Marijuana for pain counterintuitive to goals of workers' comp, paper says

Drug screening for marijuana can provide critical information about potentially problematic workers' comp claims, according to a new white paper. A pharmacy benefit management company says urine drug screening can be an essential tool.

"The presence of marijuana in a drug screen should be viewed as a red flag by practitioners in the case of any patient receiving opioid therapy for treatment of chronic pain," according to the report. "Studies have shown that illicit drug use -- mainly marijuana -- is statistically linked to a higher rate of eventual dependence on or addiction to opioids."

The paper, Navigating The Issue: Medical Marijuana In The Realm of Workers' Compensation, was developed by myMatrixx. It outlines some of the challenges to the workers' comp system and strategies employers and insurers can take to protect themselves.

States take varying actions to curb opioid abuse (02/27/12)
New report shows growing off-label narcotic use in California (05/26/11)
Food and Drug Administration to examine opioids, chronic pain (02/04/13)
Medical marijuana users denied ADA protections (12/17/12)
Better understanding can help employers address opioid crisis among injured workers (01/28/13)

Despite its status as illegal under federal law, marijuana is legal for medical purposes in 17 states and the District of Columbia. Several other states are considering legalizing it as well.

"Throughout the country, even in states that have legalized its use, federal law prevents doctors from prescribing marijuana," according to the report. "This conflict between state and federal laws raises any number of issues that directly affect the workers' compensation industry and the workplace as a whole."

No state legalizes the use of marijuana in the workplace or requires employers to allow its use on the job. However, the issue is not black and white.

For example, the report cites a South Dakota case in which it was determined an injured worker had smoked marijuana the previous day. Even though the state does not legalize use of the drug, the burden of proof was on the employer to show that marijuana use constituted an act of willful misconduct.

Marijuana is seen as being similar to codeine in the treatment of pain, the report says. However, it says research indicates the drug is counterproductive for injured workers.

"Several studies associate workers' marijuana smoking with increased absences, tardiness, accidents, workers' compensation claims, and job turnover," it says. "When viewed in light of the primary goal in workers' compensation, which is to return to work, the issue becomes much clearer. The therapeutic effects of medical marijuana treatment are counterintuitive to meeting the intended therapeutic outcome for any injured worker."

The authors recommend employers "frame a strategy with a clinical approach." It suggests a multifaceted approach to pain management, focusing on educating claims professionals, developing advanced technologies, and emphasizing open lines of communication between clinical staff and physicians.

In developing a medical marijuana strategy, the report advises asks:

Are all stakeholders viewing the issue from a return-to-work perspective?
Are you getting the real-time data and customized risk assessment that enables you to manage patient care from a clinical perspective?
Are drug screens included in your strategy and combined with sophisticated analysis and easy-to-interpret reporting?
Do you have a third party, professional communication link to prescribing physicians that can directly impact patient care?

Read more at the WorkersComp Forum homepage.

December 3, 2012

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