BLOWING SMOKE

When Victoria's Tim Wilkins realized his Health Canada licence to
possess medical cannabis was set to expire last year, he diligently
filled out the eight-page renewal form, paid $65 to obtain his
physician's signature and submitted the package to Health Canada's
Marihuana Medical Access Division in Ottawa on August 22-13 weeks
before it was due.

"I'd dealt with [MMAD] for a few years, so I knew how long it could
take," says Wilkins, who declined to let Monday publish his real last
name, fearing the stigma still attached to medical cannabis use. On
November 27 Wilkins' new license arrived-five weeks after the
promised eight-week processing period had passed-and three days after
the old one had already expired.

"The system is set up to be as frustrating and confusing as possible
and is really just a joke," says Wilkins. "I had never believed it
possible that an arm of government could be so ass backwards, so
inept, so slow and so frustrating."

The 35-year-old suffers from degenerative hereditary motor and
sensory neuropathy, a muscle-wasting disease that leaves Wilkins, a
former seismic exploration worker in the oil and gas industry, with
"constant and chronic pain." Before a colleague suggested he try
marijuana to relieve his discomfort in 1999, Wilkins says he had
never experimented with any of the illicit products on Canada's list
of controlled substances.

"I am, and have always been, a law-abiding citizen," says Wilkins.
"But it was immediately obvious what [medical cannabis] was doing for me."

Smoking marijuana, he says, provides a degree of relief from his
daily pain without the harsh side effects associated with many
laboratory-produced prescription pharmaceuticals.

Today Wilkins' is one of a growing chorus of voices-many emanating
from the progressively, critically and terminally ill-outraged by the
bureaucratic tap dance required to win crucial government support to
use the herb that can serve as muscle relaxant, pain reliever,
anti-depressant and appetite stimulant for a variety of medical conditions.

Critics, lawyers and clients alike say despite repeated orders by
Canada's court system for the federal government to provide citizens
a consistent supply of medical cannabis, or the legal protections
required to access one outside government control, Canada's MMAD and
the Marihuana Medical Access Regulations [MMAR] that form the
framework for obtaining therapeutic cannabis are plagued by a lack of
political will that forces some of the country's most vulnerable
citizens into a frontline fight for medication.

Why the government remains so reluctant to back medical marijuana
with the same enthusiasm it offers other pharmacological treatments
remains unclear. Conservative and Liberal governments alike have
cited inadequate research and continuing obligations under the United
Nations' Single Convention on Narcotic Drugs. Critics of that
explanation contend government resistance has more to do with
pressure from the United States' perpetual "war on drugs" and
intervention from a pharmaceutical industry that fears an
effective-and natural-product inundating the market.

Whatever the actual reasons, the upshot of the government's
half-hearted foray into the realm of medical cannabis is clear.
Medical cannabis proponents see Health Canada's MMAD as a barrier,
rather than a conduit, toward a safe, affordable, reliable source of
therapeutic marijuana.

Truth in Numbers

"[The Marihuana Medical Access Division] is a program that was set up
to fail from the word go," says Victoria's Jason Wilcox, who has been
HIV/AIDS positive for 15 years. He uses medical cannabis as an
appetite stimulant, pain reliever and counterbalance to the agitative
effects of the steroids he uses to keep his body from wasting away.
Wilcox claims medical marijuana allows him to avoid no less than four
prescription drugs, including Stemetil, Restoral and Percocet. From
his experience with the MMAD since its early days he identifies
myriad problems, from delays to contradictory messages to a complete
absence of advice on production, consumption and legal issues facing
growers. Wilcox says one need only look as far as enrollment numbers
to see the program is failing the very people it was ostensibly
established to help.

As of December 2007, 2,329 Canadians possessed a
government-sanctioned Authorization to Possess [ATP] dried
marijuana-a dismal record considering the program was initiated in
1999 and a 2002 study commissioned by Health Canada estimated 1.2
million Canadians use marijuana for medical purposes. By contrast,
Oregon's Medical Marijuana Program (OMMP)-also established in
1999-boasts 15,927 registered users for a population one-tenth the
size of Canada's in a country engaged in a protracted drug war.

Of the 2,329 Health Canada licensees, only 488 Canadians are
currently accessing government-grown marijuana. Critics say that
number is likely far lower factoring in the number of clients who
return their cannabis to Health Canada with complaints about its poor quality.

So despite the existence of an almost decade-old federal marijuana
program that has had its own supply of pot since 2003, the vast
majority of medical marijuana users continue to access their medical
cannabis by means still considered illegal in the eyes of the law.

In Victoria, the Vancouver Island Compassion Society provides 745
members with medical cannabis and cannabis-based products-with only a
doctor's signature and proof of condition. VICS founder Philippe
Lucas estimates only 60 of those members possess Health Canada authorization.

At Victoria's Cannabis Buyers Club, founder Ted Smith says his
downtown storefront provides between 2,200 and 2,300 sick clients
with medical marijuana, again with only a doctor's endorsement and
evidence of an illness requiring therapeutic cannabis.

"Maybe between 100 and 150 of those clients have filled out Health
Canada forms," says Smith.

Research conducted in 2006 by Wendy Little and Eric Nash, owners of
Island Harvest, a Duncan company with the only organically-certified
medical marijuana crop in Canada suggests compassion clubs supply
approximately 15,000 people with medical cannabis.

By combining the number of medical marijuana users in Canada who
access Health Canada cannabis (0.02 percent) with the number who rely
on compassion clubs (1.3 percent), Nash and Little say that leaves
98.68 percent of medical marijuana users in the nation who turn to
the black market-that is, friends and street-corner dealers-for the
product. In a country where the judiciary has stated unequivocally
that the state has a responsibility to provide safe, reliable and
legal access to marijuana, this record is particularly troubling.

"If this was any other government-run health program, the public
would be outraged," says Philippe Lucas. "But because it's medical
cannabis, [the government] figures the same standards don't apply."
Jason Wilcox says medical cannabis users in the country have had to
fight for every minimal right they've been accorded-and those rights
should extend farther than they do now.

"Why must the disabled and dying continue to go to fight for
something the courts have already said we have a right to do?" asks
Wilcox. "The disabled are being walked on."

Puzzled Politicians

Perhaps it is no surprise the government seems hesitant, if not
downright negligent, when it comes to holding the country's medical
marijuana system to a standard clients deem acceptable.

The MMAD's origins are rooted not in compassion built on sound
scientific and anecdotal research by the government, but in a
hastily-mustered bureaucracy spawned because multiple levels of the
Canadian courts ordered it to do so. Rather than launching credible
appeals, the government chose to slouch toward compliance. As noted
in the sidebar on page 10, since the 1999 Wakeford case, the federal
government has done the bare minimum to fulfill its constitutional
obligation to stakeholders, failed outright several times and has
repeatedly been brought back before the judge to defend it actions.

In 2002, then-health minister Anne McLellan told the annual meeting
of the Canadian Medical Association, "I understand the issues that we
in this room have and feel in relation to the lack of scientific
evidence, possible liability issues and the fact that the federal
Department of Health does find itself in a slightly ironic position
when I am responsible for the single largest campaign in the federal
government-the anti-smoking campaign," she said.

McLellan forgets, or was perhaps not informed, that many Canadians
who use medical marijuana do not smoke it in rolled form, but instead
utilize vapourizers that neutralize most of the carcinogenic elements
of the smoke, or ingest it in baked goods like cookies, inhale
concentrated sprays, pop cannabis-packed capsules, slurp spoonfuls of
tinctures and oils, or steep it in tea. The Victoria Cannabis Buyers
Club has even developed a cannabis patch that reportedly relieves
muscle and joint pain.

McLellan, speaking to the CMA, went on to add "I don't mean to say
that the courts made me do it, or made [former health minister] Allan
[Rock] do it, although there is some truth to that. The courts took
us down a certain path."

The courts may have made the binding decisions, but it was sick
Canadians that demanded government action in the first place. And it
is sick Canadians that continue to demand changes to the way
therapeutic marijuana is treated in this country.

Delays, Damned Delays

For many clients of Health Canada's MMAD, nothing underscores the
program's absence of compassion like the interminable delays that
occur in the processing of forms and in the program's response to
telephone inquiries.

"Because of the problems I've had, I keep a log now," says frustrated
client Tim Wilkins. "Every phone call, every e-mail. It's like some
sort of tragic comedy."

If marijuana were considered a legitimate form of medication by the
government, the branch tasked with administering it would not deign
to treat MMAD clients with the degree of contempt it regularly demonstrates.

The minutes of a July 11, 2006 MMAD staff meeting obtained by
advocacy group Canadians for Safe Access through an access to
information request provides a glimpse at the scope of barriers
placed in the way of clients exercising their constitutional right to
obtain their medication.

At that meeting, an MMAD employee identified only as Susan unveils
the new protocol for MMAD call centre staff to address clients
phoning to inquire about the status of their renewal application,
calling it the "standard line document."

"Due to the current volume of applications you can expect to wait
eight weeks after the receipt of the final piece of information to
complete your application or renewal," staff were instructed to tell
clients. "If it had been less than six weeks since we received all
required information for your application, your call will take your
file out of rotation and will delay the review and processing of your
application or renewal."

The release of this information seems to corroborate the longstanding
rumour floating around the medical cannabis community that each time
a client queried MMAD, their file would be pulled from its position,
consulted, then placed at the bottom of the pile.

"There is only one phone number and address to reach them at," says
Wilkins. "The number gets you to an exclusive answering service, they
take your name and number and then twice a day they pass along the
message to MMAD."

Despite Health Canada's promise to respond within three business days
to all inquiries, Wilkins' telephone log shows he went 36 days
without a returned call during his 2007 license renewal process. Last
year he says he went 41 days.

These delays are understandable considering only two MMAD staff are
tasked with fielding inquiries. The 2007-08 MMAD budget is only $941,109.

Delays cited by clients extend beyond phone calls to document processing times.

Duncan's Glenn Spicer told Monday he submitted his MMAD renewal forms
four months before his ATP licence was set to expire, "and it still
came two days late." The artist and biologist uses medical marijuana
to relieve the pain of prostate cancer and its corresponding treatments.

He adds that Health Canada has made a simple matter "horribly complex
and inefficient" with its mountains of paperwork. "I can get
prescriptions for far more dangerous drugs with just a visit to my
doctor," he says.

The initial MMAD ATP application form is a staggering 33 pages long
and any changes to client information-from addresses, to a change in
physician-require submitting amendment forms. The Oregon Medical
Marihuana Program asks clients to submit only an eight page form at the outset.

MMAD clients are required to renew their licence every year,
regardless whether their condition is permanent or terminal.

VICS' Lucas argues that if Health Canada will not implement a program
that can respond quickly to the needs of its clients, than some, or
all, responsibility should be delegated to compassion clubs with
corresponding legal protections.

He says that while medical cannabis often allows users a degree of
lucidity in their final days, many are forced to die criminals
because the government program can't meet their needs.

But, as Health Canada's chief of staff William King reminded Island
Harvest's Nash and Little in a January 2007 letter, "Compassion clubs
have no legal authority to produce, sell, or provide marihuana, and
therefore the conduct of these activities is in contravention of the
Controlled Drugs and Substances Act."

Since its first tentative steps toward a national medical marijuana
program, Health Canada has never deemed it necessary to conduct a
comprehensive client satisfaction study of the services it offers. It
has led two stakeholder consultation sessions, though representation
from actual clients was minimal and panel members included
representatives from the law enforcement and pharmacology sectors.

An as-yet unpublished study authored by Philippe Lucas in conjunction
with a University of Guelph professor does what Health Canada has
never found it necessary to do-it asks clients what they think. Some
of the findings are particularly instructive about who is being
harmed by Health Canada's lacklustre approach to medical marijuana access.

For example, the largest segment of the survey group (28.6 percent)
claim to have an annual income of between $10,000 and $19,000. Asked
whether they were ever worried there would not be enough food in
their household before they had enough money to buy more, the largest
number (33.7 percent) checked "sometimes."

This supports the contention of many critics of the federal program
that it is society's more marginalized members who are most in need
of access to regular, affordable marijuana. The wealthy, they
contend, can access marijuana on the black market with greater ease
and less fear of legal persecution.

Jason Wilcox says mixed messages from the government further add to
the cloud that hangs over the program. He is referring to the ongoing
confusion about the status of licences to produce under the MMAR.

"It remains the goal of Health Canada to eventually phase out
Personal-Use Production Licences," wrote Health Canada chief of staff
William King in 2007, but that is small comfort to Wilcox who says
the government has been said that since PPL's were first introduced.

Wilcox and his partner Ann Genovy, who is also HIV-positive, tend
separate crops to meet their medical needs, but have been waiting for
an answer from the government about the fate of the PPL's.

"They are holding us hostage by not letting us know what we can do,"
says Wilcox. "I don't want to move into a new home with my family,
start growing, and then have the door kicked in by the police because
they've changed the personal-production rules."

High Cost of Government Pot

For a four-month supply of government-grown pot Jason Wilcox acquired
last year while waiting for his own crop to flower, he now owes
$6,726 with a 2.5 percent interest charge each month. Wilcox, who
lives in public housing with his family, earns approximately $10,000 a year.

"We don't even open the bills anymore," he says.

Medical cannabis isn't covered by any provincial health plan in
Canada, while compensation and insurance bodies rarely condone its
use, leaving all medical cannabis clients to cover 100 percent of the
costs out of their own pockets.

Wilcox and Genovy have opted to ignore Health Canada's payment
notices until federal Health Minister Tony Clement can provide the
pair an acceptable response to their queries about the 1,500 percent
markup on MMAD pot between the price the government pays Prairie
Plant Systems for the monoculture product it grows in an abandoned
copper and zinc mine in Flin Flon Manitoba and the price it charges clients.

Wilcox and Genovy recently wrote Clement a letter tasking for
clarification. While Clement himself didn't respond, he did task MMAD
manager Ronald Denault with the job.

"Let me assure that there is no markup to the price charged for
Health Canada's supply of dried marihuana," wrote Denault. "Health
Canada strives to provide a consistent, high quality, legally
available source of dried marihuana to authorized persons at a
reasonable cost."

Denault's reply is a far cry from the findings of British Columbia
Compassion Society researcher Rielle Capler, who in a July 2007 study
found, through access to information requests filed with Health
Canada, that the contract with PPS stipulates the government pays
$328.75 per kilogram for 420 annual kilograms. It is important to
remember, notes Capler, that each kilogram contains stalk, stem, seed
and leaf, not only the potent flowering head that contains the
highest concentration of cannabinoids.

By Capler's estimate, MMAD clients collectively are charged $5,000
per kilogram when purchasing it through Health Canada. Capler's
numbers show that while Health Canada pays approximately $10 an
ounce, the final price for consumers is $150.

At the time of the BCCS researcher's writing, consumers of Health
Canada medical cannabis were more than $300,000 in arrears to the
federal government.

As of April 2007, Capler writes that only 351 out of 1742 ATP license
holders were accessing PPS pot while the total cost of the current
contract with PPS today totals $10,278,276.

The issue of the PPS monopoly is of particular concern to those who
recognize the medicinal value different cannabis strains provide
different users. There is a profound difference in the physiological
and psychological effects of sativa and indica strains; Health Canada
authorizes PPS to grow only one strain, which company representatives
have argued in the past ensures a consistent product for consumers.
But as noted previously, medical cannabis users rely on a host of
ingestion methods, most of which Health Canada explicitly forbids
MMAD license-holders from producing with their government-supplied cannabis.

Denault reminds Jason Wilcox of this in his letter when he writes,
"Finally, I would like to remind you that other activities such as
producing tetrahydrocannabinol by extraction with chemicals are
outside the scope of the MMAR."

Capler says leaving legal medical marijuana distribution in the hands
of the government does a disservice to clients and the taxpaying public alike.

"The 1,500 percent mark-up on cannabis charged to patients highlights
the risk of Health Canada creating a monopoly over supply. Health
Canada is requiring taxpayers to fund inefficient practices, capital
upgrades and equipment for a private contractor," concludes Capler.
"Health Canada has chosen a policy and program that seemingly creates
a windfall for one monopoly supplier to the detriment of patients and
taxpayers."

Times Are A-Changin' (Slowly)

While the federal government sticks resolutely to its prohibitionist
guns, medical marijuana is making a slow but relentless march toward
acceptance by the general public. A 2006 study by University of
Lethbridge sociologist Reginald Bibby found 93 percent of Canadians
polled support legally using medical cannabis for health reasons.

However, public policy, and the nation's policy makers themselves,
remain woefully behind the times. Observers say that this too may
change in coming decades as the baby boomers-the generation that
embraced widespread marijuana use in the west in the 1960s-grow older
and grow ill.

"I think there's going to be a fundmental shift as the baby boomers
begin to exercise their fundamnetal right to access medicine of their
choice," says Island Harvest's Eric Nash.

But it will surely be an uphill battle to challenge the policies of a
federal government bent on structuring public policy around ideology
instead of information.

As Tim Wilkins attests, despite the benefits of his medical cannabis
use, and despite his legal entitlement to do so, regular folks like
him, sick and in pain, remain scared to step out of the shadows.