Canada’s massive medical cannabis mistake – and how the U.S. can avoid it

Raashid Naik (Courtesy photo)

(This is a contributed guest column. To be considered as an MJBizDaily guest columnist, please submit your request here.)

President Donald Trump’s Dec. 18 executive order, aimed at modernizing U.S. policy on medical marijuana and CBD, expanded research opportunities – and created enough optimism to trigger a flurry of cannabis M&A.

But one fundamental question remains unanswered. How will medical cannabis actually be delivered to patients?

Canada faced this same question nearly a decade ago – and got it badly wrong.

In 2016, Canada expanded nationwide access to medical cannabis. At the time, I was working at Shoppers Drug Mart, Canada’s largest pharmacy retailer, where I focused on new healthcare ventures.

I am a licensed pharmacist by training, and like many healthcare professionals, I was initially skeptical of cannabis as medicine.

That changed after meeting patients and hearing their stories firsthand. I later went on to launch and lead a national medical cannabis distribution platform under the Shoppers banner.

The case that crystallized the issue for me was Charlotte Figi, a child with Dravet syndrome whose severe, treatment resistant epilepsy improved with a CBD based cannabis extract after standard therapies failed.

The issue was never whether cannabis could be therapeutic. The issue was access to it as medicine.

Charlotte’s parents, like many families since, were forced to navigate legal uncertainty, inconsistent products, and a lack of clinical oversight to obtain something that worked.

That failure was not scientific. It was regulatory.

Canada was right to legalize medical cannabis federally, but it made a critical policy choice. Pharmacists were kept out of the system.

In 2018, Canada legalized recreational cannabis nationwide. Many believed this would finally integrate medical cannabis into pharmacies.

It did not.

Physicians still could not write prescriptions. Instead, they issued “medical documents” that authorized cannabis use without specifying product type, formulation, dose, or route of administration. Pharmacists were excluded entirely. Patients were left to make these decisions on their own.

At the same time, adult use consumers gained easy access through physical retail stores and online platforms, often open late and located minutes away.

Patients noticed.

Many began bypassing the medical system altogether. Recreational access was faster, cheaper, and easier to navigate.

For patients managing chronic pain, nausea, or neurological symptoms, convenience increasingly outweighed clinical oversight.

But cannabis is not a benign consumer product for many patients. Appropriate use requires guidance on dosing, formulation, timing, and interactions with other medications. That guidance is exactly what pharmacists are trained to provide.

In Canada, it was largely absent.

Within the constraints of the regulatory framework, we attempted to build what the law failed to require.

Because patients were forced to access medical cannabis through eCommerce channels, we staffed our call centers with licensed pharmacists whose primary role was cannabis education.

Patients could speak directly with a pharmacist about dosing strategies, routes of administration, onset and duration of effect, side effects, and potential drug interactions.

Pharmacists routinely advised against smoking or inhalation, instead recommending oral or sublingual formulations with more predictable dosing and lower risk. We also applied pharmaceutical standards to a category that largely lacked them, reviewing potency claims, assessing batch consistency, and prioritizing dosage forms aligned with Good Manufacturing Practices.

This approach reduced harm and was valued by patients. But it was not sustainable.

Providing medical counseling while patients ultimately purchased cannabis through non medical retail channels did not work. The economics failed, and the regulatory structure made true pharmacy integration impossible.

The business was eventually spun out, not because of lack of demand, but because policy design made it impossible to deliver medical cannabis as medicine.

The United States is now at a similar inflection point.

As federal policy evolves, the question is no longer whether cannabis should be available. The question is how it should be delivered.

A framework that allows pharmacists to dispense and counsel on medical cannabis would immediately raise the standard of care. It would normalize evidence based discussions around dosing, administration, side effects, and drug interactions. It would also improve labeling accuracy, manufacturing quality, and patient education.

Canada’s experience shows the risks of a recreational first approach that sidelines healthcare professionals. The United States does not have to repeat that mistake. If cannabis is to be treated as medicine, pharmacists must be part of delivering that care.

Raashid Naik is a licensed pharmacist and healthcare executive with over 15 years of experience in pharmacy, digital health, and regulated healthcare markets. He previously served as Senior Director of Medical Cannabis at Shoppers Drug Mart, where he launched and scaled one of Canada’s largest medical cannabis platform.