Medical Cannabis Review Program

Background 

Cannabis (marijuana) use that has been authorized for medical purposes has soared in Canada over the last number of years. Recently, we have seen a large spike in medical authorizations, which is likely in part due to society and many medical professionals’ general acceptance of cannabis use as a treatment option for a variety of medical conditions. Despite legalization, expect there to be a continued growth of cannabis for medical purposes. 

Although authorized by a physician or nurse practitioner, cannabis, where and when it contains sufficient quantities of euphoric cannabinoid chemicals such as tetrahydrocannabinol THC, remains a psychoactive substance that has the potential for safety concerns at work, especially when working in safety sensitive or safety critical jobs. 

Not all cannabis products are the same in form and in composition. Cannabis can contain 80 to 100 or more cannabinoid chemicals, some euphoric such as THC, and some not euphoric such as CBD. As more research studies are conducted that outline the impact of various cannabis products on decision making skills, motor skills, coordination, and reflexes, it is apparent that if a worker has authorization for cannabis for medical purposes, an evaluation is required to determine whether the worker would be fit for duty in a safety sensitive occupation. 

A candidate/worker does have an obligation to work with their employer to manage risks in the workplace, and even more so if a medical issue is involved. Notwithstanding applicable medical confidentiality and privacy rules, employers have the general right to know from a worker whether or not the worker has a health condition that could impact workplace safety and/or or is under treatment that could impact workplace safety (employers should seek legal counsel in their provinces for guidance on this matter). However, the challenge for the employer is to utilize an arm's-length approach to manage the medical agenda, but still try to obtain objective and valid information regarding a medical issue, including treatment. This objective and valid information could then be used to support an employer's position in regard to how to best manage this risk and ensure safety in the workplace for the worker as well as co-workers. 

We developed a Medical Cannabis Review Process to assist the candidate/worker, the employer, as well as the treating physicians to manage the medical issue. 

Outlined below is a brief summary of the step by step process while reviewing medical cannabis files. Please note that all reviews may not require all of the steps listed, as a solution or outcome may be determined before proceeding to the next step.

• Step 1: Request for Service (Referral) 

• Step 2: Validating User Authorization 

• Step 3: Communication of Findings to Referring Party 

• Step 4: Letter to the Authorizing Physician/Nurse Practitioner 

• Step 5: Independent Physician File Review 

A Note Regarding Independent Medical Evaluation (IME) Services 

On an as needed basis, DC will facilitate an in-person evaluation with a physician specialist that is objective and evidenced based. DC will provide a plan of action, including report delivery expectations, along with the quote for service to the referring party. The process involves review of the worker case file including pertinent medical reports, examination of the worker, and preparing conclusions in a comprehensive report format for the referring party. Fee for service is dependent upon the complexity of the case file and physician specialist(s) involved. 

The intent of the initial review and report is to outline any red flags and significant concerns regarding the current authorization. In the event there is medical indication for cannabis use, DC may suggest an IME to examine the individual to ensure they are safe to work. A file review alone does not provide sufficient objective information to determine an individual is fit for safety sensitive work, unless the individual voluntarily discontinues using cannabis.