Sunday 29 January 2017
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.
Saturday 28 January 2017
So it happened again. A man from my past contacted me to tell me that he's been thinking about me. This is someone I was romantic with and then friends with for a dozen years. I consider him a friend still. However, the me that I am today sees through all of that now. Whatever the hell that is.
The ball was left in my court, his cell number left in my email. I was to text him soon. To be honest with you, having been with my hunni for over nine years, the mere thought of what this old friend could want, left me with an empty pit in my stomach. In one brief online encounter via the 1's & 0's of digital communication, I realized that being emotionally faithful to someone you love isn't done for them. It's done for you.
Theories abound supporting the belief that guilt causes cancer. I know for a fact that it causes stomach issues that can potentially lead to ulcers and other daily hindrances like locked bowels. Guilt is stressful and stress can lead to depression. Depression can affect the appetite and we're back to the stomach acid again. Guilt sucks.
Now, being older and wiser I realize concretely that I can control whether or not I suffer from this tragic human affliction. I used to do and deal with it later. Or not deal with it. But hating yourself for doing the wrong thing is engineering dis-ease in my opinion.
As for the guy, I did consider texting him. If only to tell him how awesome my life is now. When I told him I'm a Cannabis Counsellor, he just said "oh". We used to partake together way back when. Here's the kicker though, and the thing that's left me so proud of my now clear vision ... he never once asked me if I was single, or happy, or looking to reconnect. He merely dropped his pile of sentimental vagueness on my lap and in my head with no regard for how it would affect me. That's some shitty shit right there. If I were in his shoes, I hope to Goddess I'd have the decency to think about the mental well-being of the person I've been thinking about lately.
And I hold no bitterness, truly I don't. But it's nonsense and it's drumming to distract me from the path that pulls me now. A test perhaps and I'm FINALLY acing tests again! Who knew? I've proven that you can teach an old dog new tricks. You can change your gullibility and your inability to speak up and out when needed. So many mistakes are made simply because we cannot find our voice. Or our gumption. Or the bravery to stand alone in the crowd. Or the courage to rock the boat. Thing is, if we're smart we eventually say fuck the boat and we learn to swim.
Alone is only in your head y'know, we are one, we are all connected. Shitty shit changes us and sometimes we don't correct the navigation in time before something drastic happens. Life is hard. But we control so much of it, I see this now. Cognitive Behavioural Therapy to the rescue! CBT, love, forgiveness, and peace of mind. Or maybe it's the Wolf brain coming through, that basic mammal who's instinct now tells it to preserve thyself. Your future is in your own control if you feed the good wolf.*
"What you allow is what will follow."
Monday 2 January 2017
Millions of Canadians are prescribed medications that are paid for by insurance coverage. For many of them, this coverage is what allows them to take the prescriptions their doctors prescribe, as they simply could not afford them otherwise. Coverage encourages prescription compliance, and the studies are there to prove it.
In 2012, CMAJ published an article that researched the effect of cost on adherence to prescription medications in Canada. They found that approximately 1 in 10 Canadians report cost as being a reason they don’t fill their prescriptions. When they considered respondents with insurance coverage, their findings were clear, “After multivariate adjustment, we found that lacking insurance for prescription drugs was associated with a more than fourfold increase in the odds of cost-related nonadherence.” There are even statistics that show a direct correlation between co-pay fees and adherence. The lower the co-pay, the more likely that prescription will get filled.
As more and more retirees show interest in cannabinoid therapy, they’re faced with the shocking truth about switching from pharmaceuticals that have been covered for years, to cannabis which is not yet covered at all. Statistics from 2012, state that 2.3 million working-age Canadians were on disability, a quarter of which were considered severe.
Cannabinoid therapy works very well for many severe disabilities like chronic pain, Fibromyalgia, MS, some cancers even. So as it stands today, if any of these income-limited citizens wants to try cannabinoid therapy they have to pay for it out of their disability payments. Many juggle food and medicine each month, rationing everything at all times. This undoubtedly affects country-wide healthcare costs. As long as Health Canada refuses to consider medical cannabis a medicine, both patients on disability and patients with insurance coverage will have to pay out of pocket for their cannabis.
Insurers say they cannot cover our medical marijuana prescriptions because Cannabis has no drug identification number (DIN). And, at least by the standards Western medicine has set thus far, they’re right. Is this one little acronym going to keep safer medicine out of the hands of Canadians?
Upon further inspection it seems like the DIN has much less to do with how the drug affects you, and much more to do with tracking, categorizing, and marketing. The number itself is computer generated and upon search, will tell you everything from the manufacturer to the mode of administration. But since a DIN is granted only after testing is done, the DIN in effect, ensures that the product has undergone sufficient testing. You see the problem. No one wants to pay for studies on something that they’re not going to reverse engineer. And as far as the Supreme Court of Canada has ruled, we have the right to use this plant however we see fit.
Pharmaceutical companies spend millions proving the safety, efficacy, and detriment of the chemical concoctions they sell. But with successful medicines, these companies reap the rewards. If most LP’s deem themselves a part of this industry, shouldn’t we expect the same from them? It must be choking for some pharmaceutical companies who only sell pills, to see certain LP’s posting profits, hiring celebrities, buying mobile units, and trading on the stock market for selling something that they spent no funds to prove or create. Who else would we expect should pave the way to not only societal acceptance through studies, but to attain insurance coverage for their patients?
We seem to be at a standstill in Canada where studies are concerned. So many are done on animals not humans. So many are done in other countries, where standards differ from our own. But who better to perform these crucial human studies than the ones who have all the plant product! They’re literally growing more every day! And as time flies by, some of these LP’s are even opening storefronts where information and assistance can be attained. Those outlets would be a great place for data recovery and study product distribution. Sort of like study headquarters for participants to report to. All under the strict guidelines that the ACMPR demands of the Licensed Producers.
From a Licensed Producer’s viewpoint, I want you to adhere to your doctor’s authorization, and have a recurring monthly order with me. But from a patient perspective who sees the prices LP’s charge, I can tell you that isn’t likely to happen every month. ACMPR patients supplement their medicine by buying elsewhere, meaning the LP’s are missing out on revenue. Putting in the time, resources, and might that is required to legitimize this medicine to the point of insurance coverage is good for their bottom line. Insurance coverage encourages compliance, and Cannabis compliance may just have more to do with convenience than with price or quality.
Like Pharmaceutical companies, Licensed Producers just want the bill paid. If a DIN or the equivalent thereof is required for that to occur, it just seems logical that the Licensed Producers themselves be the ones to foot that bill. I foresee a CDIN (Cannabinoid Drug Identification Number) perhaps grouped by ailment identifying ranges of cannabinoids and terpenes found therein. Someone has to prove to Health Canada that Cannabis is indeed a therapeutic medicine.
I believe that this DIN argument is simply an attempt to delay progress. Someone is profiting, so why change the status quo? The status quo isn’t benefiting the average Canadian. When we adhere to our prescriptions, the country’s health care costs go down. We know what needs to be done.