Pharmacy Trends

Ecstasy as PTSD Treatment: Will You Be Footing the Bill?

As cannabis slowly achieves acceptance for treating workers’ comp injuries, reimbursement for the rave drug ecstasy may not be far behind.
By: | May 22, 2018 • 4 min read

With medical marijuana being used more frequently in the treatment of workers’ comp patients, ecstasy — widely known as a rave-culture party drug — may be next.

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Researchers found that two doses of ecstasy, termed 3,4-methylenedioxymethamphetamine, or MDMA — in conjunction with psychotherapy — reduced the post-traumatic stress disorder (PTSD) symptoms of 26 veterans and first responders in a “Phase 2” trial, according to a study published in the British journal The Lancet Psychiatry.

The Food and Drug Administration has already given MDMA “breakthrough therapy status” based on earlier results, which could expedite approval, The New York Times writes. Larger, “Phase 3” trials are set to start this summer, and if all goes well, the drug could be approved for legal use by 2021.

A small number of states, including Colorado, Vermont and Texas, cover PTSD under their workers’ compensation statutes. But recent mass tragedies such as the Santa Fe High School shooting have brought renewed focus to the impact of such events on emergency personnel.

Florida and Minnesota both passed bills this year that will allow workers’ comp benefits for first responders with PTSD injuries. A measure in New Hampshire is under consideration.

As more states follow suit and PTSD claims rise, does the potential acceptance of MDMA worry workers’ comp professionals at all? It’s complicated, experts say.

Lisa M. Haug, director of medical management, Safety National

“The first concern I had upon reading about the potential use of ecstasy for treatment of PTSD is whether this could further open up Pandora’s box, especially at a time when drug abuse is on the rise,” said Lisa M. Haug, director of medical management, Safety National, in St. Louis.

Haug is also concerned about the long-term effects of such treatment, the potential side effects and the costs. However, on the flip side, the limited study showed some potential when the drug was being used under a very controlled environment in conjunction with psychotherapy.

“While it is too early to consider ecstasy as a treatment option in workers’ compensation, we cannot say it would never be deemed appropriate,” she said. “It was not that long ago that people felt medical cannabis had no role in workers’ compensation, and now we have seen several states order this treatment and some patients have positive results with it.”

Dr. Robert L. Goldberg, chief medical officer, PBM Healthesystems, in Tampa, Fla., said the research shows a high degree of efficacy with the treatment level dosing, as compared to the control low dose of MDMA that was provided.

“Shown in a small group, this can be very effective — when paired with psychotherapy, which is the really important distinction here,” Dr. Goldberg said.

Secondly, the research study was small — a Phase 2 trial with only 26 patients, he said. As such, both the medical community and the workers’ comp community should not get “too excited” either positively or negatively about MDMA being adopted as a treatment until larger Phase 3 trials are undertaken.

“Many times in smaller trials, you do get good results and lower incidence of side effects, but the results of the complete trial might not be quite as good, or the side effects profile might become more apparent,” Dr. Goldberg said.

Standardization Will Speed Acceptance

Some of the concerns about how medical marijuana is currently “administered” — in the loosest sense of that word, could spill over to the use of ecstasy in workers’ comp claims — that is, unless the drugs can be standardized, he said.

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“With medical marijuana, it’s all self-dosing, even within a workers’ comp claim,” he said. “In a handful of states, the courts have decided that payers have to be reimbursed for medical marijuana if it was based on a recommendation by a physician, though in some states it’s by a designated expert, not just the treating physician. Yet the amount of marijuana is variable, so payers are still obligated while there’s no standardization for dosage or cost.”

“The first concern I had upon reading about the potential use of ecstasy for treatment of PTSD is whether this could further open up Pandora’s box, especially at a time when drug abuse is on the rise.” — Lisa M. Haug, director of medical management, Safety National

New Mexico set a maximum reimbursement level, but not for dosage. The good news, Dr. Goldberg said, is that once a dosage standard is established, medical marijuana will be manufactured just like any other medication in the U.S., enabling doctors to more easily prescribe and dispense the drug.

The same could be true for MDMA, though the route could be quicker, he said. Once it becomes scheduled, it will likely be a Schedule 2 or 3 drug. However, people who are self-dosing outside of clinical trials “really won’t know what they are getting on the street” — the drug may have other hallucinogens, contaminants or adulterants in it.

“But there’s a clearer path with MDMA and these trials, which could result in it being manufactured much more quickly with the proper processes, just like any standard medications such as ibuprofen,” Dr. Goldberg said.

“However, you’ll still have the same issues as with medical marijuana about how long the effects are going to last and if you can function at work after taking the medication,” he added. &

Katie Kuehner-Hebert is a freelance writer based in California. She has more than two decades of journalism experience and expertise in financial writing. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

2018 Risk All Stars

Stop Mitigating Risk. Start Conquering It Like These 2018 Risk All Stars

The concept of risk mastery and ownership, as displayed by the 2018 Risk All Stars, includes not simply seeking to control outcomes but taking full responsibility for them.
By: | September 14, 2018 • 3 min read

People talk a lot about how risk managers can get a seat at the table. The discussion implies that the risk manager is an outsider, striving to get the ear or the attention of an insider, the CEO or CFO.

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But there are risk managers who go about things in a different way. And the 2018 Risk All Stars are prime examples of that.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Goodyear’s Craig Melnick had only been with the global tire maker a few months when Hurricane Harvey dumped a record amount of rainfall on Houston.

Brilliant communication between Melnick and his new teammates gave him timely and valuable updates on the condition of manufacturing locations. Melnick remained in Akron, mastering the situation by moving inventory out of the storm’s path and making sure remediation crews were lined up ahead of time to give Goodyear its best leg up once the storm passed and the flood waters receded.

Goodyear’s resiliency in the face of the storm gave it credibility when it went to the insurance markets later that year for renewals. And here is where we hear a key phrase, produced by Kevin Garvey, one of Goodyear’s brokers at Aon.

“The markets always appreciate a risk manager who demonstrates ownership,” Garvey said, in what may be something of an understatement.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Dianne Howard, a 2018 Risk All Star and the director of benefits and risk management for the Palm Beach County School District, achieved ownership of $50 million in property storm exposures for the district.

With FEMA saying it wouldn’t pay again for district storm losses it had already paid for, Howard went to the London markets and was successful in getting coverage. She also hammered out a deal in London that would partially reimburse the district if it suffered a mass shooting and needed to demolish a building, like what happened at Sandy Hook in Connecticut.

2018 Risk All Star Jim Cunningham was well-versed enough to know what traditional risk management theories would say when hospitality workers were suffering too many kitchen cuts. “Put a cut-prevention plan in place,” is the traditional wisdom.

But Cunningham, the vice president of risk management for the gaming company Pinnacle Entertainment, wasn’t satisfied with what looked to him like a Band-Aid approach.

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Instead, he used predictive analytics, depending on his own team to assemble company-specific data, to determine which safety measures should be used company wide. The result? Claims frequency at the company dropped 60 percent in the first year of his program.

Alumine Bellone, a 2018 Risk All Star and the vice president of risk management for Ardent Health Services, faced an overwhelming task: Create a uniform risk management program when her hospital group grew from 14 hospitals in three states to 31 hospitals in seven.

Bellone owned the situation by visiting each facility right before the acquisition and again right after, to make sure each caregiving population was ready to integrate into a standardized risk management system.

After consolidating insurance policies, Bellone achieved $893,000 in synergies.

In each of these cases, and in more on the following pages, we see examples of risk managers who weren’t just knocking on the door; they were owning the room. &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, clarity of vision and passion.

See the complete list of 2018 Risk All Stars.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]