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NEW WSIB OPERATIONAL POLICY FOR MEDICAL CANNABIS

The WSIB has established an operational policy setting out guidelines for entitlement to, review of, and payment for medical cannabis under the Workplace Safety and Insurance Act, 1997 (the Act).  The new policy, OPM 17-01-10, will be effective on Friday, March 1, 2019.

While the regulation of access to cannabis for medical purposes has been legal since July 2001, the decriminalization of cannabis possession and use under the Cannabis Act in October 2018 has heightened the awareness of cannabis use in the general public.  These significant recent cultural and legal changes have made the development of a WSIB operational policy more important to clarify the conditions under which compensation for cannabis will be approved in relation to a worker’s claim for benefits.

It is notable that with the introduction of this new policy, medical cannabis will be the only drug for which the WSIB has established an operational policy.  Despite the absence of specific policy respecting other drugs, the WSIB has established a practice in relation to prescription drugs including the establishment of a Drug Advisory Committee and a Drug Benefit Program Formulary.  The review of WSIB formularies are updated and guided by the principles of evidence-based medicine, best practices, accessibility and cost-effectiveness, with a focus on use for specific medical conditions.  The WSIB has established drug formulary decisions in respect of 22 different classes of drugs including cannabinoids.  The WSIB has also established a Narcotic Strategy in respect of the authorization of narcotics for injured workers and the best practices approach to the management of opioid use.

In the context of the WSIB’s broader approach to drug review and management, the Medical Cannabis policy is not without precedent.

The Policy

The policy starts with the following statement that will, no doubt, create significant debate in the workers’ compensation community:

Medical cannabis is not necessary, appropriate, or sufficient health care treatment for most medical conditions due to the lack of strong and consistent evidence of therapeutic efficacy, and the known harms of cannabis use.  However, in limited circumstances, medical cannabis may be necessary, appropriate, and sufficient health care treatment as a result of a work-related injury/disease.

When entitlement to medical cannabis is allowed, the WSIB will regularly monitor its use and effectiveness and suspend or discontinue entitlement when it is no longer necessary, appropriate, or sufficient.

Highlights of the policy guidelines include the following:

• Medical cannabis is contraindicated for individuals who fit any of the following categories:
  • are under the age of 25
  • have a personal or strong family history of psychosis
  • have a current or past cannabis use disorder or substance use disorder
  • are pregnant, planning to become pregnant or breast feeding
  • have cardiovascular disease, or severe liver or kidney disease
  • Caution should be taken when medical cannabis is used with individuals who have a current mood or anxiety disorder, are heavy users of alcohol, are taking opioids or benzodiazepines, or have risk factors for cardiovascular disease
• Designated Conditions.There is evidence of the therapeutic efficacy of medical cannabis for the following conditions:
  • neuropathic pain arising as a direct consequence of a demonstrative lesion or disease affective the nervous system
  • spasticity from a spinal cord injury
  • nausea and vomiting associated with cancer chemotherapy
  • loss of appetite associated with HIV or AIDS
  • pain and other symptoms experienced in a palliative setting

Entitlement to benefits for medical cannabis will only be allowed if all of these criteria are met:

1. The worker has a designated condition.
2. The worker's treating health professional authorizes medical cannabis to treat the designated condition.
3. The worker has exhausted conventional treatments for the designated condition.
4. An appropriate clinical assessment of the worker has been conducted.
5. The benefits of medical cannabis for the worker outweigh the risks.
6. The dose and route of administration authorized for the worker are appropriate.
7. The worker has a valid medical document or a written order for medical cannabis

Regular review of entitlement.  Regular entitlement review will be conducted, starting with an initial review not more than three months after the initial allowance of the benefits and ongoing review thereafter no more than six months from the previous review.  Ongoing clinical assessment of the worker is a necessary component of approval for ongoing entitlement.  

Disentitlement.  Misuse of medical cannabis or diversion of the product (i.e. selling or providing it to others) will result in discontinuation of entitlement.

Payment for the cost of medical cannabis.  Of significant importance, especially in view of the revisions to the Cannabis Regulations that otherwise permit individuals to produce their own cannabis for medical use, the policy restricts payment for the reasonable costs of medical cannabis to circumstances where the product is obtained for a license holder with whom the worker is registered as a client, or from a hospital.  This means, simply, that a worker will not be reimbursed for the purchase of cannabis products from a licensed retailer or for the costs associated with one’s own production.  Moreover, approval for the use of medical cannabis must first be obtained by the WSIB before any purchases are made by the worker.