Executive Summary

Why we did this audit

Since 2008, Veterans Affairs Canada (VAC) has reimbursed Veterans for the cost of Cannabis for Medical Purposes (CMP) when obtained following federal regulations. More and more Veterans are now seeking reimbursement for CMP either because conventional treatments fail to relieve their pain or cause negative side effects.

While it is legal to access CMP, Health Canada has yet to approve cannabis as a therapeutic product in Canada. There is a need for more research on CMP’s effectiveness and safety. Ultimately, health care practitioners must weigh all of the risks with the potential benefits before authorizing the use of CMP as a treatment for a specific condition.

While VAC waits for research to better guide how cannabis might be used as a therapeutic treatment, this audit assessed what the department is doing right now to address the potential health concerns and financial impacts of this treatment benefit.

Key facts, figures and findings

• Through its policy, the Department reimburses Veterans up to three grams of CMP per day at a fixed rate of up to $8.50 per gram. However, it can reimburse up to 10 grams/day if a Veteran meets exceptional criteria. As of 31 December 2020:
  • 19% are being reimbursed less than 3 grams/day
  • 61% are being reimbursed the maximum 3 grams/day
  • 20% are being reimbursed more than 3 grams/day per exceptional criteria
  • Those that meet exceptional criteria are reimbursed on average 7.1 grams/day, which is extremely high compared to the Health Canada-reported average of 2 grams/day for Canadians accessing CMP.
  • The vast majority have mental health conditions, in particular Post Traumatic Stress Disorder (PTSD), which are considered a contraindication by health organizations such as the College of Family Physicians of Canada and Health Canada
• An extremely small number of health professionals (11) are responsible for authorizing a disproportionately large percentage (more than 6,000 or roughly 40%) of the Veterans being reimbursed for CMP.
• Between 2015-16 and 2019-20, Veterans authorized for CMP increased by 660%. Currently, more than 13,000 clients are being reimbursed for CMP.
• In 2020, CMP spending was at $85.2 million . By 2026, VAC anticipates spending of more than $300 million, with an additional $12 million in transactional costs.
• VAC continues to assess current research and support areas of needed research into CMP as a treatment for Veterans. However, VAC can do more to identify trends in the CMP program that may be problematic and adjust policy to safeguard the health and well-being of Veterans.
• As demand for the CMP program continues to grow exponentially, VAC will need to properly manage resources and examine policy and program effectiveness.

Highlights of our recommendations

As Health Canada has not approved CMP as a therapeutic treatment, VAC must take considerate and cautious measures to improve oversight when supporting Veterans in this treatment through the reimbursement of costs.

VAC has an opportunity to consult stakeholders and engage with health experts in developing a stronger policy and monitoring framework that will support the health needs of Veterans and their families.