By Mark Pew, Senior VP, Preferred Medical
This week I have two articles to share with you about the changes surrounding medical marijuana in different facets of society. One could further change how Work Comp views medical marijuana and the other sets a societal tone from a very influential place – sports. The first article is about a court ruling on an employee’s use of medical marijuana. The second article is about new rules the MLB has recently implemented.
Earlier this month, a New Jersey court ruled that an employer must reimburse its employee for medical marijuana that was used to treat for chronic pain following a work-related accident. This employee had multiple surgeries and tried many different medicines to try and alleviate his chronic pain before resorting to medical marijuana (that worked, according to him), making it a reasonable and necessary use in the court’s eyes. This quote from the decision (“only relief”) is what will drive personal / court opinion on reimbursement in the future, not just in New Jersey but across the country:
“To deprive petitioner of the only relief from the constant pain he has experienced for almost twenty years would eviscerate the principles and goals of the WCA and the MMA. As [the employer] has not presented this court with any concrete legal or legislative grounds upon which to overturn the compensation judge’s order, we affirm the order for reimbursement of petitioner’s use of medical marijuana [Opinion, p. 30].“
While the New Jersey case “Hager v. M&K Construction” is not the first mandate for Workers Comp to reimburse for medical marijuana, it shares some commonality with others. Primarily that when an injured worker tries and fails all other treatment options to relieve their condition, and cannabis does provide relief of that condition, that is the essential definition of “reasonable and necessary.” Of course, people can differ as to whether all other options have been exhausted and/or that marijuana provides relief. But when stated that way it makes a compelling argument (and, in this court case, likely final decision) that it is medicine for this one person and so it should be treated as such (i.e. paid for). Thanks to Thomas Robinson for his helpful thoughts on the matter. This prompted an interesting exchange in the comments section:
Christine Sutherland: Mark I’ve been unable find robust evidence for any benefit for pain patients in relation to cannabis. Much like sham surgery compared to real surgery for chronic pain, some people benefit, some get worse, and some have no change. This indicates that change is due to regression to the mean, false attribution, error of judgement or delusion. No health fund can or should be paying for sham treatment, and social hype or anecdotes aren’t grounds for treatment options.
My response: Your definition of “some people benefit, some get worse, and some have no change” is applicable to everything – surgery, Rx medications, PT, mindfulness. Nothing works for everybody because each individual is unique. And that is why I continually advocate for a robust suite of tools from which to select. There are doctors that agree with your opinion. There are other doctors that would disagree with your assessment that medical cannabis lacks scientific evidence in treating pain, including the non-partisan National Academies of Sciences, Engineering, Medicine that said “There is conclusive or substantial evidence that cannabis or cannabinoids are effective…For the treatment for chronic pain in adults.” There are doctors who have seen the benefits for themselves (watch my YouTube interview of Dr. Carlos Giron). And then, in the case of Vincent Hager (this NJ case), his replacement of Rx opioids with marijuana is a strong personal anecdote (and the court agreed). I’m not trying to convince you to change your mind. In my experience, everyone comes into this particular discussion with a certain bias for/against based on their personal experience and that is a prism thru which they see all arguments when forming their opinion. That is human nature and to be expected, especially for something that is as emotional as marijuana and how to best address chronic pain. I totally respect your opinion and assessment and look forward to learning together how this evolves. One thing is for certain and we can probably agree on—the discussion about marijuana as treatment for pain (including chronic) is not going away.
Prompted by the death of Los Angeles Angels pitcher Tyler Skaggs, Major League Baseball has made changes to the types of drugs they will test players for as well as how they will handle treatment and discipline. And that includes treating marijuana just like alcohol – one of the primary arguments by advocates for legalization and taxation. President Obama mentioned treating marijuana and alcohol similarly as public health issues in a 2016 Rolling Stone article so it is not a new concept. They will also be requiring players and staff to attend educational programs about the dangers of opioids and the best approach to marijuana.
Some major changes were announced by Major League Baseball in mid-December. Among them:
- “Marijuana will be removed from the list of drugs of abuse and will be treated the same as alcohol.”
- “Suspensions for marijuana use will be dropped from the minor league drug program.”
- They will also “test for opioids, Fentanyl, cocaine, and synthetic Tetrahydrocannabinol (THC). Players who test positive will be referred to the treatment board established under the agreement.”
- “Players and team staff will have to attend mandatory educational programs in 2020 and 2021 on the dangers of opioid pain medications and practical approaches to marijuana.”
The wheels of change keep turning. If you think this policy / substance won’t impact your business, you’re kidding yourself. Whether you agree (or not) that marijuana should be legalized or whether (or not) marijuana can be medicine, it’s here and it’s not going away. If you haven’t reviewed your risk management policy in a while you need to get started. Today.
To read everything on my mind this past week, please visit me on LinkedIn.
Disclaimer: The views and opinions expressed above are those of Mark Pew, and do not necessarily reflect the views of Preferred Medical.
About Mark Pew
Mark Pew, Senior Vice President of Product Development and Marketing for Preferred Medical, is a passionate educator and agitator. Known as the RxProfessor, Mark is focused on the intersection of chronic pain and appropriate treatment, particularly as it relates to the clinical and financial implications of prescription painkillers, non-pharma treatment modalities and the evolution of medical marijuana. He is a strong champion for the workers’ compensation industry to #PreventTheMess and #CleanUpTheMess, movements he created to drive attention to the importance of individualized appropriate treatment for injured workers. Mark is a vocal advocate of the BioPsychoSocialSpiritual treatment model.
Mark serves on the IAIABC’s Medical Issues Committee and SIIA’s Workers’ Compensation Committee. In addition, he serves as technical advisor to regulators and legislators in 20+ jurisdictions on subjects such as drug formularies, treatment guidelines, Opioid Task Force initiatives, encouraging support of non-pharma treatment options and the medicinal use of cannabis. Mark received the WorkCompCentral Magna Comp Laude award in 2016 and the IAIABC’s Samuel Gompers Award in 2017.