An Alberta woman has lost her appeal to have workers’ compensation pay for medical marijuana to treat post-traumatic stress disorder.
The worker, whose occupation was not revealed in the ruling, attended the scene of a suicide involving a youth on Aug. 3, 2012. She had to inform and console family members about circumstances of the young person’s death.
On Sept. 21, 2012, the Workers’ Compensation Board of Alberta accepted her claim for an acute stress reaction. Subsequent to the decision, the WCB accepted additional responsibility for PTSD.
More than seven years later, in February 2020, she asked the WCB to cover medical marijuana under her claim. That request was denied on March 6, 2020. In January 2021, the Dispute Resolution and Decision Review Body (DRDRB) upheld the decision to not cover the cost of the medical marijuana.
That ruling was appealed to the Appeals Commission for Alberta Workers’ Compensation in January 2022.
A panel for the commission pointed out that the use of marijuana for PTSD is not generally accepted. As such, it needed to meet all six criteria to be covered as a non-standard or experimental medical aid laid out by policy.
The six criteria
The criteria are spelled out as follows:
- all other conventional medical aid has been tried or at least considered and found to be medically inappropriate;
- the medical aid intervention will be used for a medical condition that results from a compensable injury;
- there is sufficient evidence to indicate the medical aid intervention has a positive effect on human health outcomes that is part of a comprehensive work return or rehabilitation program;
- there is sufficient evidence to indicate the medical aid intervention can be expected to produce the intended effects on health outcomes in the particular case under consideration;
- there is sufficient evidence to indicate the medical aid intervention’s expected beneficial effects on human health outweigh its expected harmful effects; and
- the medical aid in question can be provided legally in Canada from an accredited source.
The commission found, in this case, two of the criteria were not met.
Conventional medical aid
The first criteria, that all other conventional medical aid has been tried, was not met.
“The available reporting establishes psychological counselling and other related therapies the worker received are the principle form of medical aid for PTSD and that they remain an effective treatment option for her ongoing symptomatology,” it said.
Weighing the benefits versus the risks of cannabis
The second stumbling block was weighing the potential benefits versus the potential risks of medical marijuana.
In 2014, a psychiatrist noted that the worker reported smoking marijuana in the past four months, once or twice per week, to deal with her anxiety.
That psychiatrist offered the opinion that she met the criteria for PTSD, generalized anxiety disorder and cannabis use disorder.
Cannabis use disorder is a recognized diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM), the commission said.
The worker continued to have a diagnosis related to cannabis use disorder until at least March 2018, and — while that could have changed — there was no evidence in front of the panel to suggest it had.
In a February 2020 memo, a WCB medical consultant that reviewed the worker’s claim file to comment on her use of cannabis said the following:
“A review of the three most recent, highest quality medical studies (i.e. systematic reviews, meta analysis and prospective studies) indicates cannabis use did not have a significant effect on overall physical or emotional functioning, did not provide a clinically relevant benefit, nor did it result in decreasing generalized anxiety disorder severity scores.”
Further, medical literature did not support cannabis use as beneficial for psychological diagnoses, and the regulating medical bodies advised against its use.
In the worker’s particular case, the medical consultant noted the reporting from psychiatry has raised concerns with dependency of substances (nicotine, benzodiazepines and cannabis) and that she was at high risk of further addictions.
In considering this information, the medical consultant further opined that “given the current diagnoses, the past diagnoses and the history of substance use, (the worker) is not a good candidate for cannabis.”
The panel also noted that “medical cannabis” carries no less risk of addiction and misuse than recreational cannabis.
Family doctor and psychologist supported medical marijuana use
The woman’s family doctor prescribed her cannabis for PTSD, as the woman reported it as being effective, particularly with sleep disturbances and anxiety. But the doctor also expressed concern about her smoking the drug and recommended she use an oral form to avoid smoke exposure.
A registered psychologist provided a letter in June 2020 to support her use of medical cannabis.
“The registered psychologist advised there is ample research evidence to support medical marijuana (cannabis) use in this manner and that many of her clients suffering from PTSD, trauma, and chronic pain have reported significant benefits from its use,” the panel said in its ruling.
While it considered the opinions of the family doctor and the psychologist, the panel found the WCB’s medical consultant to be more persuasive. The doctor did not provide any medical studies to support the notion that its use for PTSD treatment outweighs the potential harms and risks.
And though the psychologist said there was ample research to support the use, she failed to cite any such research or elaborate on their findings.
“We gave little weight to the registered psychologist’s assertion that many of her clients with PTSD, trauma and chronic pain have reported significant benefit from their use of medical marijuana (cannabis),” the panel said. “Although we do not dispute the veracity of the registered psychologist’s claim concerning the reporting by her patients, we find it is, at best, anecdotal evidence that does not directly speak to the worker’s particular circumstance.”
The panel did note that the woman said she found it to be effective, and that its use has increased her functionality and allowed her to return to full-time employment.
But since all six criteria were not met, it simply didn’t matter. The appeal was denied and the DRDRB decision was upheld.
For more information see Decision No.: 2022-0399, 2022 CanLII 86625 (AB WCAC)