Who decides if medical cannabis is a treatment option for you?

Bill Howatt is the chief of research for work force productivity at The Conference Board of Canada.

Helen Stevenson is the CEO and founder of Reformulary Group.

Who decides if medical cannabis is a good option for you?

This question doesn’t have a clear answer and requires careful consideration, the guidance of your medical professional and, in many cases, a conversation with your employer.

Awareness

People often see medical and recreational cannabis as one market. Both come from the same flowers and contain the same cannabinoids. Often the same products are sold in both the medical and recreational markets, just under different names.

Medical cannabis products are treated as medicine. To become a medical cannabis patient in Canada, you need an authorization from a physician or nurse practitioner. You then order your products online directly from a licensed producer and the products are mailed to your home. Recreational cannabis, on the other hand, is seen as an adult-use substance taken for fun. Recreational users purchase their products online or in-store from government-authorized stores.

Accountability

Nineteen per cent of health-care professionals (18,086) – including doctors and nurse practitioners – have provided an authorization for medical cannabis. This number is low compared with those prescribing traditional pharmaceuticals, including opioids.

Studies cited by the National Academies of Sciences, Engineering, and Medicine and the National Institutes of Health in the United States show that medical cannabis can treat symptoms of certain medical conditions, such as chronic pain, hard-to-control epilepsy and chemotherapy-related nausea and vomiting.

Medical professionals have to ensure they consider all treatment options – including medical cannabis where relevant – and help find the best treatment based on the patient’s needs.

But both health-care practitioners and patients find that cannabis products and dosing guidelines for specific conditions are not clear. Cannabis is a highly personal medicine and each person processes it differently. A strain and dose that works well for one person may not work for someone else. This doesn’t mean that cannabis is not an effective treatment, but that it needs more research, greater education and new tools to simplify dosing and product selection.

Action

With more people using medical cannabis in Canada, employers are carefully considering its impact in the workplace. Without hard and fast rules, it helps to check with organizations that already have extensive experience with medical cannabis around coverage, pricing, dosage and impairment issues:

• Cannabis Standard can be a useful tool. It offers subscribers preferred pricing and has valuable data and insights to help patients make smart cannabis choices.
• Pricing is also a big concern. To date, few employers (only 6 per cent) cover medical cannabis, which on average can cost $6,000 a year. More insurance companies are making it easier for employers to cover medical cannabis in their benefit plans. The cost of medical cannabis can also be claimed on a patient’s income-tax return.
• Employees with a health spending account may be able to expense medical cannabis under the Canada Tax Act. If they have health benefits, they should refer to their plan booklet or administrator to see if medical cannabis is covered.
• Safety and impairment in the workplace, especially for those in safety-sensitive positions, are big concerns for employers. While cannabis high in cannabidiol (CBD) but very low in THC (delta-9-tetrahydrocannabinol) content typically doesn’t cause impairment, almost all CBD-based medicines contain a small amount of THC, which can show up in a drug test. Regardless of the CBD-THC ratio, the law requires employers to accommodate medical cannabis use to the point of undue hardship.

This step-by-step checklist shows how a person might determine if medical cannabis could be a helpful option for them, while considering the complex factors involved in this choice:

1. Identify if you have a medical need that other therapies do not help (such as chronic back pain).
2. See a medical professional to find out if medical cannabis makes sense for your condition.
3. If medical cannabis might help you, your medical professional will determine the dosing level (THC and CBD levels) and provide you with an authorization.
4. Determine with your employer if medical cannabis creates any safety risks based on your duties and dosing requirements (note that some organizations may require you to disclose any use of medical cannabis).
5. Work with your employer to determine and put in place any accommodations needed for you to use medical cannabis at work.
6. You will have to consider how you will pay for your medical cannabis (for instance, a health spending account, via a health benefits plan or out-of-pocket) and if you can afford it.
7. Finally, register to purchase medical cannabis online and order based on your doctor’s authorization.

With more Canadians securing authorizations for medical cannabis, and others asking about whether it might help with specific health issues, it’s important that employers educate themselves on this emerging medicine. With more than 342,000 medical cannabis patients registered in Canada, employers will soon see more requests for coverage.

The Conference Board of Canada and The Globe and Mail are partnering to explore the relationship between career success and cannabis use. Employers and employees (both recreational and medical cannabis users, as well as non-cannabis users) are invited to participate in this study. (Employees interested in taking the survey can click on this link. Employers interested in taking the survey can click on this link.) The data from these surveys will be aggregated and used to conduct analysis and create a report that will be presented Oct. 15, 2019, at a conference at The Globe and Mail Centre in Toronto.