Canada may have been the first country in the world to legalize medical marijuana back in 2001, but its provinces are still grappling with what that means in the workers compensation world.
The provinces that have implemented or are planning to adopt policies governing the use of medical marijuana as a pain treatment option have moved slowly out of concern about potential adverse health impacts or questions about its effectiveness, and have limited the circumstances in which it can be prescribed, experts say.
WorkSafeNB, which oversees New Brunswick’s workers comp system, led the way by issuing its marijuana policy in April 2018, which allows for the use of medical marijuana for work-related injuries in limited instances.
“Really what drove (our policy) is we were seeing more and more requests from workers and their physicians indicating that they thought cannabis would be a viable treatment” for workers injuries, said Laragh Dooley, director of communications for WorkSafeNB in St. John. “We wanted to standardize our decision-making.”
The New Brunswick policy does not allow for dry cannabis to be smoked and limits use mainly to end-of-life care or palliative settings, central nervous system injuries or chronic neuropathic pain. Even then, medical marijuana is only covered after all other treatment options have failed or been determined to be inappropriate, with a full risk assessment and follow-up monitoring.
WorkSafeNB will consider medical marijuana for harm reduction if an injured worker is on an opioid dosage amount over the daily maximum dose and is at a high risk of harm, Ms. Dooley said. Currently, 71 workers have been approved for medical marijuana, with a maximum dose of 3 grams per day. The board will pay up to CA$8.50 ($6.39) per gram, which is the same payment and amount maximum authorized by Veterans Affairs Canada.
While some stakeholders advocated for a more liberal policy, Ms. Dooley noted that medical evidence is still emerging regarding the use of marijuana as a medical treatment, but that the province is open to modifying the policy in the future.
The Ontario’s Workplace Safety and Insurance Board, which is the only workers compensation insurer in the province, looked at scientific evidence, clinical guidance, provisions of the province’s workers compensation statutes and federal regulations regarding the use of medical marijuana to craft its operational policy, Cannabis for Medical Purposes, which it released in March, said a WSIB spokeswoman.
The Ontario policy covers medical marijuana for five work-related conditions and only after all appropriate conventional treatments are exhausted. Prior to the board’s development of a policy, requests for medical marijuana were considered on a case-by-case basis and just 32 claims had been approved.
Evan Stait, commercial account executive for Hub International Ltd. based in Kelowna, British Columbia, said he believes the conservative approach taken by the provincial workers comp agencies is positive and allows employers time to assess and understand potential ramifications of the use of medical marijuana to treat worker injuries.