(OTTAWA) An internal audit at the Department of Veterans Affairs suggests that Ottawa, which spends hundreds of millions of dollars each year on medical cannabis, has all but lost control of the program.
Updated yesterday at 6:12 p.m.
Discreetly released this week, the audit report reveals that Veterans Affairs offers this program without too much supervision, guidance or evidence on the health benefits of veterans.
The audit results come as the number of veterans seeking reimbursement for their medicinal cannabis has skyrocketed in recent years, from around 100 in 2014 to more than 18,000 last year. And we don’t seem to see a downtrend on the horizon.
As a result, the Department of Veterans Affairs spent more than $150 million on medical cannabis last year, more than all other prescription drugs combined. This budget item should reach 200 million this year and 300 million by 2025-2026.
Yet even as demand has grown exponentially, the audit authors found a continuing dearth of research on the therapeutic benefits — and risks — associated with cannabis for veterans, especially those suffering from psychological trauma. .
The audit also highlights a lack of guidance and oversight regarding veterans’ eligibility for this medical cannabis, the criteria by which this drug is prescribed, and how veterans obtain a prescription.
The department “has taken steps to operationalize its policy to provide veterans with access to treatment reimbursement,” the report said. “However, significant gaps remain in internal controls over Veterans’ health and program management. »
Explosion of claims
The Department of Veterans Affairs began reimbursing a few veterans for their medicinal cannabis in 2008, when approvals were granted on an extremely limited basis, and with medical specialist approval.
The decision followed a series of court rulings over 20 years ago that for the first time granted legal protection from criminal prosecution for the use of cannabis for medical purposes.
Then, in 2014, Health Canada relaxed its rules to determine who could authorize the use of medicinal cannabis, and under what conditions and circumstances. The new rules did not impose limits on the quantity that could be authorized, 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 a fixed price of $8.50 per gram. The department can also reimburse, “on an exceptional basis”, up to 10 grams per day, “when a veteran meets additional requirements”.
The authors of the audit report point out that according to the available research, which is still limited, individuals should consume less than three grams of cannabis per day and follow up regularly with their healthcare professional.
Health Canada and the College of Family Physicians of Canada have also warned of the potential adverse effects of cannabis use in people with mental health conditions, particularly post-traumatic stress disorder.
Yet the audit report says Veterans Affairs provided no guidelines or restrictions on the types of health conditions eligible for reimbursement for medical cannabis.
Contraindications
Virtually any medical condition is eligible for the program, including post-traumatic stress disorder. However, “the vast majority” of veterans who were reimbursed for their medicinal cannabis “had mental health disorders (in particular post-traumatic stress disorder)”.
Yet these psychological states “are considered a contraindication” by health organizations like the College of Family Physicians of Canada and Health Canada, the report authors say.
During the same period, nearly 80% of authorizations were for three grams of cannabis or more per day, while specialist authorization letters for many veterans “contained very little evidence to support a close doctor-patient relationship.
“Recommendations for follow-up were vague, with specialists using wordings like ‘follow-up in six months or as clinically needed’,” the report reads. Just over half of the letters reviewed as part of the audit did not include any reference to follow-up. »
Additionally, about one-third of the records reviewed had no record of which health care provider actually authorized the veteran to receive medicinal cannabis. And many files were incomplete.
Generous professionals
In one of the most disturbing findings of the audit report, we read that 11 medical professionals issued authorizations to almost 40% of all veterans who claimed reimbursement for medical cannabis, or more than 6,000. One of these medical professionals alone approved nearly 1,300 of these requests, and three others issued between 700 and 830 authorizations.
“In particular, the verification team found that a small number of doctors authorized a very large number of veterans to use (cannabis for medical purposes), which raises questions about the rigor of the medical follow-up carried out” , reads the report.
“As the guidelines on the authorization […] are limited, there is a risk that some medical professionals will over-prescribe” this cannabis treatment.
A handful of officials
Despite these red flags, as well as the risk to veterans and taxpayers, the report’s authors note that the vast majority of claims have been approved, with the department focusing on the accessibility of this program, rather than its monitoring and control.
We note that 45 veterans whose health condition was listed as a substance abuse disorder received reimbursement. In addition, 46 veterans received reimbursement for large quantities of cannabis (7 to 10 grams per day) “while also having received reimbursement for drugs belonging to each of the four classes of high-risk drugs: antidepressants, antipsychotics, benzodiazepines and opioids”.
The authors of the report recall that this program is administered “by a small staff of 3.5 employees (full-time equivalents), with the support of the group of health professionals” of the ministry.
In response to this audit report, Veterans Affairs officials say they are considering a variety of changes in terms of reimbursement eligibility criteria, as well as limits on the daily amount that can be allowed and for what types. of products.
The ministry is also considering a new, more detailed authorization form and additional guarantees required for those requesting more than three grams per day. It’s unclear when the changes might roll out.