and I've had only good luck with my delivery personnel but others are not so lucky.  I know two Veterans who have had their medicinal Cannabis stolen while in the custody of delivery personnel.  These are heroes using a plant to treat their trauma and hundreds of dollars of it was stolen from them;  one never made it the door, the other disappeared from the sorting station itself.

Have you ever sat and waited for a delivery only to sneeze and miss the knock?  It's like there was no knock at all sometimes.  The door bell works yet, it doesn't ring.  It's easier for delivery people to put that little tag on your knob than it is to actually fulfill the contract that they've been hired to fulfill. It's not good enough.  If I pay $10 shipping because it comes to my door, but then have to drive somewhere to pick it up, then there's a problem isn't there!  What if I don't drive?  What if I'm wheelchair bound?  I'll have to wait to stop my seizures or ease my nausea?

6)  Questionable delivery policies & procedures

My prescription is split between two producers, meaning I buy from two.  The one delivers by Canada Post and the other by Purolator.  Now, the fact that these two are owned by the same entity matters not when it comes to their policies.  Canada Post workers are letter-carriers and as such are not required or allowed to go above the first floor of your tenement building.  I get a call to meet her in the foyer which is fine for me, but once again, what if I were disabled or severely ill?

Purolator on the other hands comes right to my door for the same $10 fee.  However, during the recent postal strike I waited five days for my medicine to arrive.  When I investigated their policies and time guarantees I realized that there are seven levels of service above the "standard shipping" we normally use.  This means that all packages above standard take priority.  You'd think someone would have advised the patients to prioritize their shipping.  I'm sure if it were pharmaceuticals we were buying there'd be a public service announcement to ensure no one goes a day without their pills.
Sometimes I wonder if these double standards would dissipate were Cannabis actually physically addictive!

5)  Extremely Rural Residences

I spoke to a man last week who pays $10 shipping for his medicinal Cannabis yet has NEVER gotten it at his door.  This man lives on a rural route in Ontari-ari-ario where you're lucky if you can see your neighbor's house from the road.  Canada is filled with rural areas of land like this man's that may pose difficulty to delivery personnel and their vehicles.  This guy has to walk half an hour to the sorting station to carry his cannabis-in-a-box half an hour back home.  How long before he gets mugged for his meds?  If we had storefronts, this guy could get a ride once a month to a legal storefront in a civilized manner.

4)  Caveat Emptor: but no returns allowed

'Caveat emptor' or 'buyer beware'.  More than half the legal patients are experienced enough to have purchased Cannabis by seeing it, smelling it, maybe even testing it first.  But you can't do that when you're legal.  Seems ass-backwards doesn't it?  You have to trust that the digital pic on the producer website is what you're actually getting.  It's a lot to ask when you're paying upwards to $15 per gram. And the worst part is, they normally will not take returns or give refunds.  This I can totally understand.  You can't take your Tramadol back to the pharmacy and get a refund.  But a lot of people are getting dinged by the 'pre-ground' option and drop-down menus that default at this instead of whole flower.  Trixy hobbits.  It's a stupid move because many patients think that's what they call whole bud and tell everyone they know that LP cannabis is crap.  If any of the above patients were able to buy their bud in a legal storefront, NONE of this would happen.  Sadly, many of the conditions that Cannabis is prescribed for are conditions that are a exacerbated by stress. Nothin' stressful about paying this much money for something that you're not sure will work. Those are two days of delivery waiting hell.

3)  No face-to-face counsel w/ a Cannabis-educated human

I have a pretty good handle on all things Cannabis, but it's taken me 15 years.  New patients are not getting enough guidance.  Even for the patients using mere milliliters of Cannabis oil per day need more guidance than is available.  Dosing cannabinoids is individual and that is one of the most foreign ideas in healthcare right now.  Patients are advised to start low and raise up slowly, starting at .25 mls.  But that same patient could have a maximum daily dose of 8 mls.  Questions arise quickly, like how fast should I increase?  How soon can I expect to feel it?  Will it impair me?  We're used to taking 2 pills 3 times a day until the bottle is empty.  But with Cannabis, you have to see how it works for you.  Try explaining that efficiently over the phone.  Try ensuring that .25 mls IS what this patient is taking.  Legal storefronts could offer in-person counsel with people who can tell you what to expect and ensure you're dosing properly.  We could make dosing charts with tips and other options for ingestion.  The new patients getting legalized today are used to talking to their friendly neighborhood pharmacist who will explain everything to them.  In fact, you can book hour-long visits with your pharmacist to discuss your scripts!  The fact that the same guidance isn't really offered to patients in the ACMPR is shameful and dangerous in my opinion.

2)  Ordering mistakes=adverse events=healthcare costs

For the Cannabis naive, starting in this program requires that you learn some lingo.  Allowing elderly patients to order over the phone for something so esoteric, is engineering adverse effects from the onset.  Speaking of which, I just spent thirty minutes trying to explain the difference between an Indica and a Sativa cannabis strain to a 72 year old patient.  If she didn't understand me, and mistakenly buys a Sativa strain she's going to be disappointed, and unable to sleep.  There is far too much to learn with this medicine for new patients and they deserve face-to-face counsel when ordering!

Of course, mistakes happen on the other side too.  I know of one patient with a 12% THC cap who was sold a 25% THC oil.  Thankfully he was fine, but others may not be so lucky.  And what happens when a person takes too much too soon? They go to Emerg, that's what happens.  And at Emerg, they're often humiliated, marginalized, given fluids, an anti-nauseant, and the advice to stop using the product immediately.  The other thing about these visits is the cost.  It's been said recently that 1 in 5 visits to the Emerg are unnecessary so piling on even more is going to effect national healthcare costs.  Remember, if the meds these patients were taking were pharmaceuticals, they could have a seated chit-chat with a Pharmacist to make sure they understand it all.  Medicinal Cannabis doesn't get that respect I guess, and neither to its patients.

1)  Missed delivery means the patient must turn criminal

So you've missed your deliver for whatever reason.  Now how will you kill your pain, tremors, nausea, depression, anxiety, insomnia?  Too bad it's not pills you're on, because there's a 24 hour drug store in almost every city out there.  But there are no stores to help you out yet, only friends.  Because of this, many Cannabis patients in this predicament will go elsewhere to buy in a pinch.  According to the rules of the ACMPR though, buying this medicine from anyone other than a licensed producer is against the rules.  The only way to rectify a missed delivery is to step back into your criminal skin, and that isn't good for anybody.

Did any of this surprise you?  Are you as choked as me?  In what Universe can mail-order only medicine really work efficiently and sustainably?  Ugh.... don't even get me started on the packaging involved with mail order only!  With baby-steps it's improving, not nearly soon enough.  Patients in their 90's are even trying medicinal Cannabis.  What must those patients think having seen this plant in all of its many stages of legality?  They likely shake their heads at the insanity of it all, just relieved to not be in cuffs.