By Sherri Hickey, Assistant Vice President of Medical Management, Safety National
Medical marijuana has already been legalized in 29 states and D.C., with 12 states pending legislation. It is time for the workers’ compensation industry to embrace this new reality and learn how to incorporate the use of medicinal marijuana into claims handling where appropriate. It might surprise many to hear that there are actually advantages and improved outcomes related to its use.
Understanding Recreational Versus Medical Marijuana
There are many misconceptions regarding differences between recreational and medical marijuana. A cannabis plant is made up of over 80 cannabinoids. With recreational marijuana, the primary cannabinoid is tetrahydrocannabinol (THC). It is traditionally smoked and the THC is what provides the high or the impairment. Recreational marijuana is metabolized through the liver. Drug tests are designed to detect THC, which can stay in the system for weeks or months.
In the case of medical marijuana, the primary cannabinoid is cannabidiol (CBD). It is not smoked, but rather is delivered in forms like oil and liquid. In addition, medical marijuana contains 0% THC, so use provides no high or psychotropic effect. It is metabolized through the blood stream, therefore it will exit the body within 24 hours. Because of these elements, standard drug tests looking for THC will not detect its use.
Medical marijuana can be used for many symptoms, however, in the workers’ compensation arena it will primarily be used to manage pain, anxiety, muscle spasms, post-traumatic stress disorder and to control seizures. It can be vaporized, added to food or liquid, developed into a topical that is rubbed into skin or a transdermal that can be applied as a patch. Unlike recreational marijuana, medical marijuana can be delivered in managed doses. It is currently regulated individually by state and each state is actively managing quality and consistency in items produced.
It is important to mention that THC-based marijuana can have some medicinal capabilities and individuals could benefit from using both forms. However, for treatment of injured workers that are likely to re-enter the workforce, it is not recommended for use – especially when there are so many benefits associated with the THC-free version.
Where to Begin
Let’s face it, this country is in the midst of an opioid crisis due to opioid overprescribing in general. It is reported that nearly 65,000 people died in 2016 due to opioid addiction. In workers’ compensation, opioids are the most-frequently prescribed medications to manage pain and this is turning injured workers into opioid addicts every day.
At Safety National, we have witnessed medical marijuana’s success firsthand in treating injured workers. There have been instances where our claimants have gone out on their own and obtained medical marijuana. In these cases, we have noticed that the injured workers are not refilling their opioid prescriptions or the side-effect medications as frequently.
As a carrier, Safety National has begun to investigate how we can implement medical marijuana into our claims handling. We have one injured worker currently in a medical marijuana pilot program where we think we can eliminate up to eight different medications by replacing them with medical marijuana. Our analysis has determined that, in this case, we would save $40,000 a year in pharmaceuticals and $1.5 million off MSA costs.
So how would that work? To try to clear up some of the uncertainty, Safety National is currently working with a third-party vendor that grows, manufactures and distributes medical marijuana. This vendor would serve as our intermediary who would manufacture and distribute the medical marijuana in the forms of patches or gel when we deem that it is the appropriate treatment for an injured worker. This would allow us to control the amount and type prescribed. The vendor has nurse practitioners who will evaluate the patient’s height, weight, diagnoses and other medications to determine the strain and dosage most appropriate for each individual. The vendor would then work with the injured worker’s personal physician, explaining a written treatment plan.
Since Safety National would not be buying marijuana, but rather doing business with the manufacturer that produces medicinal delivery methods, we are legally allowed to pay for this service. In fact, they can work within our corporate requirements and accept checks as payment unlike dispensaries who have to deal in cash. Still in the investigation phase, this pilot program is already illustrating the multiple benefits associated with implementation of medical marijuana into our claims handling. Less medical complications means a healthier employee and direct cost savings to us as the carrier.
What Does The Future Hold?
Is medical marijuana the solution we have been looking for? Not entirely. Opioids have their place and purpose, so it is not going to replace them completely. However, medical marijuana is going to be an effective tool in our claims management toolbox to help manage chronic pain. It is inexpensive, the side effects are minimal and it does not impair. It is hard to find a downside.
This train is coming down the tracks, so to speak. The workers’ compensation industry has to begin fully understanding it, determine guidelines to control it and prepare to implement it into programs. We must fully embrace it to our benefit. This is not the miracle drug that is going to save people or solve all of our problems, however, we need to determine how we are going to make this safe and appropriate and provide the injured worker what they need. The time for that is now.
Sherri Hickey is the Assistant Vice President of Medical Management for Safety National. She oversees the medical management unit, establishes medical policy for the claims team, oversees medical services for catastrophic claims and manages all vendor partnerships for the claims department. Sherri has nearly 20 years’ experience in insurance and managed care with a primary focus on workers’ compensation and over 10 years as a registered nurse with specialization in emergency medicine and trauma management. Sherri has a bachelor’s degree in Nursing Management and a master’s degree in Business and Administration.
Safety National is a leading provider of alternative risk funding products such as excess workers’ compensation, deductible casualty, loss portfolio transfers and reinsurance. Safety National is a member of the Tokio Marine Group and is rated “A+” (Superior), FSC XIV by A.M. Best. Learn more at www.safetynational.com.
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This is not a paid placement.