Medical marijuana and workers’ comp. Seriously?

I was chatting with Jennifer Wolf-Horesjh, Executive Director of IAIABC, this morning when the conversation turned to medical marijuana in workers comp.  I have no idea how we ended up there, but Jennifer is a great conversationalist and very well informed about everything work comp-related, so she’s on top of the issue (and pretty much everything else).

As luck would have it, IAIABC just completed a survey of states’ positions on work comp and medical marijuana.  A couple states have specifically banned the use of medical marijuana in worker’s comp treatment (Montana and Vermont), while others have administrative restrictions/requirements in place. Others allow it.  (Jennifer also told me about a recent court case wherein an insurer was required to pay for the marijuana growing equipment used by a claimant; if anyone has a record of that send it over and I’ll update the post. )

So, here’s the deal.  What logic would one use to approve the use of medical marijuana in workers’ comp?  There’s very little evidence that it is beneficial for most conditions for most people, although some anecdotal evidence that it works for a few. But just because a (very) few find relief from cannabis does not make it a viable medication – and one employers should be paying for – without careful scrutiny and ample evidence that it works for a specific claimant.

Alas, logic and workers’ comp aren’t often used in the same paragraph, so perhaps this is just another indication of how screwed up WC is.  As if we needed one.

There’s an excellent white paper on the topic from PBM myMatrixx as well as a webinar for your edification.  PMSI’s Jay Krueger has also authored a paper on the subject, and WorkCompInsider was an early reporter on the subject as well.  Oh, and in case you think you’ve heard it all, read Jon Coppelman’s piece on an idiot who a) got stoned and b) then went to feed bears in an animal park.

8 thoughts on “Medical marijuana and workers’ comp. Seriously?

    • Good point – Although I can’t speak to the price – there are countless cases where carriers have had to settle litigation with family members who have died as a result of their WC pain treatment.

  1. Below is the ODG evidence-summary and guideline recommendation on Medical Marijuana-

    “Not recommended. In total, 11 states have approved the use of medical marijuana for the treatment of chronic pain, but there are no quality controlled clinical data with cannabinoids. Restricted legal access to Schedule I drugs, such as marijuana, tends to hamper research in this area. It is also very hard to do controlled studies with a drug that is psychoactive because it is hard to blind these effects. At this time it is difficult to justify advising patients to smoke street-grade marijuana, presuming that they will experience benefit, when they may also be harmed. (Mackie, 2007) (Moskowitz, 2007) One of the first dose-response studies of cannabis in humans has found a window of efficacy within which healthy volunteers experienced relief from experimentally induced pain. But although mid-range doses provided some pain relief, high doses appeared to exacerbate pain. (Wallace, 2007) Results of a double-blind crossover study suggest that smoked cannabis may reduce pain intensity for patients with neuropathic pain, although the Food and Drug Administration (FDA), Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institute for Drug Abuse (NIDA) report that no sound scientific studies support the medicinal use of cannabis. Psychoactive effects were also seen, including feeling high, although these were less apparent at the lower dose. Of more concern, were effects on cognitive performance, which in this chronic pain population was at or below the threshold for impairment already at baseline. Cannabis use was associated with modest declines in cognitive performance, particularly learning and recall, especially at higher doses. The finding necessitates caution in the prescribing of medical marijuana for neuropathic pain, especially in instances in which learning and memory are integral to a patient’s work and lifestyle. (Wilsey, 2008) Cannabinoids as analgesic agents can have an undesirable CNS impact, and, in many cases, dose optimization may not be realizable before onset of excessive side effects. Therefore, formulation, composition, and delivery system issues will affect the extent to which a particular cannabinoid product may have a desirable risk-benefit profile and acceptable abuse liability potential. (McCarberg, 2007) This study concluded that nabilone, a synthetic cannabinoid approved for treatment of severe nausea and vomiting associated with cancer chemotherapy, may be a useful addition to pain management and should be further evaluated in randomized controlled trials. (Berlach, 2006) See also Nabilone (Cesamet®). The results of this preliminary study suggest that dronabinol, a synthetic THC, resulted in additional analgesia among patients taking opioids for chronic noncancer pain. (Narang, 2008) Adding a cannabinoid to opioid therapy may lead to greater pain relief at lower opioid doses, according to a new study. As with many studies investigating medical marijuana, the study was small and not designed as an efficacy trial using randomization or control participants, but it does add to emerging evidence that cannabinoids and opioids have clinically significant synergistic effects. More study is needed. (Abrams, 2011) The 2 main chemical ingredients in marijuana, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), can have very different effects on behavior and in the brain, this research shows. Even a single modest dose of THC, the main ingredient in marijuana that is responsible for the high, can induce psychotic symptoms, whereas CBD can be useful as a treatment for psychosis. Regular marijuana use in vulnerable individuals is associated with increased risk of developing psychotic disorders such as schizophrenia, in which patients lose contact with reality. CBD, on the other hand, had the opposite effect, increasing the response of the left caudate, an area of the brain weakened by THC. (Bhattacharyya, 2012)”

  2. The main reason behind non-approval of medical marijuana, particularly in Montana, is that it is ILLEGAL even at a federal level. If you “google” or “bing” “Montana medical marijuana federal raids” you will find that it isn’t legal to sell it in any form, so paying for it as an insurance company would put one in the crosshairs of the federal government.. Probably not a good idea considering how messed up WC already is.

  3. Pingback: Medical marijuana and workers’ comp. Seriously? - The Doctor Weighs In | The Doctor Weighs In

  4. The real challenge is when it is legal. I work in the transportation industry. How do you monitor that within Dot guidelines?

  5. Hey Joe,
    No argument from me that the WC system has its problems. However, I support looking into the use of marijuana for treatment of chronic pain as an alternative to opioids. The erroneous classification of marijuana as a Schedule I narcotic has indeed hampered both solid research and rational discussion. However, I think it quite clear that there is a therapeutic benefit and furthermore that there are few good drug alternatives for treatment of chronic pain as an adjunct to other, more effective treatment modalities (e.g. diet, exercise, topical medications, distractants, physical therapy, obesity treatment etc). Many studies have shown that chronic pain treatment should not primarily revolve around medication. But that is exactly what is happening and the meds we do use have a terrible cost.
    Drugs with extensively proven, long-term negative health effects and extremely high potential for abuse such as Ocycodone and other opioid derivatives cause havoc when used to treat chronic pain. Don’t get me wrong, opioids are wonderful for acute, short-term pain management. However, I am shocked by how often these powerful and dangerous drugs are used are used for chronic pain management. This is beginning to change as evidenced by The American College of Occupational and Environmental Medicine (ACOEM) guidelines http://www.acoem.org/Guidelines_Opioids.aspx. Also, check out this fantastic info sheet for patients regarding long-term opiate use: http://www.webility.md/pdfs/Patient%20Education%20on%20Extended%20Opioid%20Use%20-%20Webility%202012-10-09a.pdf.

    I think the “it hasn’t been proven” argument is a bit weak because the negative effects of our current modalities have been researched extensively. It reminds me of the argument the Canadian Health Ministry had against e-cigarettes as a nicotine replacement therapy. Are e cigarettes potentially bad for you? Perhaps, but we know for a certainty smoking cigarettes is deadly. Which would you choose?

    In summary, we are well aware of our current paradigms’ shortcomings. Let’s give medical marijuana its day in court, reschedule it appropriately and do the research. Lord knows we need to think outside of the box when it comes to chronic pain management and cannot afford to shut the door on new treatments. We need more options, not fewer.