Are dispensaries indispensable? Patient experiences of access to cannabis from medical cannabis dispensaries in Canada.

BACKGROUND: In 2001, Canada established a federal program for cannabis for therapeutic purposes (CTP). Medical cannabis dispensaries (dispensaries) are widely accessed as a source of CTP despite storefront sales of cannabis being illegal. The discrepancy between legal status and social practice has fuelled active debate regarding the role of dispensaries. The present study aims to inform this debate by analysing CTP user experiences with different CTP sources, and comparing dispensary users to those accessing CTP from other sources. METHODS: We compared sociodemographic characteristics, health related factors and patterns of cannabis use of 445 respondents, 215 who accessed CTP from dispensaries with 230 who accessed other sources. We compared patients' ratings of CTP sources (dispensaries, Health Canada's supplier, self-production, other producer, friend or acquaintance, street dealer) for quality and availability of product, safety and efficiency of access, cost, and feeling respected while accessing. RESULTS: Patients using dispensaries were older, more likely to have arthritis and HIV/AIDS, and less likely to have mental health conditions than those not using dispensaries. Those accessing dispensaries used larger quantities of cannabis, placed greater value on access to specific strains, and were more likely to have legal authorization for CTP. Dispensaries were rated equally to or more favourably than other sources of CTP for quality, safety, availability, efficiency and feeling respected, and less favourably than self-production and other producer for cost. CONCLUSION: Given the high endorsement of dispensaries by patients, future regulations should consider including dispensaries as a source of CTP and address known barriers to access such as cost and health care provider support. Further research should assess the impact of the addition of licensed producers on the role and perceived value of dispensaries within the Canadian medical cannabis system.

A new clinic model for refugee health care: adaptation of cultural safety.

INTRODUCTION: Non-English speaking refugees new to the USA face challenges to and barriers in accessing healthcare services resulting in missed medical provider appointments and increased reliance on hospital emergency departments. To confront the issues, a new clinic model for prenatal and pediatric refugee patients was started. Success of the model is largely due to the role of C.A.R.E. (Culturally Appropriate Resources and Education) Clinic Health Advisor that was developed in conjunction with the organization and evolution of the clinic. The purpose of this publication was to differentiate the role of C.A.R.E. Clinic Health Advisor from certified medical interpreter and to evaluate the lived experiences of each role. Theoretical framework was the adaptation of two overlapping ecological models, combined with principles of cultural safety. METHODS: Qualitative data collected to evaluate lived experiences, efficiency and effectiveness of the role of C.A.R.E. Clinic Health Advisor were collected from observations, focus groups, and individual interviews with health advisors and members of the healthcare team. Quantitative data were collected from retrospective chart reviews for the purpose of validating patient outcomes. RESULTS: Themes emerging from qualitative data included communication, navigating the system and community. Chart reviews validated success of the clinic as evidenced by missed clinical appointments dropping from 25% to 2.5%, and childhood immunizations being sustained at 100% compliance through a baby's first year of life. CONCLUSIONS: This new clinic model and health advisor role are recommended for use with other vulnerable populations such as migrant farmers, the socioeconomically disenfranchised, rural populations and the elderly. The increase in bi-directional cultural understanding, human caring, social justice and trust become their own rewards.