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Medical Marijuana

Solutions Needed for Marijuana Concerns

An exploratory program may help identify answers for some of the thorny issues surrounding medical marijuana in workers' comp.
By: | October 18, 2017 • 7 min read

The steady march of medical marijuana legalization is leaving employers and workers’ comp insurers in a tricky position — especially now that courts have begun to accept the substance as a covered medication for workers’ comp patients.

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For starters, marijuana remains a Schedule 1 drug on the federal level, which means payers can run afoul of the law if they purchase it for an injured worker. There’s also no concrete way for payers to control the dosage.

So far, there have been no easy answers, but some experts are actively thinking outside the box. Safety National embarked on a pilot project aiming to bring the industry closer to solutions.

The St. Louis-based workers’ comp carrier is currently participating in a pilot program with a third-party vendor that manufactures and distributes medical marijuana in the forms of patches or gel, said Sherri Hickey, Safety National’s assistant vice president of medical management.

When Safety National deems medical marijuana an appropriate treatment for an injured worker, working with this manufacturer changes the dynamic so that Safety National is not directly buying marijuana but purchasing a method of medicinal delivery — the patches or gel.

Sherri Hickey, assistant vice president of medical management, Safety National

The carrier is legally allowed to pay for this service, and the manufacturer can be paid by check, unlike dispensaries, which can only accept cash because of marijuana’s federal drug classification.

The use of patches or gel as a delivery method allows the carrier to control the amount and type prescribed. The vendor employs nurse practitioners who evaluate a patient’s height, weight, diagnoses and other medications to determine the strain and dosage most appropriate for each individual. The vendor then works with the injured worker’s personal physician on a written treatment plan.

A Viable Alternative

Hickey said the conversation about how to approach medical marijuana has been ongoing at Safety National.

“A lot of jurisdictions are requiring workers’ comp to start covering medical marijuana as an option for injured workers, and judges are saying that is reasonable and appropriate and that you’ve got to pay for that,” she said.

But in practice, most payers are still largely in uncharted territory. Hickey said Safety National noticed on one large claim a young man was taking Dronabinol, a pharmaceutical manufactured synthetic cannabis.

“While it is a generic, it was still very expensive,” Hickey said. “So we thought, what if we gave the patient the real thing — what would that cost? We had several conversations with different sources and found that it is significantly less than the generic synthesized cannabis.”

Starting with that case, Safety National obtained input from experts in the field on how the carrier could address many of his medications in this category.

“That created a huge savings, and we said to ourselves, maybe this could actually work,” she said. “That’s where we started.”

The carrier found several injured workers in its book of claims purchasing medical marijuana on their own. They had previously been on large dosages of opioids, along with a range of medications needed to counter the side effects of the opioids. These workers stopped the other medications on their own and were using medical marijuana instead.

“There are studies showing that the states that have legalized marijuana have a 25 percent lower death rate from opioids than the states that have not. Coincidence? I don’t think so — I think there’s probably some meaning there.” — Sherri Hickey, assistant vice president of medical management, Safety National

“As a result, their pharmacy bills were extremely low or zero — and they were off all of their opioids,” Hickey said. “We said to ourselves, there is something to this.”

Safety National is conducting its pilot program on a case-by-case basis in jurisdictions that allow the use of medical marijuana for the patient’s particular condition, she said. The carrier is now looking at several additional injured workers who might benefit in replacing their opioids with medical marijuana.

“There are studies showing that the states that have legalized marijuana have a 25 percent lower death rate from opioids than the states that have not,” Hickey said. “Coincidence? I don’t think so — I think there’s probably some meaning there.

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“Now that medical marijuana is becoming legalized in more states, there is more research going on that will soon be telling us the outcomes and benefits of medical marijuana and not just anecdotal information.”

There are now 29 states, Washington D.C., Puerto Rico and Guam that have legalized medical marijuana and there are another dozen or so states with pending legislation, she said.

“As more and more states pass these laws and more research is done, it will just be a matter of time [until] the federal government will change marijuana from a Schedule 1 drug,” Hickey said. “I predict that will happen within the next two or three years.”

Richard Krasner, who blogs on workers’ comp topics, said the Safety National pilot program “is a positive step.”

“It’s a good sign that they are willing to put themselves out there to see if there is a scientific basis for claims that medical marijuana has benefits,” Krasner said.

“If the use of medical marijuana in workers’ comp cases helps [injured workers] to avoid using opioids that would lead to worse outcomes, then I say go ahead and start doing that,” said Krasner, noting that opioid users are increasingly going down the slippery slope to heroin and eventually overdose.

Even if workers stay on opioids alone, they can get hooked, which keeps them wanting the drugs more and more, Krasner added.

Medical marijuana, by contrast, does not have the deleterious effects of the traditional smoked marijuana, which contains THC. Moreover, medical marijuana has been shown to improve outcomes for pain management like opioids — but without developing a dependency.

Impairment Concerns

Most employers are also worried about how they can maintain a drug-free workplace even while recovering workers may be using the drug. Zero tolerance policies and drug testing programs don’t align easily with medical marijuana use.

Hickey agreed that testing for marijuana is a challenge.

“Testing for the presence of THC from recreational marijuana has been around for a long time,” she said. “However THC is metabolized through the liver and remains in the liver for days or even weeks. So when someone is tested, it is only documenting that they smoked marijuana sometime in the past couple of weeks. It does not measure a level of impairment, it is just a matter of presence or not.”

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However, the standard marijuana testing does not test for the presence of cannabidiol, or CBD, which it the most common type of medical marijuana, Hickey said. CBD is metabolized through the blood stream and leaves the body within 24 hours.

“There is no impairment from CBD as it has no psychotropic effect, so there is no need for impairment testing of CBD,” she said.

Interest Is Widespread

Dr. Tom Denberg, senior medical director at Pinnacol Assurance in Denver, said the carrier would be “very interested” to see what Safety National experiences with its pilot program.

“Like other carriers across the country, we are very intrigued about other effective treatment options for injured workers who are experiencing chronic pain,” Denberg said.

Currently, Pinnacol promotes minimal and more appropriate prescribing of opioids, encourages the use of non-steroidal anti-inflammatories as first-line therapy, and makes available a variety of complementary and alternative treatments that are helpful for some patients, including therapeutic massage and acupuncture, he said.

“We do suspect that medical marijuana is more benign and less addictive than opioids, but the science and clinical experience aren’t yet at a point that make us comfortable.” — Dr. Tom Denberg, senior medical director, Pinnacol Assurance

One of the challenges within the industry is that there’s still not a high level of evidence for the use of medical marijuana, and like many carriers, Pinnacol is very focused on utilizing evidence-based treatment guidelines, Denberg said.

“The level of evidence for the use of marijuana in the treatment of chronic, non-cancer pain is probably similar to the level of evidence currently available for opioids, but many stakeholders promoted opioids too aggressively and now we’ve gotten ourselves in a big mess,” he said.

If there was stronger evidence for the use of marijuana, more knowledge about effective dosing and more understanding about which patient groups benefit the most, workers’ comp programs could minimize the risk that marijuana could adversely affect large numbers of patients “in ways we don’t yet understand.”

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“We do suspect that medical marijuana is more benign and less addictive than opioids, but the science and clinical experience aren’t yet at a point that make us comfortable,” Denberg said. “We’d like to see Safety National’s experience with the gels and patches.”

Denberg said marijuana’s Schedule 1 classification remains a point of concern for now.

“This is a primary reason we’ve decided not to use medical marijuana in workers’ comp programs at this time,” he said. “If this changes, it will be easier for us to consider programs like Safety National’s.” &

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

Risk Management

The Profession: Curt Gross

This director of risk management sees cyber, IP and reputation risks as evolving threats, but more formal education may make emerging risk professionals better prepared.
By: | June 1, 2018 • 4 min read

R&I: What was your first job?

My first non-professional job was working at Burger King in high school. I learned some valuable life lessons there.

R&I: How did you come to work in risk management?

After taking some accounting classes in high school, I originally thought I wanted to be an accountant. After working on a few Widgets Inc. projects in college, I figured out that wasn’t what I really wanted to do. Risk management found me. The rest is history. Looking back, I am pleased with how things worked out.

R&I: What is the risk management community doing right?

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I think we do a nice job on post graduate education. I think the ARM and CPCU designations give credibility to the profession. Plus, formal college risk management degrees are becoming more popular these days. I know The University of Akron just launched a new risk management bachelor’s program in the fall of 2017 within the business school.

R&I: What could the risk management community be doing a better job of?

I think we could do a better job with streamlining certificates of insurance or, better yet, evaluating if they are even necessary. It just seems to me that there is a significant amount of time and expense around generating certificates. There has to be a more efficient way.

R&I: What was the best location and year for the RIMS conference and why?

Selfishly, I prefer a destination with a direct flight when possible. RIMS does a nice job of selecting various locations throughout the country. It is a big job to successfully pull off a conference of that size.

Curt Gross, Director of Risk Management, Parker Hannifin Corp.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

Definitely the change in nontraditional property & casualty exposures such as intellectual property and reputational risk. Those exposures existed way back when but in different ways. As computer networks become more and more connected and news travels at a more rapid pace, it just amplifies these types of exposures. Sometimes we have to think like the perpetrator, which can be difficult to do.

R&I: What emerging commercial risk most concerns you?

I hate to sound cliché — it’s quite the buzz these days — but I would have to say cyber. It’s such a complex risk involving nontraditional players and motives. Definitely a challenging exposure to get your arms around. Unfortunately, I don’t think we’ll really know the true exposure until there is more claim development.

R&I: What insurance carrier do you have the highest opinion of?

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Our captive insurance company. I’ve been fortunate to work for several companies with a captive, each one with a different operating objective. I view a captive as an essential tool for a successful risk management program.

R&I: Who is your mentor and why?

I can’t point to just one. I have and continue to be lucky to work for really good managers throughout my career. Each one has taken the time and interest to develop me as a professional. I certainly haven’t arrived yet and welcome feedback to continue to try to be the best I can be every day.

R&I: What have you accomplished that you are proudest of?

I would like to think I have and continue to bring meaningful value to my company. However, I would have to say my family is my proudest accomplishment.

R&I: What is your favorite book or movie?

Favorite movie is definitely “Good Will Hunting.”

R&I: What’s the best restaurant you’ve ever eaten at?

Tough question to narrow down. If my wife ran a restaurant, it would be hers. We try to have dinner as a family as much as possible. If I had to pick one restaurant though, I would say Fire Food & Drink in Cleveland, Ohio. Chef Katz is a culinary genius.

R&I: What is the most unusual/interesting place you have ever visited?

The Grand Canyon. It is just so vast. A close second is Stonehenge.

R&I: What is the riskiest activity you ever engaged in?

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A few, actually. Up until a few years ago, I owned a sport bike (motorcycle). Of course, I wore the proper gear, took a safety course and read a motorcycle safety book. Also, I have taken a few laps in a NASCAR [race car] around Daytona International Speedway at 180 mph. Most recently, trying to ride my daughter’s skateboard.

R&I: If the world has a modern hero, who is it and why?

The Dalai Lama. A world full of compassion, tolerance and patience and free of discrimination, racism and violence, while perhaps idealistic, sounds like a wonderful place to me.

R&I: What about this work do you find the most fulfilling or rewarding?

I really enjoy the company I work for and my role, because I get the opportunity to work with various functions. For example, while mostly finance, I get to interact with legal, human resources, employee health and safety, to name a few.

R&I: What do your friends and family think you do?

I asked my son. He said, “Risk management and insurance.” (He’s had the benefit of bring-your-kid-to-work day.)

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]