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NATIONAL HARBOR, Maryland — The debate over whether cannabis is preferable to opioids as a pain management treatment presents a “false choice,” and employers should instead focus on how to mitigate cannabis-related risks in their workplaces, experts say.
“One of the things that a lot of people hung onto was, ‘Well, opioids are very addictive and marijuana is not,’” Marcos Iglesias, Sunrise, Florida-based chief medical officer for Broadspire Services Inc., the third-party administrator unit of claims manager Crawford & Co., said at the Disability Management Employer Coalition Inc. conference in National Harbor, Maryland, on Tuesday. “There is still a perception in the population … about 37% of us believe it is not addictive, and it is. It’s called cannabis use disorder, and there are 7 million of us who have it. Cannabis use disorder is not rare, it is serious, and my fear is that it’s going to be an increasing problem.”
The “definitive answer” about the often-discussed association between medical marijuana and lower levels of opioid overdose deaths came from a study released by the Proceedings of the National Academy of Sciences in June, Dr. Iglesias said. The study found it unlikely that medical cannabis — used by about 2.5% of the U.S. population — has had a large offsetting effect on opioid overdose mortality.
“The bottom line is it’s not preventing opioid overdoses?,” Dr. Iglesias said.
“Marijuana is not going to be the next solution for” chronic pain, Dr. Glenn Pransky, scientific adviser for Lincoln National Corp. and associate professor at the University of Massachusetts Medical School in Worchester, Massachusetts, said at a separate conference session on Tuesday. “It appears to be trading one form of mind- and mood-altering substance for another, but it’s not a cure for chronic pain.”
Employers cannot put their heads in the sand and hope the tide turns against marijuana usage among their workforces, said Stuart Colburn, shareholder and workers compensation specialist in the Austin, Texas, office of Downs Stanford P.C. For example, Texas just expanded who can access medical marijuana products in the state.
“We have passed the tipping point,” he said. “We are not going to go back.”
Dr. Iglesias even rejects the use of the phrase medical marijuana. “I don’t like those terms because they’re not clinical, they’re not scientific,” he said. “Marijuana is a product, and I think we err when we talk about medical marijuana versus recreational marijuana. It’s the same substance. There’s no difference, and that’s one of the misconceptions that we have in our industry — that somehow medical marijuana is different, it’s safer, it has certain safeguards around it. It doesn’t.”
Six states — Arizona, Colorado, Michigan, Montana, Oregon and Vermont — preclude reimbursement for marijuana in their workers compensation systems, but six other states — Connecticut, Maine, Massachusetts, Mississippi, New Jersey and New Mexico — require reimbursement, and “it’s growing,” Mr. Colburn said.
Employers are particularly concerned about employees using marijuana operating heavy machinery or motor vehicles, he said. “You should be scared by that,” Mr. Colburn said, adding that it raises “concerns for you and/or your liability carrier.”
But “there is no test today that allows us to make a determination of impairment” for cannabis, Dr. Iglesias said. There are tests that can detect tetrahydrocannabinol components, but that likely only means that the individual used it anywhere for a day or two to several weeks prior to testing, he said.
There are companies currently developing breathalyzer tests for cannabis usage, but that raises legal questions about whether these tests can be used to demonstrate impairment, experts say.
“The answer is going to be very tenuous at least for long time until the science catches up and is able to make those correlations,” Dr. Iglesias said. “While I understand our desire to find a breathalyzer for THC, what I really think is more important is to train our supervisors and to train them well to detect signs of possible impairment, know what to do (such as) removing that person from that safety-sensitive position and getting that individual help.”
And employers need to consider the potential implications of the U.S. Occupational Safety and Health Administration’s electronic record-keeping rule despite the fact that the Trump administration released a proposal to enshrine its stance that employers are not prohibited from establishing workplace safety incentive programs or post-incident drug testing in a standard.
“If you have a policy that can somehow be interpreted as trying to convince people not to file a claim, then you can still today be sued under OSHA regulations for discriminating against your workers,” Mr. Colburn said.
Conflicting state and federal laws and regulations concerning the treatment of cannabis can present risk managers involved in the industry with myriad challenges, according to a report from the Risk & Insurance Management Society Inc. on Thursday.