title: Barriers to access for Canadians who use cannabis for therapeutic purposes.
abstract: BACKGROUND
  There is increased interest in the therapeutic potential of cannabis in recent decades. Canada, the Netherlands, Israel and some states in the United States have developed programs to allow access to cannabis for therapeutic purposes (CTP). In Canada, enrollment in the federal CTP program represents fewer than 5% of the estimated users of CTP. The discrepancy between the number of Canadians who report using CTP and the rate of utilization of the federal CTP program suggests the existence of barriers to access to this program.
  
  
  METHODS
  In the present study we employ a health services analytical framework to examine barriers to access to CTP among 628 current CTP users. We define barriers to access as areas of poor fit between clients and services. We use five dimensions of accommodation, accessibility, availability, affordability, and acceptability to examine access to CTP.
  
  
  RESULTS
  Our findings reveal that it is difficult for Canadians to find a physician to support their application to access CTP. Accessing CTP from unauthorized sources was common; only 7% of respondents accessed CTP exclusively from authorized sources. Access to CTP was positively associated with the presence of medical cannabis dispensaries, which were not included in the regulatory regime. Access to CTP varied by medical condition and general quality of health. Affordability of CTP was a substantial barrier to access.
  
  
  CONCLUSIONS
  Strategies need to be developed to encourage scientific inquiry into CTP and address the barriers to access to CTP and the stigma and controversy that surround CTP and strain patient-physician relationships.
authors.affiliation: Canadian AIDS Society, Ottawa, Ontario, Canada; Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada. Electronic address: lynnebel@uvic.ca.
authors.forename: Lynne
authors.initials: L
authors.lastname: Belle-Isle
authors.affiliation: Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Zach
authors.initials: Z
authors.lastname: Walsh
authors.affiliation: Medical Cannabis Advocate, Vancouver, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Callaway
authors.affiliation: Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lucas
authors.affiliation: Canadian Association of Medical Cannabis Dispensaries, Vancouver, British Columbia, Canada.
authors.forename: Rielle
authors.initials: R
authors.lastname: Capler
authors.affiliation: GreenLeaf Technologies, Kelowna, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Kay
authors.affiliation: Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Holtzman
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008385:Marijuana Smoking; D064086:Medical Marijuana / Q000600:supply & distribution*; D008875:Middle Aged; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires
chemical_list: D064086:Medical Marijuana
keywords: Barriers to access; Canada; Cannabis; Cannabis for therapeutic purposes; Health services analytical framework; Medical cannabis; Regulations