Canada: Workers’ Compensation Benefits May Now Cover Medical Cannabis in Ontario

Ontario’s workers’ compensation body, the Workplace Safety & Insurance Board (“WSIB”), has implemented guidelines governing benefit entitlement for medical cannabis. The guidelines are set out in the WSIB’s newest Operational Policy Manual Document No. 17-01-10, “Cannabis for Medical Purposes” (the “Policy”), which was published on March 1, 2019.

The Policy is indicative of the WSIB’s cautious approach to accepting cannabis as a medical treatment. Notably, the WSIB has accepted the therapeutic value of medical cannabis for only certain designated conditions, and has stated that the current body of scientific evidence does not support cannabis as an effective treatment for most medical conditions.

How is benefit entitlement determined?

The WSIB may grant entitlement to medical cannabis for a compensable injury only if the following criteria are satisfied:

1. The worker must have a designated condition that is clinically associated with his/her compensable injury or treatment thereof. The Policy defines “designated condition” as neuropathic pain, spasticity resulting from a spinal cord injury, nausea and vomiting associated with cancer chemotherapy, loss of appetite associated with HIV/AIDS, or pain and other symptoms experienced in a palliative setting.
2. The worker’s treating health professional must authorize medical cannabis as a treatment for the worker’s designated condition, and must conduct regular clinical reassessments of the workers’ response to medical cannabis.
3. The worker must exhaust conventional treatments for the designated condition before entitlement to medical cannabis will be considered by the WSIB. The conventional treatments used by the worker and their lack of efficacy must be clearly documented in the worker’s medical records.

NOTE: This criterion does not apply in palliative care cases.

4. The worker must undergo an appropriate and documented clinical assessment before any entitlement to medical cannabis will be considered. The results of the clinical assessment must clearly establish the necessity, appropriateness, and sufficiency of medical cannabis as a treatment for the worker’s condition.
5. The benefits of the worker’s medical cannabis use must outweigh its risks. Situations that the WSIB considers to increase the risks of medical cannabis use include where:
   • Medical cannabis is contraindicated (which is defined by the Policy as including use by individuals who are under the age of 25 or who have a current or past disorder relating to cannabis use or substance use);
   • Precautions are present;
   • There is a potential for adverse drug reactions; or
   • The treatment may impede recovery.

6. The WSIB must consider the worker’s authorized dose and route of administration of medical cannabis to be appropriate. Typically, such appropriateness will be measured in terms of the daily quantity and THC percentage of the lowest safe and effective dose for the worker. Moreover, the dose and route of administration:
   • Must not involve smoking;
   • Must not exceed three grams of dried medical cannabis per day;
   • Must be CBD-rich but contain minimal THC;
   • Must have a THC concentration of 9% or less; and
   • Should not exceed more than 30 mg of THC per day and in no case shall exceed 75 mg of THC per day.

7. The worker must have a valid medical document or written order for medical cannabis. Such document or order must comply with the Policy’s criteria regarding dose and route of administration. The route of administration and maximum THC percentage authorized for the worker must also be specified.

What benefit coverage does the Policy provide?

The Policy applies to purchases of medical cannabis or vaporizers for work-related injuries/illnesses made on or after March 1, 2019. It is scheduled to be reviewed in two years.

If the entitlement criteria are met, the WSIB may grant entitlement to medical cannabis. Such entitlement will cover the reasonable costs of medical cannabis obtained from a hospital or a licensed vendor with whom the worker is registered as a client. If a worker is medically authorized to vaporize medical cannabis, the WSIB may also cover the reasonable cost of the worker’s vaporizer. However, the worker must first obtain the WSIB’s approval before purchasing medical cannabis or a vaporizer in order to have the purchase costs covered by the WSIB.

Where entitlement to medical cannabis is allowed, the WSIB will monitor the worker’s medical cannabis use and its effectiveness every three to six months. Entitlement may be suspended or discontinued if the WSIB determines that medical cannabis is no longer necessary, appropriate, or sufficient treatment. Entitlement may also be discontinued upon evidence that a worker is misusing or selling medical cannabis.