New Brunswick tackles issue of medical cannabis for injured workers

Annette Balkam isn't sure whether she would be alive today if she hadn't discovered medical cannabis.

The Moncton woman said she slipped and fell on the job as a security guard in 2011, severing two ligaments and developing a neurological disorder that's left her in "constant pain."

Six years ago, she decided to try medical cannabis. Balkam said she was taking too many pills, including addictive opioids, and nothing seemed to help.

Now, Balkam said, she has stopped taking opioids. She feels more alert and is able to function better.

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But she said it took months to persuade WorkSafeNB back in 2014 to cover the costs of her medical cannabis.

"We're not drug addicts," Balkam said. "We're not looking to get high. We're looking to relieve our pain."

Now, there is a clearer path forward for injured workers like Balkam.

Last spring, WorkSafeNB became the first workers compensation body in the country to develop a policy that spells out situations where an injured worker can have the costs of cannabis covered as a medical aid, according to WorkSafe chief medical officer Dr. Paul Atkinson.

The board was seeing an increase in requests to cover cannabis and costs were mounting.

"We felt that there was a lack of guidance, especially when varied practice was noticed in that there were varied amounts, dosages, for different indications," Atkinson said.

One year later, only three workers' compensation bodies in Canada have developed policies that spell out when, and how much, cannabis is appropriate for injured workers.

In addition to New Brunswick, Ontario and Prince Edward Island also have policies. Nova Scotia has been consulting with New Brunswick as it develops its own policy.

"Others perhaps will try something slightly different.," Atkinson said.

"Some may follow what we've done. I think, over time, we will see which works best and probably reach a consensus."

WorkSafe won't cover 'smoked' cannabis

New Brunswick's policy applies to "plant, dried and oil forms" of cannabis.

There are only a handful of situations where WorkSafe will approve the use of cannabis as a medical aid.

They include treating symptoms encountered in a palliative or "end of life care setting," treating nausea, vomiting or loss of appetite related to treatment for diseases such as cancer or AIDS, for spasms related to a nervous system injury or, in Balkam's case, for chronic neuropathic pain.

When the policy is approved, WorkSafe will only pay for cannabis prescriptions high in cannabidiol or CBD, a component of marijuana that can provide medicinal benefits, and low in THC, the component that can cause impairment.

"We have a very clear policy of not approving THC-containing cannabis," Atkinson said.

According to Atkinson, CBD can have an anti-inflammatory effect and can help with neurological conditions but won't get you high.

WorkSafe also won't cover cannabis that will be smoked, but in some cases, may cover the costs of dried product that can be inhaled using a vapourizer.

The Crown corporation will pay for up to three grams per day, the same upper limit set by Veterans Affairs Canada.

At least 71 patients have been approved to have cannabis covered by WorkSafe.

Moving away from opioids

WorkSafe "may also consider" covering cannabis as a harm reduction tool for people who are trying to stop using addictive prescription medication such as opioids.

In that case, the injured worker has to be part of a "monitored program" where their opioid use and function is being tracked to see if they're improving.

Atkinson estimated about 1,100 injured workers in New Brunswick have the costs of their opioid prescriptions covered, down from about 1,500 only two years ago.

WorkSafe has also lowered the maximum dose of opioids it will cover, following new national opioid-prescribing guidelines created in the wake of a national opioid overdose crisis.

"It was becoming very apparent that many of the workers are receiving doses of opioids that were beyond what was recommended," Atkinson said.

While opioids can help a person feel less pain, there's no evidence that long-term opioid use helps a person function better, Atkinson said.

Doctor says policy should go further

Dr. Douglas Smith, a specialist in physical medicine and rehabilitation, has been prescribing medical marijuana for the last 14 years.

He's also the medical director of Tidal Health Solutions, a licensed medical cannabis producer based in St. Stephen. He said he plans to phase out his medical practice.

Smith has seen positive outcomes for his patients using medical cannabis, starting with a man in 2005 who had back pain and was taking high doses of opioids. Smith said the patient was able to get off all the opioids he'd been taking once he started using medical marijuana.

"I've seen many patients who have been very reclusive who have become more sociable, who've returned to gainful employment, less time lost from work, better family relationships," Smith said.

He said WorkSafe should be "applauded" for its cannabis policy, but he believes it should go even further.

Smith describes the restriction on approving smoked cannabis as an "overreaction." He said the risks of inhalation are greatest in people who also smoke tobacco and believes it can be an effective tool for people who need immediate relief from their symptoms.

The doctor recently filled out his first WorkSafe cannabis authorization application for a patient. The form is 10 pages long and took more than a half an hour to fill out.

"It is a very tedious document to work through and would tend to discourage most physicians from participating and result in patients not receiving approval for their medical cannabis," Smith said.

Atkinson said WorkSafe will review the policy within the next year, looking at such issues as whether the three-gram-per-day limit is appropriate.