Jenna is a PhD candidate at the University of Toronto in sociology and the Collaborative Program in Addiction Studies.

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Federal Health Minister Rona Ambrose can't seem to catch a break. First, Kimberley, B.C., grants a business licence to a medical cannabis dispensary and then Vancouver City Council votes to regulate and license medical cannabis dispensaries. Coupled with the recent Supreme Court of Canada ruling that patients can possess all forms of cannabis for medical purposes, Ms. Ambrose is left with feelings of sheer "outrage."

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But that outrage is misplaced. Pushing aside both scientific literature and the personal experiences of Canadians, the Health Minister still refuses to acknowledge cannabis as a medicine. By refusing to take a leadership role and create a medical cannabis-access program that could serve the diverse needs of patients, the federal government is responsible for what we are seeing in the "wild west" of Canada – a disconnect between realities on the ground and sound public policy.

While Vancouver has always been known for its local innovation in drug policy, the continued existence of dispensaries is really premised on the government's failure to create a program that can stand up to constitutional scrutiny and the increasingly relaxed attitudes of Canadians toward cannabis.

The existence of medical cannabis dispensaries is not new. Long before the federal cannabis-access program was initiated in 2001, dispensaries operated quasi-legally, or as an act of civil disobedience, across Canada. Although the new federal program, the Marihuana for Medical Purposes Regulations (MMPR), allows qualifying patients to purchase medical cannabis from companies licensed by Health Canada, the number of dispensaries in Vancouver has exploded from 14 in 2013, to more than 90 dispensaries today.

Taking a common-sense approach, the City of Vancouver decided to move forward with regulating dispensaries after four days of public hearings, despite strong warnings from the federal government.

The truth is that thousands of Canadians, arguably more than are registered with the MMPR, use dispensaries. One of the oldest and largest clubs in Vancouver serves more than 6,000 members alone. There are even patients registered officially with the MMPR who continue to access dispensaries exclusively, or in conjunction with their licensed producer (LP).

While the MMPR is a step in the right direction, many issues continue to limit patient care and access. Much of this is based on how heavily regulated LPs are, operating out of Fort Knox-type facilities under Health Canada's rule. LPs are restricted to a mail-delivery model and the advertising restrictions are so rigid that LPs are essentially muzzled when it comes to speaking about medical benefits or effects of particular strains.

On the other hand, dispensaries, lacking inclusion in the federal system, offer on-site dispensing, in-person education about strains of marijuana, administration and dosing, and allow patients to examine different strains before purchasing. The latter is important to many patients, particularly those who are from an earlier generation of self-taught medical cannabis use. And it definitely gives dispensaries an edge in the market.

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Existing in what seems a different world, a cannabis consultant said recently that many MMPR-hopefuls are "fed up" with the long, slow, bureaucratic approval process, and have been in touch about opening dispensaries instead.

But the most baffling part about the MMPR has to be the restriction to purchasing the dried buds only, its most smokable form. At least with the recent Supreme Court decision, patients can possess extracts and derivatives such as oils and tinctures, but they are not able to purchase these from a licensed producer under the MMPR, at least not yet. Last Wednesday, however, Health Canada issued a Section 56 exemption under the Controlled Drugs and Substances Act, which allows LPs to sell cannabis oils and fresh cannabis buds in addition to dried cannabis to registered patients.

This is a step forward, but it will take some time to implement – with concerns about safe production, packaging, labelling and record keeping.

For many patients who can't make extracts themselves, dispensaries are the only way to get these products, which include more than just oils. In Vancouver, regulations allow for capsules, tinctures and oils, but not food products such as cookies, which authorities worry will appeal to youth. Since some patients depend on food products to manage their conditions, the regulations leave room for improvement.

But it's a start. While there are justifiable concerns from critics about the lack of testing of the products some dispensaries sell, there are dispensaries that test their products using the same analytical test labs as some LPs under the MMPR.

It is also estimated that fewer than 7 per cent of physicians will sign a medical document for cannabis, particularly for diagnoses where cannabis use is more contested, such as for anxiety or depression. Although admission requirements vary depending on the dispensary, becoming a member is fairly straightforward: individuals can often submit a statement of diagnosis, a letter from their doctor or a signed dispensary-specific application.

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More troubling is that Health Canada's promise of 400,000 patients over the next 10 years means nothing without physicians who are comfortable with, and supported by their governing bodies in, prescribing cannabis for medical purposes. Instead, clinics and intermediary services that connect patients to doctors for large fees are popping up almost as quickly as dispensaries in Vancouver.

While ethics around these organizations are contested, many people currently registered under the MMPR would not have been able to acquire a medical document any other way.

Of course, some dispensaries in Vancouver operate with recreation more in mind. Some justify this in the belief that cannabis should be legalized and available to consenting adults.

In a sense, the only available and tolerated discourse is a medical one, so under the guise of medical, the distinction between medical and recreational becomes less clear.

While Ms. Ambrose is focused on convincing Canadians that cannabis is not a medicine, local governments have been forced to address these underlying issues with the tools available to them. It is expected that other cities, such as Victoria, will follow suit.

Why does the federal government insist on turning a deaf ear to science and the solutions Canadians are demanding? If the ongoing Allard case (a legal dispute about the preservation of patients' right to grow marijuana) is decided in the patient's favour, Ms. Ambrose is really going to have a rough year.

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Jenna Valleriani's doctoral dissertation looks at the role of social movements and entrepreneurship in an emerging industry, focusing on dispensaries, licensed producers and the MMPR as her case study.