1.0 Background

Prior to the introduction of the Marihuana for Medical Purposes Regulations (MMPR), the Medical Marihuana Access Regulations (MMARs) extremely limited access to cannabis to a small number of conditions and circumstances and only when authorized by a specialist. Since 2008, Veterans Affairs Canada (VAC) has provided coverage for the cost of marijuana for medical purposes (MMP) to Veterans who obtained the product in accordance with Health Canada regulations. Under the MMARs , access was in limited circumstances and the number of Veterans receiving MMP were appropriately low.

On April 1^st, 2014, Health Canada released new regulations which eliminated the need to meet certain health criteria before obtaining MMP. The new regulations allow private producers, licensed by Health Canada, to supply MMP to Canadians who have authorization from a physician to access the product. The licensed producers determine the price to charge their recipients.

Health Canada’s Consumer Information – Cannabis (Marihuana, marijuana) document of December 2015 noted that MMP may be authorized for the relief of symptoms associated with a variety of disorders which have not responded to conventional medical treatments. However, MMP is not an approved therapeutic product in Canada. At present, while pointing to some potential therapeutic benefits, the scientific evidence does not establish the safety and efficacy of marijuana to the extent required by the Food and Drug Regulations for marketed drugs in Canada^{Footnote 1}. However, the MMPRs provide a mechanism for patients to access MMP in response to decisions of the Canadian courts requiring reasonable access to a legal source of MMP^{Footnote 2}.

Currently, VAC will reimburse up to 10 grams of dried MMP per day for Veterans as identified by the authorizing physician. With no established rates, VAC pays the rate charged by licensed producers.

Timeline

• In 2001, Canada was the first country to adopt a formal system to regulate the medicinal use of marijuana - the MMARs.
• Under the MMARs, Health Canada was responsible for approving all requests for MMP, approval was dependent on certain categories of symptoms and conditions and required a specialist recommendation. The MMP was supplied by Health Canada and the price was set at $5.00 per gram.
• In 2008, VAC approved MMP on an exceptional basis for one Veteran.
• VAC proceeded to develop a position that allowed for VAC to cover costs of MMP for eligible Veterans who were approved by Health Canada. VAC became the only public funder of marijuana in Canada.
• VAC's Medical Marijuana Guidelines for Treatment Benefits became effective as of July 2012. The purpose of these guidelines was to provide direction pertaining to requests for approval of medical marijuana as a VAC Benefit.
• The MMPRs came into force in June 2013. The regulations created conditions for a commercial industry that was responsible for the production and distribution of MMP. They also ensured that Canadians with a medical need could access quality controlled marijuana grown under secure and sanitary conditions, similar to medication.
• The MMARs were revoked on March 31, 2014.
  As of April 1, 2014:
  • Recipients were no longer allowed to grow their own MMP. (A court injunction allowed individuals who had a license to grow cannabis under MMARs to continue to do so until the court case was heard or the injunction was appealed.)
  • MMPRs granted individuals access to MMP on the submission to a licensed producer of a medical declaration from a health care practitioner authorized to prescribe in a given jurisdiction. The MMPRs define health care practitioner as a medical practitioner or nurse practitioner. A medical specialist recommendation was no longer required.
  • MMPRs do not limit access based on medical conditions or symptoms and therefore MMP may be legally authorized and supplied in relation to any health condition or symptom.
  • The price was no longer regulated and was established by the licensed producer and varies from $6 - $14/gram depending on the strain.
  • Regulations were silent on authorization limits and maintain the same rules regarding possession limits.
• April 2015 – Canadian Medical Association Statement Authorizing Marijuana for Medical Purposes (Update)^{Footnote 3}
  • While acknowledging the unique requirements of patients suffering from a terminal illness or chronic disease for which conventional therapies have not been effective and for whom marijuana may provide relief, physicians remain concerned about the serious lack of clinical research, guidance and regulatory oversight for marijuana as a treatment. Marijuana is a complex substance, and there is not sufficient clinical information on clinical safety and efficacy. Notably, there is little information around indications for its use, therapeutic and toxic dosages and knowledge on interactions with medications.
• In 2015 Health Canada grants access to cannabis oil and fresh marijuana. VAC continues to reimburse for dried MMP only.
• In spring 2016, The Office of the Auditor General of Canada (OAG) released a report on VAC drug benefits. The report included a recommendation for VAC to explore ways that costs associated with marijuana for medical purposes could be contained. VAC fully agreed with this recommendation.
• In March 2016, the Minister of Veterans Affairs, the Honourable Kent Hehr, announced a comprehensive review of MMP. This review was a component of the comprehensive review and was to provide an assessment of the Department’s approach to reimbursing the cost of marijuana with particular focus on the health, safety and well-being of Veterans.

Expenditure History

The number of recipients with active authorizations for MMP have been increasing every year. Expenditures on MMP have increased from approximately $416,000 in fiscal year 2013-14 to $20,538,153 in fiscal year 2015-16 as outlined in Table 1.

Source: VAC Statistics Directorate