Canada has now operated under a legalized recreational cannabis framework for nearly eight years. The Cannabis Act came into force in October 2018, and what was framed as a transitional policy question has become a settled one.
Cannabis is legal. Use is broadly normalized. The conversation has shifted from whether cannabis should be in the workplace conversation, to how that conversation should be conducted with clinical rigor.
In our work at SOMA, cannabis use is now a routine question in disability and injury claims. The assessment standards, however, are still catching up.
Federally, the Cannabis Act framework has remained stable. Provincial OHS frameworks continue to govern workplace fitness in safety-sensitive roles. Human rights jurisprudence continues to treat substance use disorder as a protected ground, with the implication that workplace cannabis policies must distinguish between recreational use, problematic use, and use that meets the threshold of a disorder.
In practice: most employer cannabis policies have matured beyond their early post-legalization drafts. The policy framework is no longer the bottleneck. The bottleneck is the assessment standards that translate policy into individual decisions.
SOMA's Alexandra Perry adds:
"Assessment standards for cannabis have come a long way since legalization. Early conversations often focused on whether cannabis use was present, with use itself sometimes being treated as a proxy for impairment. Today, we have a much better understanding that cannabis use, impairment, and substance use disorder are distinct clinical questions.
What has changed most significantly is the expectation that assessments provide meaningful context rather than simply documenting use. Employers, insurers, and case managers are increasingly looking for information that helps explain how cannabis use fits within the broader clinical picture, including chronic pain, sleep concerns, mental health conditions, medications, treatment engagement, and recovery.
Recent research has also challenged some of the assumptions around cannabis as a treatment for mental health conditions, reinforcing the need for individualized, evidence-informed assessment. In many ways, the next evolution in assessment standards is moving beyond asking whether cannabis use is present and toward understanding whether it is clinically relevant to recovery, function, disability, and return-to-work outcomes."
One of the most consistently misunderstood features of cannabis in workplace and claims contexts is the distinction between tolerance and impairment. A regular user develops tolerance to many acute effects of THC. The same dose, in a tolerant user, produces a different functional picture than in a naïve user - well-established in the clinical literature, with direct implications for assessment.
It also has implications for testing. Cannabinoid testing measures presence - or, in some matrices, recent use. None of the standard methods measure impairment in the way breath alcohol testing does. A positive test does not establish that the person was impaired at the time the question matters. Testing alone cannot answer the workplace fitness question.
Several elements have meaningfully matured. Most large employers now have cannabis-specific policies distinguishing safety-sensitive roles, recreational from medical use, and use from impairment. Frontline supervisor training has expanded. Accommodation pathways are clearer than they were in the early years.
Where the gap remains is the assessment lens applied when cannabis use becomes a clinical question. Single-appointment psychiatric IMEs often lack the cannabis-specific depth needed for a defensible decision. Toxicology results are sometimes treated as if they answer the functional question (they don't). And the intersection of cannabis use with chronic pain, sleep, and mental health is frequently under-assessed.
SOMA's Alexandra Perry adds:
“A good cannabis assessment should answer the questions employers, insurers, and case managers are trying to make decisions about. It should clarify the pattern of use, including timing, frequency, dose, and purpose, while also exploring cognitive and behavioural impacts, workplace demands, and the broader clinical context.
Most importantly, a good assessment should move beyond diagnosis and focus on practical next steps. The strongest assessments help determine whether cannabis is helping, hindering, or having no impact on recovery. They identify barriers, opportunities for treatment coordination, and supports that may improve function and return-to-work outcomes.
The best reports provide more than a diagnosis. They provide context, clarity, and actionable recommendations that help move the file, and the individual, forward. Ultimately, the goal is to support improved health, functioning, recovery, and sustainable participation at work.”
The cannabis-in-the-workplace conversation in 2026 is at a turning point. The policy framework is mature enough to support nuanced decisions. The clinical literature is mature enough to support assessment standards beyond use-versus-no-use binaries. What the next phase requires is the assessment infrastructure to support it - specialized cannabis IME services with the clinical depth, disability claims context, and multi-condition skill to address cannabis as the layered question it usually is.
This is exactly the practice we have built at SOMA. Our specialized cannabis and substance use IME services, led by Alexandra Perry, are designed to deliver the assessment depth these files require - without the stigmatizing posture that has historically characterized some segments of substance use assessment work.
Reach out at alex.perry@somamedical.com.