Accessing illicit medicines : the search for medicinal cannabis in Flanders

Introduction: The Belgian legislation on cannabis still prohibits its use, sale and possession. No approval for medicinal use exists, except for the cannabis-based medicine Sativex. Therefore, current policy limits the sources of supply patients can rely on for the purchase of other cannabis products. Previous research with medicinal cannabis user populations shows that accessibility of cannabis is an issue in countries where cannabis for medicinal use is unregulated (Ware et al., 2005) and even in countries where official medical cannabis programs are installed (e.g. Canada) (Belle-Isle et al., 2014; Aggarwal et al., 2009). This paper addresses the implications of the prohibition of medical cannabis for Belgian self-identified medicinal cannabis users regarding access. Methods: This paper is based on the qualitative and quantitative results of a wider study that is designed to better understand the experiences and characteristics of medicinal cannabis users living in Flanders. In-depth interviews (N=62) and an online survey (N=381) were conducted with adult self-identified medicinal cannabis users. Results: More than half of the survey sample obtained their cannabis products from at least three different sources of supply. A recurring difficulty discussed during the interviews was the accessibility of cannabis. Barriers included distance, legal concerns, problems with cultivating cannabis, costs, medical support, health problems and the availability of cannabis products. This paper shows how these obstructions influence cannabis use patterns, users’ health and daily lives. Conclusion: Data indicate that medicinal cannabis users in Flanders face multiple problems in their search for cannabis products and are forced to rely on multiple supply sources. Based on their personal narratives it becomes clear that several factors cause access problems and impact the lives of medicinal cannabis users in specific ways. If Belgium continues to prohibit all cannabis products, except for Sativex, the access of cannabis remains problematic. If policy debates on regulating cannabis start, these findings can be taken into account together with the existing literature regarding access to medical cannabis products.