The audit results were quietly released this week amid an explosion in the number of veterans seeking reimbursement for their medical pot, from about 100 in 2014 to more than 18,000 last year — with no end in sight. As a result, Veterans Affairs spent more than $150 million on medical marijuana last year — more than on all other prescription drugs combined. And that number is expected to grow to $200 million this year and $300 million by 2025-2026. But even as demand has grown exponentially, auditors found a continued lack of research on the medical benefits — and risks — of veterans using cannabis, especially those struggling with psychological trauma. Veterans Affairs spent more than $150 million on medical marijuana last year — more than on all other prescription drugs combined. And that number is expected to grow to $200 million this year and $300 million by 2025-2026. (Lars Hagberg/The Canadian Press) This coincided with a lack of direction and control over who can get medical marijuana, what conditions the drug is prescribed for, and how veterans get their CMP (medical cannabis) licensed. “VAC has taken steps to make its policy work to provide veterans with access to reimbursement for their CMP treatment,” the audit states. “However, serious gaps remain in internal controls in the areas of veterans’ health and program management.” Veterans Affairs began reimbursing a small number of ex-servicemen for their medical cannabis in 2008, so approvals were granted on an extremely limited basis and with the approval of a medical specialist. The move followed a series of court decisions more than 20 years ago that allowed for the first time a legal exemption from criminal prosecution for consuming medical marijuana.
The rules were relaxed in 2014
Then in 2014, Health Canada relaxed its rules on who could approve the use of medical marijuana and for what conditions and circumstances. The new rules placed no limit on the amount of pot that could be approved or the cost. That change led to an explosion in claims and spending — despite the Liberal government’s decision in 2016 to limit claims to three grams a day at $8.50 a gram, with an allowance of up to 10 grams a day with medical permission. The reviewers noted that the limited research information available suggests that people should use less than three grams of cannabis per day and have regular follow-ups with their health care providers. Health Canada and the College of Family Physicians of Canada have also warned of the potential negative effects of marijuana use by people suffering from mental health conditions, particularly post-traumatic stress disorder.
Lack of instructions or restrictions
However, the audit report states that Veterans Affairs has not provided guidelines or restrictions on what type of health conditions are eligible for reimbursement for medical marijuana. Almost any medical condition is eligible. That includes PTSD, which auditors found was a diagnosis for the “vast majority” of veterans who have been reimbursed for medical cannabis. At the same time, nearly 80 percent of licenses involved three grams of cannabis or more per day, while specialist authorization letters for many veterans “also show very little sign of a strong doctor-patient relationship.” “Follow-up recommendations were vague, using wording such as ‘follow-up in six months or as clinically necessary,’” the report says. “Just over half of the special letters we looked at didn’t say anything about tracking.” That wasn’t all that was missing. About a third of the records reviewed by auditors had no record of which health care provider had actually authorized the veteran to receive medical cannabis. And many files were missing other data. One of the audit’s most troubling findings was that 11 health care providers were responsible for approving nearly 40 percent of all medical weed requests. One had signed nearly 1,300 such petitions. “There (are) a small number of CMP-licensed physicians with very large caseloads of veteran patients that calls into question the robustness of medical oversight,” the audit report said. “With limited guidance available on the approval of CMP, there is a risk that some healthcare professionals may over-prescribe the treatment.” Despite these red flags and the potential risk to veterans and taxpayers, auditors found that the vast majority of reimbursement requests were approved as the department focused on ensuring access rather than monitoring and control. This included reimbursements for 45 veterans whose medical condition was listed as a substance abuse disorder and 46 who were also reimbursed for antidepressants, antipsychotics, benzodiazepines, opioids and narcotics. Auditors suggested the problems were a result of the department’s excessive focus on regulating the reimbursement process and ensuring access. They noted that the entire program is run by 3.5 staff members. “VAC can do more to identify trends in the CMP program that may be problematic and adjust policy to protect the health and well-being of veterans,” the report states. “As demand for the CMP program continues to grow exponentially, VAC will need to properly manage resources and review policy and program effectiveness.” In response to the audit, Veterans Affairs officials say they are considering a variety of changes to what conditions are eligible for reimbursement, as well as limits on the daily amount that can be approved and for what types of products. The department is also considering a new, more detailed authorization form and additional safeguards for those requesting more than three grams per day. It’s unclear when the changes might roll out.
