The Supply of Cannabis for Medical Use Through Cannabis Social Clubs in Belgium

Abstract

Cannabis Social Clubs (CSCs) are nonprofit associations of adult cannabis users, which collectively organize the supply of cannabis among their members. As CSCs currently also serve members using cannabis for medical purposes, this article aims to detail the particular features of Belgian CSCs as suppliers of cannabis for medical use, and how those are perceived by CSC members. In this article, we draw on data gathered through interviews with the managing staff (n ¼ 21) of seven currently active Belgian CSCs. In addition, we conducted interviews (n ¼ 21) and an online survey (n ¼ 80) with members of Belgian CSCs using cannabis for medical reasons. We present Belgian CSCs' practices building on an adapted version of the health services analytical framework proposed by Belle-Isle et al. This article thus provides a first overview of the features of Belgian CSCs as suppliers of cannabis for medical use as well as members' perceptions. Structural differences emerged as to how the Belgian CSCs have accommodated medical members' needs (in mixed CSCs where no formal distinction is made between recreational and medical members, in a separate CSC subunit or in a CSC admitting medical members only). Candidate medical members must fulfill specific criteria, particularly when applying for the medical units. The CSCs have adopted two different types of distribution methods, and the cannabis supplied is produced organically-systematic quality control is, however, lacking. We noted some flexibility in relation to frequency and quantity distributed to medical members. Affordability was positively appreciated by CSC members. Collaboration between CSCs and the health sector remains challenging. Some degree of diversity in practices among CSCs remains, as well as common issues which continue to affect the model in Belgium and are important in understanding the role and potential of CSCs as providers of cannabis for medical use.

Cannabis Use and Supply Patterns Among Belgian Cannabis Social Club Members

“…The smaller group of members indicating having received cannabis on seven or more occasions (7.1%) tended to be primarily CSC members (self-reportedly) using cannabis for medical reasons (in nine out of 10 cases). This echoes the reports from CSC representatives, who have acknowledged organizing more frequent distribution moments for members using cannabis for medical reasons (Pardal & Bawin, 2018). The quantity of cannabis typically received at each distribution moment organized by the CSC can be situated mainly between 10 and 59 g, with the most common amount reported being 20 to 29 g (Figure 3).…”

“…While cannabis cultivation and distribution remain prohibited in the country (Pardal, 2016), the CSC members participating in our survey seem to share their representatives’ claims that the CSC activities can be understood in light of the 2005 Ministerial Guideline (Pardal, 2018b), as this participant pointed out: “to act within the spirit of the Ministerial Guideline of 25 January of 2005” (M101). Some respondents ( n = 38) alluded also to their (self-defined) medical use of cannabis and saw the CSCs as adequate suppliers for that end (Pardal & Bawin, 2018), for instance: Because I needed cannabis as a medicine and I was tired of having to buy my medicine in shadowy back rooms in the Netherlands. (M81)…”

“…13 Among those respondents, about 51% did not currently have a written recommendation, such as a prescription or a letter, from a health care professional (i.e., a general physician, a specialist, or a nurse) advising the use of cannabis. 14 Given the relevance of this issue to understanding the CSC model, we discuss several aspects related to the supply and use of cannabis for medical reasons in separate (Pardal & Bawin, 2018). CSC members were most predominantly current cannabis users, as most reported using cannabis in the past 30 days (92.9%).…”

“…Most respondents did discuss their use of cannabis with CSC representatives in different moments, which suggests that the CSCs may create opportunities to aid and follow up on members' consumption levels and identify cases of problematic use. CSC representatives reported having a conversation about cannabis use (among other issues) with candidate members upon admission, and maintain somewhat regular contact afterward (Pardal & Bawin, 2018). As most Belgian CSCs currently lack a dedicated facility for members to gather, peer and social contact within the CSCs remain limited (Pardal, 2018a).…”

“…We have no evidence of quantity discounts (as discussed for instance in relation to the U.S. cannabis market by Caulkins & Pacula, 2005) being applied by the Belgian CSCs. In some cases, there might be a price differentiation for CSC members using cannabis for medical reasons though (Pardal & Bawin, 2018).…”