Until late last year, Canadians could purchase legal medical cannabis through a licensed seller. None of those sellers, however, had a pharmacy as part of their operations.

That changed in December when Health Canada gave Shoppers Drug Mart the green light to sell dried and fresh cannabis, plants, seeds and oil to customers purchasing medical cannabis. The licence is potentially ground-breaking. It opens the door to other pharmacies selling cannabis, a contentious and evolving issue.

The Canadian Pharmacists Association (CPhA), for example, supports pharmacists dispensing cannabis for medical purposes as long as there is a clear distinction between medical and recreational cannabis streams, including product and pricing differentiation and separate access points, Shelita Dattani, CPhA’s director of practice development and knowledge translation, says from Ottawa. “We believe that these measures are essential to ensure that patients are not unintentionally diverted into the recreational stream and left to self-medicate without the additional guidance that comes with pharmacist care,” Dattani says.

The Neighbourhood Pharmacy Association of Canada, the national organization representing the community pharmacy industry, is actively engaged in advocating for pharmacies to sell medical cannabis. This will, says Aimee Sulliman, the association’s senior vice-president of public affairs in Toronto, “ensure patients have access to a stable distribution channel for medical cannabis, with the oversight of their trusted pharmacists to counsel on appropriateness of therapy, contraindications, drug-to-drug interactions and dosing.”

Some professional regulating bodies are also coming on board with this way of thinking. Last summer, the Ontario College of Pharmacists approved an expanded position on cannabis distribution. The new position notes the college would not oppose any federal or provincial legislation permitting the dispensing of non-smoked forms of cannabis for medical use within pharmacies.

The professional body would also not oppose legal dispensing for medical use within pharmacies, regardless of whether cannabis is approved as a drug by Health Canada or whether it receives an assigned Drug Identification Number, although sufficient quality control measures would need to be in place federally.

Cannabis route to access “atypical”

It’s a position the Halifax-based Nova Scotia College of Pharmacists (NSCP) cannot endorse, pointing out that the medication use system in Canada is built on a series of checks and balances to ensure drugs meet Health Canada requirements. Drugs are authorized for sale in Canada only after they have successfully gone through the drug review process.

“Cannabis is unique. Its route to access has been atypical,” suggests NSCP registrar and CEO Beverley Zwicker. It was the courts—and not rigorous studies—that led to the use of medical cannabis in Canada, Zwicker says. This included the 2008 decision from the Federal Court of Canada striking down regulations that limited producers to growing cannabis for only one person.

“Cannabis is not an approved drug; there is no prescription. It is professionally, and ethically, challenging for pharmacists to be involved in the sale of this product,” Zwicker maintains.

Like other regulators and professional associations across the country, however, the NSCP believes pharmacists, as medication experts, are well-positioned to assist patients with questions and concerns about medical cannabis. “Our position is you don’t have to provide the product to be a provider of information about the product,” says Zwicker. “Pharmacies are well-positioned to help the public, but they don’t need to be involved in the distribution to do that.”

Health Canada is open to having medical cannabis sold in pharmacies across the country. This would, however, require endorsement from the provinces and territories, the regulatory authorities responsible for pharmacists and pharmacists themselves, Tammy Jarbeau, senior media relations advisor, serving Health Canada and the Public Health Agency of Canada, says from Ottawa. “Health Canada has previously indicated that it is open to discussing other models of distributing cannabis for medical purposes, including pharmacy distribution, if support exists,” Jarbeau says.

Canada would not be breaking new ground if pharmacies begin selling medical cannabis in their stores. Indeed, the country is late to the table.

“Internationally, almost all countries that dispense medical cannabis dispense the product through pharmacy,” says Sulliman. She provided a chart listing 11 countries—Canada, Germany, Australia, the Netherlands, Chile, Croatia, Israel, Italy, Macedonia, Puerto Rico and Uruguay—and whether or not they had licensed pharmacies dispensing medical cannabis. Of the 11, only Canada and Puerto Rico currently did not.