Shoppers Drug Mart’s announcement they will be advising those who qualify for Manulife’s enhanced medical marijuana insurance coverage is being hailed by cannabis business owners and those already in the medical marijuana field as a major step forward in access for patients and mainstream public acceptance.
In July, Manulife Financial announced that Shoppers Drug Mart will be partnering with them to offer enhanced medical marijuana insurance coverage. Policyholders will be able to consult with Shoppers Drug Mart pharmacists at one of Ontario’s patient care centres about different strains of marijuana and different ways to take it. The policyholder can then choose a treatment covered by their policy and receive ongoing case management from a Shoppers care centre pharmacist.
More information on the enhanced coverage will reportedly be revealed when the program becomes available in Fall 2018, but for now, Canada’s cannabis community is celebrating the increased access to cannabis for patients, even while they remain skeptical of Shoppers Drug Mart pharmacists’ abilities to truly provide informed advice in this area.
“Fantastic that people have easy access to medicine – amazing! But what do pharmacists actually know about cannabis?” asks Abi Roach, owner of The Hot Box Cafe, a pot-positive vape lounge and head shop in Toronto’s Kensington Market neighbourhood.
From pills to pot
Yahoo Canada Finance reached out to representatives of both Shoppers Drug Mart and Manulife to find out the answer to Roach’s question, but have yet to respond as of publication time.
What is known is that Shoppers Drug Mart applied to be a licensed producer of medical marijuana in 2016 as an administrative requirement to be able to distribute the plant to patients. They then entered into a deal with Ontario-based supplier Aphria Inc. (APH.TO) the next year.
“We believe that allowing medical marijuana to be dispensed through pharmacy would increase access, safety, quality and security for the thousands of Canadians who use the drug as part of their medication therapy,” a Shoppers spokesperson said in 2016.
That same year, the Canadian Pharmacist Association called for their members to “play a front-line role” in patient management and dispensing of medical marijuana, a reversal of its stance in 2013 when Health Canada included pharmacy distribution in its Marihuana for Medical Purposes Regulations [MMPR].
Though Roach says she remembers the Canadian Pharmacist Association being against medical marijuana much more recently.
“The Pharmacist Association was against medical marijuana I think up until last year. I remember going to a city council meeting about a year and a half ago where their representative screamed hell and high water about how cannabis is not medicine,” she says.
In this Feb. 20, 2015, file photo, Alaska Cannabis Club CEO Charlo Greene prepares to roll a joint at the medical marijuana dispensary in Anchorage, Alaska. (AP Photo/Mark Thiessen, File)
Andrea Dobbs, co-owner of Vancouver medical cannabis dispensary The Village Bloomery, recalls Shoppers Drug Mart having a similar stance in the past:
“I think right now they’re excited. They’re nervous because [Shoppers Drug Mart] did come out for a long time saying they absolutely wanted nothing to do with cannabis – that it was a drug. They fought against having any mention of medical cannabis or even having any coverage or access through them, but then they had a change of heart.”
With that change of heart comes a steep learning curve, one that Canada’s cannabis community agrees will take a complete overhaul of the way Shoppers Drug Mart typically assists its pharmacy customers.
Different tokes for different folks
Though Shoppers Drug Mart has yet to reveal what the knowledge base of its pharmacists is regarding medical cannabis, those in the dispensary business agree that they will have to allow their patients much more latitude than they are used to giving for experimentation and exploration.
“There is no baseline prescription that they can fill that is going to react the same way with every person,” says Dobbs.
“It’s going to change their style of interface. They’re not just going to be able to be that pharmacist who says, ‘Okay, your doctor says this. Take this and go about your day.’ It’s going to be, ‘Oh, I came back that was scary,’ or ‘That made me feel funny,’ so those relationships are going to be a little more intricate than the ones they are used to having.
“They’re going to have to ask a lot of questions and have much longer, more intimate conversations with their patients than the pharmacy counter at Shoppers Drug Mart traditionally allows.”
Medical cannabis is still a new enough treatment that some doctors who prescribe it overestimate the amount that is appropriate for a given ailment afflicting a given person. It’s not uncommon for dispensary employees to have to dial dosages back or adjust a cannabis delivery method for a patient. They are used to tweaking dosages or delivery methods over multiple visits.
“It’s an iterative process of trying something, seeing if it works and trying something else,” says Jeremy Jacob, president of the Canadian Association of Medical Cannabis Dispensaries and co-owner of The Village Bloomery.
“It becomes a pretty complicated thing and the personal connection, the interaction and the feedback has been invaluable for people to help them navigate, especially new consumers who are looking for an alternative,” he says.
Until doses are truly standardized, what is allowable under the current legal framework will set the parameters for what can be prescribed and in what amount. Shoppers will be able to prescribe oils with a concentration no higher than three per cent THC, in addition to dried flowers. The available tools will be relatively limited, so pharmacists will have to dig deep in ways they haven’t before to find the right dose for their patients.
“It really depends how open [pharmacists] are and how willing they are to access the expertise that already exists in the cannabis space. The people who’ve been on the front lines talking with patients about potential benefits and side effects have developed strategies,” says Jacob.
It will also force Shoppers pharmacists to start learning herbology since plants are one of the current allowable delivery methods for this medication.
“Does a pharmacist know better than an herbalist with the same education? Probably not,” says Roach.
“There’s a lot of people who aren’t pharmacists who have been studying the effects of medical cannabis for a very long time. They may not have medical degrees, but they do have knowledge and studies, so maybe the very idea that only pharmacists can do this is wrong. Maybe there should be a whole course just in pharmaceutical cannabis and how to dispense it that isn’t just for pharmacists,” she says.
Increased access, mainstream acceptance
Despite the hurdles still in front them, Shoppers Drug Mart’s entrance into the medical cannabis arena is a huge step forward in the access to and acceptance of the herb as a treatment method in Canada.
“What they’ve got is a lot of reach to seniors in suburban and rural areas and they create a nice bridge for the brand newbies,” says Dobbs.
“I deal with a lot of people who are very new, they have a lot of questions and they really want to run parallel to pharmaceuticals and it’s really hard to switch them from ‘Take this pills three times a day, you’ll be fine,’ which you can’t do with cannabis, so this is going to give them that bridge: they’re going to feel like they trust the pharmacist because they’ve got that relationship with them already and it will help them make the transition from pharmaceuticals to this natural alternative.”
With Shoppers Drug Mart in the mix, the company’s foray into the medical cannabis industry opens the door for the first serious mainstream conversation around medical cannabis and pharmaceuticals.
“The people who are most at risk are still the ones who are least able to afford cannabis because not everybody has a job that allows them to afford extended medical, so what we really want to see in the bigger picture is coverage at the federal medical level,” says Jacob. “Cannabis should be part of universal health care.”
“If we can subsidize prescriptions for Oxycontin…anti-anxiety meds, anti-depressants and anti-seizure medication, certainly we should have support for people who want this non-toxic alternative, but don’t have extended medical insurance coverage,” he adds.
“It’s good we’re seeing this get into the public eye, but we really need to see this access as a bottom-line right for all Canadians.”
Even if cannabis never becomes part of universal health care coverage, the cannabis community agrees Shoppers Drug Mart supporting it is still an amazing first step.
“People will point fingers and say they’re in it for the money, which may or may not be the truth, but when it comes down to the front-line people who work at the shop, it’s not going to matter what the company’s mandate is,” says Dobbs.
“People getting access to cannabis through insurance is wonderful, so if they can facilitate that –that’s great.”