Ontario injured workers shut out of medical pot coverage — told to take opioids instead

Many injured workers in Ontario are being given an ultimatum: take potentially addictive cocktails of opioids and other pharmaceuticals, or pay for your own help, a CBC Toronto investigation has revealed.

Insurers like Ontario's Workplace Safety and Insurance Board (WSIB) are frequently refusing to help injured workers who want to turn to seemingly less harmful drugs like medical marijuana.

"We have an opioid epidemic here in Canada," said Maurice Sagle, 60, a former carpenter. 

"I'm thinking [the WSIB] better get out of the past."

For it's part, the WSIB says it's reducing the number of drug claims for opioids and deals with requests for medical pot "on a case-by-case basis." 

Sagle's spine was compressed, some of his discs were shattered, his left leg muscle was ruptured and his arch was flattened in 2016 when a roof truss fell on his shoulder.

He says the WSIB has agreed to pay for the thousands of dollars in opioids he's been prescribed, but won't pay a cent for medical marijuana.

'The more you do, the more you want to do'

Sagle says the opioids left him dazed, depressed and often unable to leave his home. He says he was becoming increasingly unsociable and felt he was becoming addicted.

"The more you do, the more you want to do" said Sagle. "To me it was very dangerous stuff. It was pretty well controlling my life. I said, 'I need to get my life back, I need to do something about this.'"

Sagle, who doesn't drink or use recreational drugs, did his own research and discovered pot might help him.

He got a medical marijuana licence with the help of his doctor and turned to a strain of pot that is high in a compound called cannabidiol, better known as CBD. 

He says it reduced his chronic pain. Also, the strain he was using has no THC — the psychoactive compound that makes pot-smokers high.

"I don't want to be buzzed out, and can't afford a fall," Sagle said.

Yet despite its many benefits, Sagle says, he is still fighting the WSIB for coverage.

"They said they don't recognize this and they sent me a paper saying no, they wouldn't cover it."

Sagle says it's frustrating. 

"I'm trying to help myself get a better life," he said.

"It's organic, it made my body feel much better and it did a lot of things for me." 

Sagle orders his pot from a government licensed producer. But he's now locked in a lengthy, complicated and costly process of appealing the WSIB`s decision.

'Absurd scenarios'

He's not alone.

"You often end up with these absurd scenarios where the WSIB is happy to pay for opiates and antidepressants that are not effective, that the worker does not want to take" said David Newberry, a community legal worker with the Injured Workers Community Legal Clinic in Toronto.

Newberry says in many cases, marijuana is also cheaper than the host of opiates and other pharmaceuticals workers are being prescribed.

Medical marijuana has been legal in Canada since 2001, yet there appears to be an ongoing debate about its use in treating the sick or injured. The Canadian Medical Association (CMA) has been opposed to medical marijuana since the beginning and says the vast majority of doctors aren't comfortable prescribing it.

"It's important to recognize that by and large, that level of evidence doesn't reach the quality that we demand for every other product that physicians prescribe," said Dr. Jeff Blackmer of the CMA during an interview with the CBC's Quirks & Quarks. 

Newberry says there's another reason why the WSIB is leery of medical marijuana.

"I'm sure WSIB and other private insurers have a fear of being accused of funding recreational drugs," he said.

'I look like a 90 year old'

Robert Vachon is another Ontario worker who battled with the WSIB over his use of medical marijuana after years of heavy manual labour destroyed his back.

"I couldn't work; the pain got so bad I was using a walker. I couldn't stand up straight. I was bent over. People would say I look like a 90-year-old," said Vachon, 49.

For years, the WSIB paid for his many prescriptions, including opioids and muscle relaxants. 

"I had three different pages of medications I was on, and none of it worked," he recounted.

When he complained about the drugs and the lack of improvement in his health, he claims his WSIB case manager told him to go back to work.

Vachon says the drugs also left him dazed and bedridden for days at a time.

"My depression got so bad, there was a couple of times I did suicide attempts," he said. 

Vachon began researching the effects of medical marijuana — specifically the strain full of CBDs with little or no THC. His doctor initially refused to prescribe pot for him, but changed his mind after Vachon got his hands on some and began taking it. 

'There's no side effects, it's not addictive'

"After three days, I'm getting out of bed without stiffness," he said.

After three weeks of taking the medical marijuana, he says, he was able to dump the motorized scooter he had relied on, as well as his walker.

"I was standing up straight," he said. "There's no side effects, it's not addictive, it's natural."

Vachon says he no longer needs the antidepressants, because his mental health is back to where it was prior to his workplace injury. He takes three capsules of ground marijuana a day and makes his own cream he can apply to his back when needed.

Despite the dramatic turnaround, the WSIB  refused to let him essentially trade in his many pharmaceutical prescriptions for medical marijuana.

It took several years, and an endless stream of paperwork, Vachon recalls, but he eventually won an appeal of the WSIB's original decision.

The WSIB is now covering his approximately $500 a month in medical marijuana costs.

But as Newberry notes most injured workers aren't as fortunate when dealing with the WSIB.

He says the WSIB refuses most medical marijuana requests, but is often forced to pay when workers take on the arduous task of taking the insurance agency to a third-party appeal tribunal. The process can take two years or more.

'2 classes of injured workers'

That "creates two classes of workers," said Newberry.

"One where people who are able to access representation because they can afford a lawyer or because they qualify for legal aid are able to get the medicine that is right for them. And one where people can't get a lawyer and can't afford the medicine."

Christine Arnott of WSIB Ontario says the board can't discuss specific cases.

But the WSIB is "always looking at the evolving scientific evidence around the effectiveness of pain management and update our approach accordingly," she said.

"We are focused on limiting exposure to the harms associated with opioid use and lowering risk of addiction. So far we have reduced the number of WSIB drug claims for opioids by 47 per cent. We treat requests for coverage of medical marijuana on a case-by-case basis.

"We will continue to help people manage their pain based on evidence, so they can safely return to work."