Manitoba ordered to pay sexual assault victim back for medical cannabis used to treat PTSD

Manitoba's Court of Appeal has ordered the provincial government to reimburse a woman who was a victim of sexual assault for her prescription cannabis expenses, saying the government's victims of crime program made an unreasonable decision to deny her coverage.

The victim services department will have to pay back the woman for cannabis she bought through a regulated dispensary, after she was given a prescription for it to treat post-traumatic stress disorder and major depression in May 2015, according to a decision delivered by three appeal court judges last Monday.

The director of the provincial victim services program relied on the opinion of one consulting doctor on the use of medical cannabis to treat the woman's symptoms as the basis to deny her expenses, against the "otherwise uncontradicted evidence" presented by the woman's family doctor and a clinical psychologist, the decision says.

The provincial government says it's reviewing the appeal decision and doesn't have a comment at this time.

The appeal court heard that the woman, whom CBC is not naming because she's a victim of sexual assault, suffered a "horrific crime" in 2010 and has lasting psychological injuries as a direct result.

Her family doctor said she was unable to work for years and was sometimes unable to leave her house as a result of her trauma, according to the court document.

Under Manitoba's victims' rights legislation, a person who is injured as a result of a crime is entitled to compensation that includes reimbursement for expenses incurred as a result of the injury, compensation for related counselling services, and compensation for lost wages if the victim is disabled by their injury.

In 2011, the victim services department approved a $4,000 payment to the woman for counselling, and in 2016, she was granted just over $19,500 for psychological impairment because of her inability to work.

In the years following the assault, the woman had been prescribed nine different pharmaceutical drugs to address her symptoms, but all of them had unfavourable side effects, the decision said.

In May 2015, the woman's doctor prescribed medical cannabis to treat her symptoms. 

Consultant recommended against application

In 2016, the woman submitted the receipts for her prescribed medication to victim services, which reviewed her application over the course of a few months.

Under the department's policy, staff are to seek the advice of a medical adviser if there is "uncertainty regarding the nature of a medication and the relation to the victim's injury," the court decision said.

The province sought the help of a medical consultant who made inquiries with the woman's family doctor and her psychologist, but didn't speak to the woman or do his own examination.

The doctor who acted as the consultant advised denying her application, saying there is a lack of clear evidence on the use of cannabis to treat post-traumatic stress disorder. The department subsequently denied her application, the appeal decision says.

The woman asked the department to reconsider that decision, saying it was inconsistent with the mandate of the department, that cannabis was a "significant help" in her management of PTSD, and that Health Canada had determined medical cannabis was appropriate for such treatment.

Victim services sought the advice of the same medical consultant as before, who again advised denying her coverage. The doctor maintained Health Canada's public advice to health-care professionals is that cannabis is not an "approved therapeutic substance" and that Health Canada does not endorse its use. 

He also said Health Canada has stated there are no properly controlled clinical trials on the management of PTSD symptoms through the use of medical cannabis.

The woman appealed the director's decision to an appeal commission in early 2017. In November 2018, the appeal commission released a decision denying that appeal.

The woman then sought a judicial appeal, but that application was denied by a judge.

Positive experience with cannabis: doctor, psychologist

The Manitoba Court of Appeal judges' ruling said that because the medical consultant hadn't examined her, his opinion didn't take her experience into account, but was rather based on a blanket policy to deny coverage for cannabis to treat PTSD.

"[His] opinion fails to address the unchallenged evidence that, unlike the nine prior pharmaceutical drugs that had been tried and failed, medical cannabis was improving the mental health of the applicant," the decision said.

The woman's family doctor said cannabis has been "very efficacious" in stopping her symptoms and resulted in very few side effects. In addition, she hadn't developed a dependency or withdrawal side effects like she did with other medications, the family doctor said.

The woman's clinical psychologist said he had seen other patients suffering from PTSD experience "considerable improvement in their condition" after using medical cannabis.

The appeal judges ordered that the woman be reimbursed for her expenses immediately, rather than going through a further victims services appeal process.

"This merry-go-round as to the applicant's original entitlement to prescription drug coverage almost seven years ago has gone on long enough," the decision said.