An unexpected drama played out at a conference centre in Toronto recently, beginning with a presentation about the future of medical marijuana and ending in insults, jeers and a minor Twitter storm. At the heart of the dispute was a question that producers and users of medical cannabis feel strongly about: Once recreational pot is legal, should there still be a separate medical marijuana system?

The uproar was an unusual occurrence at a largely scientific meeting, attended by doctors, nurses and pharmacists, but it highlighted just how fraught the discussion about medical cannabis can be. With the legalization of recreational pot just around the corner, the medical marijuana industry now finds itself at a crossroads, seeking to cement the status of cannabis as a legitimate medicine even as the Canadian Medical Association (CMA) advocates for a single regulatory system.

Right now, patients may not see a lot of tangible benefits to sticking with the medical system. The excise tax the government has announced for recreational pot is to be applied to most medical cannabis products, too, much to the chagrin of producers and users.

Employees process harvested marijuana at the 7Acres facility in Tiverton, Ont.

The controversy erupted on April 5 at the conference of the Canadian Consortium for the Investigation of Cannabinoids, a non-profit that promotes research on the medical uses of marijuana. Dr. Jeff Blackmer, vice-president of medical professionalism with CMA, gave a presentation in which he outlined the organization’s position that there shouldn’t be a separate regulatory framework for medical cannabis once pot becomes legal. “We don’t think that makes any sense,” Blackmer told the Post in an interview before the conference. “(People) can simply go to a legal source and acquire it there.”

It was an unpopular opinion at a conference focused on the use of cannabis in medicine. Afterward, Dr. Michael Verbora, medical director with marijuana company Aleafia, stood up and asked why Blackmer thought a child with epilepsy should have to buy cannabis from a dispensary. “And he didn’t really have a good answer for that,” Verbora told the Post. 

At one point, someone did mention that it was like an ostrich with their head in the ground

The atmosphere in the room quickly became more hostile. Dr. Ian Mitchell, an associate professor of emergency medicine at the University of British Columbia, said an oncologist stood up and said she was ashamed of the CMA. Her comments were greeted with cheers, he said, while Blackmer was booed. Verbora said about 10 or 15 people stood to criticize the CMA’s position. “At one point, someone did mention that it was like an ostrich with their head in the ground,” he said. 

Blackmer eventually left the conference and took to Twitter to express his displeasure. “It was a lost opportunity for an important conversation,” he wrote.

Once the name calling, personal attacks, jeering and booing started at #CCIC2018 I decided it was time to leave. And all this from fellow physicians and HCP’s because they disagree with a policy position of @CMA_Docs. I’m embarrassed and ashamed for them. #professionalism

— Jeff Blackmer (@jblackmerMD) April 5, 2018

“I thought that his presentation was sensible and reasonable and he was given a very rough, rude ride,” said Dr. Alan Bell, a family physician and assistant professor at the University of Toronto. “I did not think it was appropriate, and I thought it was embarrassing to be part of the audience.”

Bell said the only source of disagreement between Blackmer and his audience was the question of a separate medical cannabis stream.

The CMA maintains there’s a lack of data about the benefits of cannabis. “What’s out there is primarily anecdotal,” Blackmer said. “The level of the research is very low and it’s for a very limited number of conditions.”

But Bell and others at the conference argue there’s a dearth of research simply because it’s hard to do, in part because cannabis producers don’t have the resources that pharmaceutical companies command. The CMA’s position only creates another barrier to research, Bell said.

Flowering medical marijuana plants are photographed at Canopy Growth’s Tweed location in Smiths Falls, ON, Wednesday, March 21, 2018.

The number of medical marijuana patients recorded by the federal government has been increasing rapidly, up to more than 235,000 by the end of September 2017, despite the fact that cannabis doesn’t have drug approval from Health Canada. The government has suggested the existing regulatory framework for medical marijuana will remain largely unchanged once recreational pot is legal, despite the CMA’s stance. 

But in the medical marijuana industry, some are concerned that once recreational pot is legal, medical cannabis users could simply switch over.

“It’s certainly a concern that people will stop seeing their doctors and health-care providers and just self-medicate through the new cannabis stores,” said Jonathan Zaid, founder of Canadians for Fair Access to Medical Marijuana, a non-profit organization. Zaid is campaigning to have the government lift the excise tax on medical cannabis and treat it more like other medications.

For medical cannabis, legitimacy is the name of the game as legalization approaches. A key part of that effort, according to Vahan Ajamian, a research analyst with Beacon Securities, is moving away from dried buds and getting medical pot “to look more like medicine.”

To that end, medical marijuana producer Tilray Inc. signed an agreement with pharmaceutical company Sandoz Canada in March, in part to develop non-smokable cannabis products like gel caps and sprays that look more like other types of medicine.

Verbora said the involvement of pharmaceutical companies will help drive research. One barrier medical cannabis producers face, he said, is that marijuana plants can’t be patented. “When you can’t patent a plant, you’re not going to do research,” he explained. But specialized delivery mechanisms — patches and capsules, for instance — could be patented. “We’re really just at the start of the pharmaceuticalization of this plant,” Verbora said.

There are also signs the insurance industry is warming up to medical pot. Currently, coverage is rare except for certain groups like veterans. But in February, Sun Life Financial added medical marijuana as an option for its group benefits plans, and Ajamian said other major insurers will likely follow suit.