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Marijuana could help injured workers with chronic pain

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Medical marijuana

BOSTON — Marijuana may have benefits over addictive opioids as a pain treatment for injured workers, but federal drug laws and a lack of guidelines for marijuana prescribing could hinder its use in workers compensation.

A recent report from The National Academics of Sciences, Engineering, and Medicine looked into marijuana as a medical treatment option, said Dr. Dean Hashimoto, chairman of the Massachusetts Health Care Services Board.  The report found that there was “moderate scientific support for improvement” of short-term sleep outcomes for people with chronic pain, he said.

“Relief from chronic pain is by far the most common condition cited by patients in terms of their need for medical marijuana,” said Dr. Hashimoto, who said the report pointed to substantial evidence that marijuana is an effective treatment for chronic pain in adults, he said.

Dr. Hashimoto spoke during a presentation at the Workers Compensation Research Institute's Annual Issues & Research Conference in Boston.

Medical marijuana legalization laws are associated with a 25% decrease in annual opioid mortality, said Dr. Hashimoto, citing a 2014 study reported in the Journal of the American Medical Association. He also pointed to a 2015 RAND Corp. study, which said states that allowed medical marijuana dispensaries saw a 20% decrease in opioid addiction and an 18% decreases in drug overdose deaths.

Despite reported benefits of medical marijuana, Dr. Hashimoto warned of the downsides of marijuana, including increased risk of motor vehicle crashes, the development of major psychoses, and increased substance dependence on alcohol, tobacco, and illegal drugs.

Additionally, Dr. Hashimoto said that there are obstacles in covering medical marijuana under workers compensation claims.

“It’s illegal under federal law… it’s not FDA approved, and as a result of that, you don’t have your traditional sophisticated nuanced studies associated with advocacy and safety,” he said. “There is also a lack of prescription standards … Furthermore, the existing medical treatment guidelines upon which workers compensation is so reliant on don’t really address the issue of medical marijuana.”

California Reforms

Workers compensation reforms in California have been an ongoing process, but the efforts have created some positive changes in the state’s comp system, said Alex Swedlow, president of the California Workers' Compensation Institute during a separate presentation at the WCRI conference.

California Senate Bill 863, a comprehensive workers comp reform bill, was passed in 2012 and began being implemented in 2013. Reforms in S.B. 863 included an independent review process for medical treatment and billing disputes, fee schedules for home health care, language interpretation and other comp-related services and fees for lien filings.

Research from the Oakland, California-based CWCI shows that S.B. 863 reforms have led to stabilization in California workers comp medical cost trends, Mr. Swedlow said. He credited the improvement partially to the implementation of a resource-based relative value scale medical fee schedule, as well the removal of duplicate payments for the surgical hardware used in the spine surgeries.

The California Workers’ Compensation Insurance Rating Bureau estimates that S.B. 863 has generated $1.3 billion in systemwide savings for California’s workers comp system, said Mr. Swedlow, who called the developments “good news.”

“We are a big state and play an important role in the national workers comp economy,” he said.

ACA and Cost Shifting to Workers Comp

Potential changes to the Affordable Care Act by the Trump administration could cause medical costs to be shifted from group health coverage to workers compensation insurers as workers seek to replace lost health insurance, a former congressman says.

Former U.S. Rep. Harry Waxman, a Democrat from California, said that the Trump administration’s plans to repeal and replace the ACA could lead to uninsured individuals seeking healthcare under various social programs including workers comp.

Workers affected by a repeal of the ACA “will have to buy a very high-deductible insurance and may not be able to afford it because we are going to take away the tax breaks, the subsidies that we have used to help people who couldn’t afford their policy,” Mr. Waxman said in another WCRI presentation.

He added that losing coverage under a repeal of the ACA could prompt people to seek care under workers comp claims. “If somebody can get into the workers comp system…they are going to and do that.”

Former U.S. Senator Tom Coburn, a Republican from Oklahoma, said that while the ACA aimed to make health insurance accessible, many people struggled with high deductibles.

“The deductibles shot up and the premiums shot up under the Affordable Care Act,” Mr. Coburn said during the WCRI presentation. “Lots of people didn’t get insurance because they couldn’t afford it.”

Mr. Coburn said medical advancements in the next 20 years could benefit injured workers.

“It’s going to be nothing but personalized precision medicine, and at first it’s going to cost a lot. But the outcome, especially in terms of workers comp, is going to be phenomenal in terms of curing chronic problems, in terms of developing treatments that solve limitations that are created through work injury.”