Canada may have been the first country in the world to legalize medical marijuana back in 2001, but its provinces still intervene in what it means in the workers compensation world.
The provinces that have implemented or are planning to adopt policies that govern the use of medical marijuana as a pain management option have been slowly concerned about the potential adverse health effects or issues of its effectiveness and have limited the circumstances to which it may be prescribed, experts say.
WorkSafeNB, which oversees New Brunswick's company, led the way by issuing its marijuana policy in April 2018, allowing for the use of marijuana medical for work-related injuries in limited cases.
"It was really what drove (our policy) is we were seeing more and more inquiries from workers and their doctors indicating that they believed cannabis would be a viable treatment" for work injuries, says Laragh Dooley, head of communications for WorkSafeNB in St. John. "We wanted to standardize our decision making."
New Brunswick policy does not allow dry cannabis to be smoked and limits its use primarily to life-cycle 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 complete risk assessment and follow-up.
WorkSafeNB will consider medical marijuana for damage reduction if an injured worker is at an opioid dosage rate above the daily maximum dose and is at high risk of death, Mrs Dooley said. Currently, 71
While some stakeholders advocated 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 changing future policies.
Ontario's Workplace Safety and Insurance Committee, which is the sole employer of insurance in the province, looked at scientific evidence, clinical guidance, provisions in the province's employment compensation regulations and federal regulations on the use of medical marijuana to produce its operational policy, Cannabis for medical purposes , as it released in March, a WSIB spokeswoman said.
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, the request for medical marijuana was considered on a case-by-case basis and only 32 claims had been approved.
Evan Stait, business manager of Hub International Ltd., based in Kelowna, British Columbia, said that he believes the conservative approach of regional workers is positive and allows employers to evaluate and understand the potential consequences of the use of medical marijuana to treat work injuries.
One reason for compensation for workers has been restrictive in covering the use of medical marijuana, the lack of clear evidence of how effective it can be in treating certain conditions and potential adverse health effects, said Darren Avery, associate in London, Ontario, office of Filion Wakely Thorup Angeletti LLP.
"With work-related injuries, cannabis can be helpful, but what happens when you go back to work?" he said.
Other provinces still determine medical marijuana compensation on a case-by-case basis. WorkSafeBC, which handles employees working for the province of British Columbia, noted in a statement at the end of 2018 that it is consulting with other jurisdictions and regulators on new national frameworks that would require changes to the province's labor compensation law or its professional health and safety regulations.
Gillian Burnett, the chief executive of government and media relations at WorkSafeBC, said the agency does not include cannabis – including medically approved cannabis – for the treatment of musculoskeletal pain.
"In a small number of cases, WorkSafeBC will cover cannabinoids approved by Health Canada for the treatment of neuropathic pain," Burnett says in an email.
Nova Scotia is expected to release a policy in early April and a spokesman for Nova Scoti's Compensation Committee said it will be governed by the best medical practice and that the province will consider, on a case-by-case basis, if medical marijuana can be part of recovery process. So far, the provincial government has approved medical marijuana in fewer than 10 work competencies.
In Quebec, the Commission has the norms, the equities, the santé and the la securité du travail, also known as CNESST, to replace marijuana for medical purposes only when it has been prescribed by the physician responsible for the worker and the prescription is related to employment injury, "wrote a CNESST spokeswoman in an email. "CNESST nevertheless ensures the need for this treatment through a medical assessment procedure" as described in the province's workers' legislation.