Opioid use in work comp has dropped – and cannabis does reduce chronic pain

Several states have seen precipitous decreases in the amount of opioids dispensed per claim.  KY, NY, MD, and MI all saw reductions in excess of 35%.

In every one of the states WCRI studed, at least 30% of patients with opioid scripts also had a script for a central nervous system depressant.  That’s just remarkable; the risk of adverse consequences goes up dramatically when patients take both drugs.  The good news is the percentage of workers who were prescribed this combination declined in most states – but the average decrease was a few percent.  While there can and may well be good reasons for docs to prescribe these drugs for individual patients, the research indicates there are significant risks.

Some have said medical marijuana should be considered an alternative to opioids.  If that’s a valid claim, that’s wonderful news indeed – and not just for growers, marketers, and pizza purveyors.

Dean Hashimoto MD reviewed the National Academies of Science’ report on all literature and evidence concerning the medical use of marijuana. Summary is here.

There’s conclusive support for cannabis’ ability to reduce chronic pain in adults, BUT at great risk of motor vehicle accidents and the development of schizophrenia and other psychoses.  This is a big deal, as most patients using medical marijuana cite chronic pain as the reason for consumption. There’s a lot of evidence that medical marijuana is effective – evidence derived from well-controlled clinical trials.  But little is known about efficacy, dosage, frequency, administration routes, or side effects.

There was moderate support for better sleep outcomes but at the price of impairment of learning and memory and increased dependence on other substances eg tobacco and alcohol.

Interestingly, there isn’t enough data or research to associate non-medical cannabis use with occ injuries or accidents.

There’s more good news.

Two solid studies documented significant decreases in opioid overdose mortality rates and opioid addiction in states that allowed medical marijuana.

What does this mean for comp?

Well, 22 million Americans used cannabis in the last month. So it’s real, and it’s common. There’s no legal way to use the banking system to pay for medical marijuana, and there’s no guidance on dosage or other prescribing standards.

And there’s conflict between state regulations, case law, and federal law.

We live in interesting times indeed.

 

3 thoughts on “Opioid use in work comp has dropped – and cannabis does reduce chronic pain

  1. Interesting article, as it raises the ‘pros and cons with Medical Cannabis. I have a 22-year-old niece who feels it is ‘safe’ to smoke cannabis as it is going to be legal soon. She just spent 24 days in a psychiatric facility and is now diagnosis with paranoid schizophrenia and psychosis.

    The article states: there’s conclusive support for cannabis’ ability to reduce chronic pain in adults BUT at significant risk of motor vehicle accidents and the development of schizophrenia and other psychoses. This is a big deal, as most patients using medical marijuana cite chronic pain as the reason for consumption. There’s a lot of evidence that medical marijuana is effective – evidence derived from well-controlled clinical trials. But little is known about efficacy, dosage, frequency, administration routes, or side effects.

  2. As a practicing pain specialist, I have been impressed that the great majority of patients I see using marijuana are not working and are dysfunctional. There are a few exceptions. Perhaps we will truly find evidence of a Marijuana product without psychoactive properties that purely provides pain reduction – I will believe it when it happens. Marijuana, morphine alcohol and tobacco all make us feel better for a bit. Most people can handle alcohol and Marijuana recreationally – some become addicts and some lose their life to these substances. Best we focus on non-pharmacological pain management strategies but keep a mind open for judicious use of opioids and Marijuana for pain management as an adjunctive tool.

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