Limits on Medical Marijuana for Veterans

Chelsea Cox questions the federal government’s recent decision to limit reimbursement for the cost of medical marijuana used by veterans to three grams a day.

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Post-Traumatic Stress Disorder (PTSD) affects thousands of Canadians every year and represents a major healthcare challenge in terms of appropriate treatment. At this time, over 3,500 Canadian veterans use medical marijuana for Post-Traumatic Stress Disorder, chronic pain, and other health issues that stem from line of duty experiences. Funding for this drug is provided by the federal government as it is responsible for the delivery of primary care to eligible veterans.

In November 2016, Veterans Affairs Minister Kent Hehr announced a significant change in federal funding for medical marijuana for Canadian veterans. In future, reimbursement for this drug would be limited to three grams a day, instead of 10 grams a day.  Prior to this announcement, there was no national policy on reimbursement for the drug, and the prescribing of 10 grams a day was based on unclear dosing guidelines for physicians due to a lack of clinical data. So why the change in funding guidelines?

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Base of National War Memorial, Ottawa, Ontario, Canada (Photo Credit: D. Gordon E. Robertson)

It has been suggested that Health Canada was strong-armed into allowing the use of medical marijuana by the Supreme Court decision in 2000 (R v Parker), and that it has since tolerated an environment of considerable uncertainty. In the intervening years, anecdotal evidence has accrued suggesting that medical marijuana may become a first choice treatment for Canadian veterans. This is not only because of its capacity to treat, but also because of its ability to replace highly addictive opiates.

Minister Hehr has stated that the health and well-being of veterans are at the forefront of the new approach. He insists that the new policy was developed through careful consultation with key stakeholders. However, it does not appear that the decision to diminish reimbursement is widely endorsed by these stakeholders.

Colonel Pat Stogran (the former Veteran Ombudsman) believes that the “efficacy of cannabis is indisputable.” He suggests that instead of focusing on the financial cost of medical marijuana, the government should focus on the social cost of the widespread misuse of opiates. Other veterans argue that the decision to limit reimbursement is another example of government action aimed at controlling costs rather than improving patients’ quality of life.

The fact is that utilization rates of the drug have risen astronomically in the past eight years with spending increasing from $19,088 in 2008 to over $31,000,000 in April to September of 2016. But this says nothing about the cost savings to the healthcare and social welfare systems if one accepts that medical marijuana is an effective treatment.

More generally, according to some, the federal government’s new reimbursement policy, with its apparent focus on cost-cutting rather than quality of care, amounts to interference in the doctor-patient relationship. The new policy will cover up to three grams per day across the board, requiring patients to pay out of pocket for additional amounts unless they have a special authorization form from a clinician. Requiring special authorization is typical of other drug guidelines; however, the details as to what will be required on this form are unknown.

Ensuring that the new policy does not limit patient access and cause unnecessary economic hardship are two issues that will need to be addressed on a go-forward basis. The Trauma Healing Center, a clinic in Nova Scotia, has confirmed that in the coming months it will work with Veterans Affairs Canada to ensure that the new reimbursement policy truly meets the needs of veterans.

What the new reimbursement policy will mean in the long run for medical marijuana use by Canadians veterans remains unclear. What is clear, however, is the need for ongoing conversation. Researchers need to share their findings, patients need to share what is working for them, and the government needs to take a comprehensive look at the implications of its new dosing reimbursement policy. Continuing research on the usefulness of marijuana as a medicine, solidifying current anecdotal evidence, and diminishing the stigmatization associated with the use of medical marijuana are all essential elements of good practice.

There is no ‘one size fits all’ in terms of the correct dosage for medical marijuana for veterans—each patient has different needs and will require different dosing. This fact alone suggests that there will be problems with the government’s new reimbursement policy. As we move forward the need for a policy that positions access and quality care at its heart rather than cost-cutting should be a top priority for our veterans.

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Chelsea Cox is a student at Dalhousie Schulich School of Law completing a combined Juris Doctor and Master of Health Administration.