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Medical marijuana a growing workers comp challenge

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Medical marijuana poses challenges for the workers compensation industry, but some experts and recent research say it could be an alterative to long-term opioid use.

There's a growing consensus among workers comp payers and doctors that “any treatment that could reduce opioid dependency is something to look into, or something to keep an eye on,” said Tom Atchison, associate attorney at Heacox, Hartman, Koshmrl, Cosgriff & Johnson P.A. in St. Paul, Minnesota.

Long-term opioid use can be unsafe for injured workers and costly for payers, Mr. Atchison said.

On Monday, the Minnesota Department of Labor and Industry adopted a rule establishing criteria for long-term opioid treatment that also said medical marijuana is not an “illegal substance” for injured workers under state law.

It remains illegal under federal law, however.

The U.S. Food and Drug Administration has not approved marijuana for any medical condition, so it's difficult to compare its effects with other drugs used in workers comp, such as opioids, said Dr. Damon Raskin, a Pacific Palisades, California, internist who specializes in treating addiction and substance abuse. However, “the risk of death and other severe addiction issues with opiates make looking at (medical marijuana) more palatable,” he said.

“Until I see good scientific evidence that this is something that works (for pain), it's going to be hard to endorse,” Dr. Raskin said. “But if there's a choice between opiates vs. medical marijuana, I will still pick medical marijuana if that helps the patient's pain … If we can do anything except for opiates for pain, that's ideal.”

But in a report published in a June issue of the Journal of the American Medical Association, Dr. Amy E. Thompson says “so far, evidence suggests that marijuana may be an effective treatment for chronic pain, neuropathic (nerve) pain and muscle spasms due to multiple sclerosis or paraplegia.”

If medical marijuana, which became legal in Minnesota last month in addition to the 22 other existing states and the District of Colombia, “were to fall under the 'illegal substance' category, I think there would be some confusion with regard to whether it's compensable” under workers comp, Mr. Atchison said.

In New Mexico, the state Court of Appeals has ruled three times since last year that medical marijuana is “reasonable and necessary” for injured workers and that it should be covered under workers comp.

In each New Mexico case, physicians supported the use of medical marijuana when opioids and other medications failed to relieve injured workers' chronic pain. In the most recent case, Sandra Lewis v. American General Media and Gallagher Bassett, Ms. Lewis' health care provider opined that the “benefits of medical marijuana outweigh the risk of hyper doses of narcotic medications.”

Though medical marijuana is now considered a legal substance in Minnesota for workers comp, it won't “be reasonable and necessary in all circumstances that it's recommended,” Mr. Atchison said. “It provides a little guidance as to whether or not it's still an illegal substance for the purpose of the law, but it doesn't change the analysis that payers, insurers and employers have to go through when determining if treatment is compensable.”

It's important to remember other pain-fighting options with zero addiction potential also exist, experts said.

Dr. Raskin said that could include anti-inflammatory drugs, anti-seizure medications, physical therapy or acupuncture.