Ottawa lost control of $150 million program to reimburse veterans for cannabis: audit

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An internal audit from Veterans Affairs Canada suggests the federal government has all but lost control as it shells out hundreds of millions of dollars each year for veterans’ medical marijuana without oversight, direction or proof of health benefits .

Released quietly this week, the audit findings come amid an explosion in the number of veterans seeking reimbursement for their medical pot, from around 100 in 2014 to more than 18,000 last year – with no end rising in sight.

As a result, Veterans Affairs spent more than $150 million on medical marijuana last year, more than all other prescription drugs combined. And that number is expected to reach $200 million this year and $300 million by 2025-26.

Yet even as demand grew exponentially, listeners found a continuing dearth of research on the medical benefits — and risks — of veterans using cannabis, especially those dealing with psychological trauma.

Veterans Affairs spent more than $150 million on medical marijuana last year, more than all other prescription drugs combined. And that number is expected to reach $200 million this year and $300 million by 2025-26. (Lars Hagberg/The Canadian Press)

This has coincided with a lack of direction and control over who can obtain medical marijuana, what conditions the drug is prescribed for, and how veterans obtain clearance for their CMP (cannabis for medical purposes).

“VAC has taken steps to operationalize its policy to provide veterans with access to reimbursement for their CMP treatment,” the audit read. “However, there remain serious deficiencies 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, when approvals were granted on an extremely limited basis and with medical specialist approval.

The move follows a series of court rulings over 20 years ago that for the first time allowed legal exemption from criminal prosecution for medical marijuana use.

Rules relaxed in 2014

Then, in 2014, Health Canada relaxed its rules on who could authorize the use of medical marijuana and for what conditions and circumstances. The new rules did not impose a limit on the amount of pot that could be allowed, nor on the cost.

This change has resulted in an explosion of claims and costs – despite the Liberal government’s decision in 2016 to limit claims to three grams per day at $8.50 per gram, with an allowance of up to 10 grams per day with medical clearance.

Auditors noted that the limited research information available suggests that individuals should consume less than three grams of cannabis per day and have regular follow-ups with their healthcare providers.

Health Canada and the College of Family Physicians of Canada have also warned of the potential negative effects of marijuana use in people with mental disorders, particularly post-traumatic stress disorder.

Lack of guidelines or restrictions

But the audit report says Veterans Affairs provided no guidelines or restrictions on the types of health conditions eligible for reimbursement for medical marijuana.

Virtually any medical condition is eligible. That includes PTSD, which auditors said was a diagnosis for “the vast majority” of veterans who were reimbursed for medical cannabis.

Meanwhile, nearly 80% of clearances were for three or more grams of cannabis per day, while specialist clearance letters for many veterans “also show very little evidence of a strong doctor-patient relationship.” “.

“Follow-up recommendations were vague, using wording such as ‘follow-up in six months or as clinically needed,’ the report reads. “Slightly more than half of the specialist letters we reviewed were silent on follow-up.”

That wasn’t the only thing missing. About a third of the records reviewed by auditors had no record of which health care provider actually authorized the veteran to receive medical cannabis. And many files were missing other data.

One of the most disturbing findings of the audit was that 11 healthcare providers were responsible for authorizing nearly 40% of all medical herb requests. One of them had approved nearly 1,300 such requests.

“There (are) a small number of CMP physician authorizers with very large veteran patient loads, which calls into question the robustness of medical oversight,” the audit report states.

“With limited guidance available on CMP authorisation, there is a risk that some healthcare professionals will over-prescribe the treatment.”

Despite these red flags and the potential risk to veterans and taxpayers, auditors found the vast majority of claims were approved, with the department focusing on ensuring access rather than monitoring and controlling. .

This included reimbursements for 45 veterans whose condition was listed as a substance abuse disorder and 46 who were also reimbursed for antidepressants, antipsychotics, benzodiazepines, opioids and narcotics.

Auditors suggested that the problems resulted from the ministry focusing too much on getting the reimbursement process in place and ensuring access. They noted that the entire program is managed by the equivalent of 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 said.

“As demand for the CMP program continues to grow exponentially, VAC will need to properly manage resources and examine the effectiveness of policies and programs.”

In response to the audit, Veterans Affairs officials say they are considering a variety of changes in terms of eligibility for reimbursement, as well as limits on the daily amount that can be allowed and for what types of products.

The department is also considering a new, more detailed permission form and additional safeguards for those requesting more than three grams per day. It is not clear when the changes will be able to be rolled out.

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