Author: Daniel Gates

I’ve learned very quickly that the Land Down Under and the Great White North have a lot in common: we’re both parliamentary democracies; we’re both partial to smothering french fries in gravy (even if Aussies call them “chips” and don’t add cheese); and of course, we both have universal healthcare.

Both our countries are understandably proud of our healthcare systems. While witnessing the current heated debate in the United States over universal healthcare, Australians and Canadians alike can find themselves thinking: “oh how primitive, we did that ages ago.” Yet despite our fantastic systems, in both Canada and Australia, patients still struggle to access a vital, all-natural pain relief medicine that has demonstrated a range of other positive health benefits, including helping children with epilepsy reduce their risk of seizure (Thomas & Cunningham, 2019). I am of course talking about cannabis.

In Canada, medicinal cannabis isn’t a government subsidized medication. This means costs are prohibitively high. In 2019, across Canada the cost of medicinal cannabis per gram was on average 75 cents higher than non-medicinal cannabis. This might seem like a small amount, but when buying in larger quantities to fill a prescription, these costs add up. Medicinal cannabis isn’t subsidized in Australia either; a six- to eight-week course of medicinal cannabis can cost over $750 AUD ($662 CAD). This can cause healthcare costs to rapidly increase; in Australia the cost of treating an epileptic child with a standard dose of medicinal cannabis is $60,000 AUD ($52,573 CAD) a year. Since these costs are not subsidized, this translates into crippling medical bills for a lot of families.

In response to this, Canada has seen some changes. Organizations like CanniMed subsidize the cost of medicinal cannabis for people on disability or unemployment benefits, and Veterans Affairs Canada also covers registered members for use of medicinal cannabis. Unfortunately, these are the outliers. Large numbers of low-income Canadians in need of medicinal cannabis are still unable to surmount the prohibitive costs.  In Australia, some state governments have sought to surmount financial burdens through compassionate access schemes, such as the framework set up in Victoria under the Access to Medicinal Cannabis Act 2016. This scheme subsidizes the cost of cannabis, but only for children with epilepsy and only if other treatments have failed. Whilst this is an important protection for vulnerable children, the scheme is currently capped at 90 participants, so it too is limited in scope.

Similarly, both Australia and Canada face issues of “postcode injustice” since there is a far greater degree of access to medicinal cannabis in cities than rural areas. In both countries there are troubling reports of people travelling hours from regional areas to fill prescriptions either due to a lack of clinics altogether or (as occurred in Manitoba in March 2018) clinics running out of stock.

Of course, the tide is turning in Canada. With cannabis legally regulated for recreational use, doctors are becoming less hesitant to prescribe it. As the normalization of cannabis use continues, insurance companies and government bodies are moving closer towards subsidizing medicinal cannabis. The legal cultivation of cannabis plants also helps bridge the gap for rural communities who might otherwise struggle to access medicinal cannabis.

Meanwhile, the illegality of cannabis in Australia creates additional barriers to health outcomes, which jeopardizes marginalized people in need of medicine. Whereas wealthy people can overcome the prohibitive costs of accessing pain relief, lower income families are forced to choose between agonizing pain, or the risk of arrest. This is another stark reminder that our outdated approach to drugs has real negative impacts that disproportionately affect disadvantaged groups.

Australia’s prohibitive regime at least (logically) makes sense: we’re still clutching our collective pearls at the thought of cannabis being used recreationally, so there is accompanying hesitation around its medical use. Despite slow moves to decriminalize recreational use of cannabis in some states and territories, there is still a long way to go before we see widescale legal regulation. But it’s a sad sight that in Canada you can purchase marijuana from a store as easily as you can buy alcohol, yet the medical benefits of this substance are not endorsed by health insurance providers or the government.

Australians and Canadians have a right to be proud of our healthcare systems. But we shouldn’t forget that when it comes to medicinal cannabis, we’ve got a long way to go. If both countries don’t take greater steps to improving access, our claims of superiority will be little more than blowing smoke.

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Thomas, Rhys H & Cunningham, Mark O (2019). Cannabis and epilepsy. Practical Neurology, 10, 465-471.

Being an Australian in Vancouver, I’m used to confusing people a bit. Sometimes folks can’t tell if I’m a Pom or a Kiwi. Sometimes my coffee order leaves baristas with furrowed brows. And once I made the mistake of using the slang phrase, “that’s fair dinkum” (meaning “that’s the truth”) in conversation with a Canadian friend, who insisted that Australian must be its own language.

But in the Canadian drug policy world, one observation of mine leads to more confusion than any quirks of pronunciation. When I say, “Australia is way behind Canada on harm reduction” people’s jaws hit the floor. A common response is: “but you folks have had safe injection sites since the 1990s!” They’re half right.

Australia currently has two supervised injection centres. One is run by the Uniting Church in Sydney and another is a government-run facility in my home city of Melbourne, which opened in 2018. So right off the bat, we’re lagging behind just on numbers: the city of Vancouver has more harm reduction facilities on one block than Australia has on a whole continent. But there’s more we could copy from Canada than numbers.

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I’ve been interning at the Canadian Drug Policy Coalition (CDPC) since January and after getting here I took the opportunity to volunteer once a week at the Overdose Prevention Society (OPS), which operates a low-barrier overdose prevention site. I wanted to help a life-saving organization and understand a perspective on drug policy outside the confines of academia. I received a rapid reminder of how important overdose prevention sites are: on my first shift, there were three overdoses in three hours. Thanks to the intervention of staff, volunteers and paramedics, all three individuals survived—three lives saved. This work happens everyday, and the number of deaths prevented is much larger.

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But there’s something else to OPS that sets it apart from the safe injection sites back home. OPS is a peer-led program; the staff and supervisors live in the Downtown Eastside and many of them have been or currently are people who consume substances or have experience with homelessness. Paying community members to work at the site gives them a “safe hustle” (a chance to make legal money) while also offering an empathetic ear to participants, rather than having privileged people talking down to them. As an outsider looking in, it’s so inspiring to see the respect that the supervisors and staff engender in participants.

You get a tangible sense of community by just looking around the space and observing the casual interactions between people. The notice board next to the sign-in desk is covered with artwork and poems made by community members. There are couches, which some people sleep on, and a big table in “the chill,” a space where people can hang out while they wait for a booth or just to chat with others. Even people’s handles (aliases that they use to sign in) are creative, personalized expressions—a mix of innuendo, puns or significant words or phrases from their lives. All of this combines to give a sense that this space belongs to the participants.

Being a volunteer at OPS has been a highlight of my time in Vancouver. It’s a really positive environment, which might sound odd since my first shift involved intervening in three overdoses, but I truly mean it. The staff are genuinely kind and warm, and it’s always great when I get the chance to chat to a participant as they sign in. Aside from getting to meet some inspiring people, OPS gives me a lot of hope, just as it does the countless community members who use its life-saving services. Working in drug policy, it is easy to become pessimistic when governments, police and uninformed people put hurdles in the path of progress. But OPS is a reminder that people are making a positive difference in the overdose crisis every day despite such obstacles.

This is what Australia is missing. Besides people being misinformed about safe injection sites, we lack a community-led approach to harm reduction. Australia should be focussing on creating spaces that aren’t just physically safe, but that also allow people to congregate, build community, and find hope. In short, Australia doesn’t just need more safe injection sites; it needs more spaces like OPS. And that’s fair dinkum.

Daniel Gates is a research intern with the Canadian Drug Policy Coalition studying a double degree of Law and International Relations at Monash University in Australia. The Overdose Prevention Society welcomes donations of clothing, blankets, and food. You can drop items off at 58 East Hastings Street, Vancouver between the hours of 8:00 a.m. – 9:00 p.m., 7 days a week. You can also donate to them online here.