Melissa Ellsworth is a psychiatric nurse who worked in federal corrections. After a workplace injury, she was left with severe chronic pain and her life changed forever. When pharmaceutical medications didn’t work, her doctor recommended that she switch to cannabis. That suggestion brought her unparalleled pain relief but, it also began the fight of her life. The Workers Compensation Board(WCB) of Nova Scotia has no problem with opiate medications; medical cannabis is a whole other matter. Getting cannabis covered by WCB has been a non-stop fight in Nova Scotia; This is Melissa Ellsworth’s story.

Photo courtesy of Melissa Ellsworth

Injury to opiates

In 2006, Melissa Ellsworth was working as a licensed practical nurse at a psychiatric facility in Dartmouth, Nova Scotia. She was hit in the head by a chair and sustained injuries that will be with her for life. Left with neuropathic pain in her neck, jaw, shoulders, and head, Melissa took various prescriptions to try to manage and go back to work. At one point, she was taking a mixture of opiates, sedatives, and benzodiazepines; up to twenty pills per day and all of it covered by Nova Scotia’s Workers Compensation Board. Everything changed when she started using THC.

Synthetic to Natural THC

“I ran the gambit on medications as far as prescriptions and traditional medications went. Nothing worked. Finally, they put me on Cesamet, which is basically a synthetic THC. Once I maxed out at 6 mg, my pain doctor at the time suggested switching to cannabis.” – Melissa Ellsworth

Image courtesy of PubChem

If you’re taking a lot of synthetic THC, switching to the natural form would seem like an obvious choice. When you work for the Federal government, it’s just not that simple. As a healthcare worker in the prison system, she had major reservations when it came to using cannabis. With encouraging results from synthetic THC and her doctor’s recommendation, She decided to give it a try. 

Cannabis use

Today, Melissa is able to manage her neuropathy using only cannabis. She will vape when she needs fast-acting pain relief. Plus, she makes her own edibles and topicals. As a healthcare worker, Melissa only orders from a licensed producer and she knows what works best for her. When it comes to reducing pain, sour diesel and cannabliss are her most effective strains. When these buds are in stock, she will make a mail order but the inventory is never guaranteed. 

An average month of cannabis medication costs around $1900. She has a prescription for all of it. She has completely replaced a routine of heavily addictive medication with natural plant medicine. The only issue is paying for it.

WCB Nova Scotia – Medical Cannabis Policies

When you navigate to WCB Nova Scotia’s website, you can find all the forms and policies relating to medical cannabis. One such document is a Patient Treatment Agreement Sample 2 and it specifically mentions heroin and cocaine. If you want to use medical cannabis instead of prescription opiates, you have to sign a form and promise you won’t take heroin. However, you cannot try medical cannabis without first using heavy pharmaceuticals, including opiates. 

Image created by Author

The WBC of Nova Scotia has published a document titled ‘Medical Cannabis Guidelines’ and it outlines their coverage criteria. According to this document, a patient must have exhausted pharmaceutical trials before coverage can be considered. Specifically, this means a failure “to respond to adequate trials of a minimum of THREE DIFFERENT categories of first line agents (e.g., TCA, SNRI, Gabapentinoid) and/or second line agents (e.g. Tramadol or Opioids). If any category of agent was not trialed, a compelling reason must be provided.” In addition, the patient must try synthetic cannabinoids for a minimum of twelve weeks. WCB will only consider coverage, once every medication has been found to be unsuccessful.

Nova Scotia WCB Cannabis Coverage Limits

When it comes to coverage limits, the guidelines are strict and without explanation. 

The medical cannabis and route of administration authorized for the worker must satisfy all of the following:  

  • The route of administration must not involve smoking.  
  • The daily quantity of dried medical cannabis must not exceed three grams per day.  
  • Medical cannabis should be CBD-rich with minimal THC.  
  • The THC percentage of medical cannabis must not exceed nine percent.  
  • The milligrams (mg) of THC per day should be no more than 30 mg, but in no case shall exceed 75 mg. The daily quantity of dried cannabis must not exceed 3g/day. If alternate forms are prescribed (i.e. oil), they must be converted to a similar ratio and amount.
  • Cannabis must not be homegrown.  

Fighting for Coverage – Nova Scotia WCB Tribunal

For Melissa Ellsworth, the road to recovery has been long and hard. Healing has been challenging and stressful but getting coverage has been a fight. Initially, she asked her WCB case manager to cover her medical costs, but the request was denied. So, she asked again. When it was rejected a second time, she brought it to a hearing officer; they also rejected the claim. Melissa did not give up. In 2018, her claim was brought to a tribunal and finally, she won her right. After a five-year bureaucratic battle, Nova Scotia’s WCB would cover the cost of four grams of cannabis per day. 

“My Cesamet was covered 100% without question. I picked it up at the pharmacy the same day. All increases from 1mg/day to 6mg/day of Nabilone nor Marinol (first trialed) were not questioned nor did I need a tribunal. I did not need a tribunal for the opiates, gabapentin, or sleeping pills…  nor were the increases questioned/disputed.” – Melissa Ellsworth

Still fighting for insurance – Nova Scotia WCB Tribunal #3

As time went on, Melissa Ellsworth developed a tolerance to cannabis which required a change in her prescription. Her doctor increased her daily allotment in 2019, 2020, and 2022 but all coverage increases were denied by WCB. Here’s where things get really messed up: when her first increase was denied, the recommendation was opiate medication. WCB would approve any costs relating to a narcotic prescription but they wouldn’t cover an extra gram or two. Once again, Melissa geared up for battle.

As it stands today, Melissa Ellsworth has won eight WCB tribunals.

Photo courtesy of Melissa Ellsworth