Question Period Note: CANNABIS FOR MEDICAL PURPOSES

• The health and well-being of Veterans and their families is at the core of Veterans Affairs’ programs and services.

• In 2016, Veterans Affairs Canada introduced its Reimbursement Policy for Cannabis for Medical Purposes for dried cannabis or its equivalent in other forms.

• The policy balances available scientific evidence and clinical practice, with what Veterans Affairs Canada has heard from Veterans and their advocates concerning how cannabis helps with their health problems.

• Recognizing that the use of cannabis for medical purposes continues to be an emerging practice, Veterans Affairs Canada is continuing to monitor developments in research

• In October 2019, the Policy was amended to include three new classes of cannabis products: cannabis edibles, cannabis extracts and cannabis topicals to reflect the changes made in the Cannabis Act.

BACKGROUND - CANNABIS FOR MEDICAL PURPOSES

Veterans Affairs Canada implemented the Cannabis for Medical Purposes Reimbursement Policy in November 2016. The reimbursement policy established a limit of three grams per day for dried cannabis or its equivalent in other forms up to a maximum reimbursement rate of $8.50 per gram.

An exceptional approval process was developed as part of the reimbursement policy to assist Veterans who may require more than three grams per day. To add more rigour to this approach, these reimbursement requests may only be approved when supporting documentation is provided from a medical specialist with expertise in the Veteran’s diagnosed condition(s).

The policy further explains the information to be included in the supporting documentation from the medical specialist. The following are the four requirements:
a) the medical rationale for the use of cannabis for medical purposes for the Veteran’s condition(s);
b) the specific quantity over three grams per day being recommended;
c) a list of contraindications that were considered and confirmed absent; and
d) a list of alternative treatments that were tried and why they were ineffective or contraindicated.
Each request is reviewed on a case-by-case basis.

In October 2018, Health Canada’s Cannabis Act and Cannabis Regulations came into effect, providing legal access to recreational cannabis for Canadians. Provincial and territorial retail outlets were opened for the purchase of recreational cannabis. Veterans Affairs Canada does not reimburse purchases from these retail outlets.

In October 2019, Schedule 4 of the Cannabis Act was amended to legalize three new classes of cannabis – edible cannabis, cannabis extracts and cannabis topicals. These new classes of cannabis products can be used for medical purposes and were added to the reimbursement policy, along with the previous classes of fresh and dried cannabis. All cannabis products used for medical purposes must be purchased from federal licensed sellers authorized by Health Canada.

For the fiscal year 2021-2022 (April 1 2021– March 31 2022), Veterans Affairs Canada expenditures for cannabis for medical purposes were $153,780,785 for 18,388 Veterans.

WHEN PRESSED:

Q1 – How many Veterans are approved for reimbursement of an exceptional amount of cannabis for medical purposes (i.e., over three grams per day)?

As of March 31, 2022, 3742 Veterans are authorized for reimbursement of more than three grams per day, which accounts for approximately 20% of all Veterans authorized for reimbursement of cannabis for medical purposes. Veterans may be authorized for reimbursement of an exceptional amount provided that they meet the requirements outlined in the Reimbursement Policy for Cannabis for Medical Purposes. This includes supporting documentation from a medical specialist with expertise in the condition for which cannabis is authorized.

Q2 – Why are program expenditures so high? What is this fiscal year’s forecast?
Program expenditures for cannabis for medical purposes have been increasing annually. This is primarily due to the increased number of Veterans seeking reimbursement once authorized by their health care practitioner and an increase in the number of grams reimbursed per Veteran.
In fiscal year 2021/2022, program expenditures were $153.8M. For fiscal year 2022/2023, program expenditures are forecasted to be $195.2M.

Q3 – Has Health Canada approved cannabis for medical purposes as a therapeutic product?
No, Health Canada has not yet approved cannabis for medical purposes as a therapeutic product. In March 2021, the College of Family Physicians of Canada published revised guidelines for health care practitioners to use when authorizing cannabis for medical purposes in primary care.

Q4 – Are there changes to the Reimbursement Policy for Cannabis for Medical Purposes anticipated for the future?
As cannabis for medical purposes is an evolving area of treatment, Veterans Affairs Canada is regularly reviewing the latest available evidence and adjusting our policy as needed. Since its implementation in November 2016, the Reimbursement Policy for Cannabis for Medical Purposes has been revised several times due to changes in Health Canada’s cannabis legislation.