The fact that marijuana use is legal in 25 states and District of Columbia creates an interesting dichotomy for physicians, insurers, employers and users as they traverse the sea of state regulations.
Marijuana (also known as cannabis or THC) is still considered a Schedule 1 (Class 1) drug by the Drug Enforcement Administration. Class 1 drugs are illegal because of their potential for abuse, and include substances such as heroin, LSD and ecstasy.
At the 71st Annual Workers' Compensation Educational Conference in Orlando, Florida, Donald Bucklin, M.D., medical review officer for U.S. Healthworks, provided an overview of medical uses for marijuana and dispelled some commonly held beliefs about it.
Bucklin said that more than 483 chemicals can be found in marijuana, and 50 of them are known carcinogens. In order for THC to become active, it must be dried and heated (burned). Left as a leafy green plant, it is relatively harmless. King James I ordered English colonists in America to grow 100 hemp plants each so they could be used for rope and fabric. Pharmacies started selling it for medicinal purposes in the 1850s.
The concentration of cannabis sold then was a mild 3 percent compared to the 21 percent available on the market now. He described the difference as three puffs of today's weed is enough to cause an individual to be giggling on the floor.
As a Class I drug, physicians cannot prescribe it to patients even though medical marijuana has been legalized in half of the states. It also has no accepted medical use. Some doctors get around this legality by “recommending” its use to alleviate pain in certain situations. The patient can take a note indicating this to a seller of medical marijuana.
Scientific evidence proves that recreational use of marijuana is does not lead to the use of more dangerous Class 1 drugs. (Photo: Shutterstock)
|Myth busting
Bucklin said that the DEA will not schedule marijuana in 2016, and anticipates that 35 to 40 states could legalize it by 2017. Since there is no federal regulation of the drug, he compared buying medical marijuana to filling a penicillin prescription at a flea market.
According to Bucklin, science has disproved the myth that it promotes drug addiction. “It is not addicting to 95 percent or more of users, especially for adults over the age of 18.” He also said there is no evidence that it is a gateway drug to harder drugs such as methamphetamines or cocaine.
It also does not cause criminal activity because it is so inexpensive to buy, unlike cocaine or meth addictions, which are far more costly for addicts to fund.
He indicated there is scientific evidence that marijuana is safe and effective in the treatment of multiple diseases. For those who suffer from the human immunodeficiency virus (HIV) or other wasting diseases that affect an individual's appetite, it works better than most drugs on the market for nausea. “There is a huge therapeutic window for patients who may individually titrate their dosage,” explained Bucklin. Another benefit of marijuana is that increases the appetite, a positive side effect for those suffering from HIV or a wasting disease.
Researchers have found evidence-based improvement in muscle spasms and pain for individuals who suffer from multiple sclerosis. Bucklin said there are few conventional treatments that are effective and like patients suffering from HIV, individuals with MS can also self-titrate to find the most effective dose.
Some patients have used cannabis to treat epilepsy because there is evidence that it suppresses seizure activity. He said there is a huge safety window with the amount a patient can use, but there is no standard effective dosage.
It has also been used in the treatment of glaucoma because there can be an evidence-based reduction of intraocular pressure, although Bucklin says there are conventional therapies that are more effective and last longer.
Bucklin also shared that recreational use of marijuana is less dangerous than alcohol, despite a documented increase in auto accidents following its use by drivers. While drivers under the influence of marijuana are four times more likely to be involved in an accident, their risk is still lower than the increase in the number of accidents for drunk drivers. Unlike excessive alcohol use, marijuana is not associated with liver disease or and brain disease. In fact, studies have shown that a small amount of THC in the system acts as a neuroprotector for the brain, providing a measure of protection from concussions and other head traumas. “Doses as low as 1/1,000 of normal use offer significant protection,” said Bucklin.
In addition, people who use marijuana in conjunction with opiates for pain management have been found to need lower dosages of the opiates. However, because it is a Schedule 1 drug, workers' compensation will not pay for it as an experimental treatment.
Insurers will not cover the cost of medical marijuana, even when “recommended” by a physician. (Photo: Shutterstock)
|Legal challenges
For employers and law enforcement officers, the use of medical or recreational marijuana by employees and drivers presents some challenges.
Currently, there is no breath test to determine whether or not an individual has smoked marijuana. It also affects everyone differently and is easily absorbed by the fat cells in the body, meaning it can show up in a urine or blood test weeks after use. For employers with a no-tolerance drug policy, a drug test of an employee could show as positive weeks after using medical marijuana.
The government and the insurance industry will need to determine how they will handle cases involving the recreational and medicinal use of marijuana as more states legalize it. Pressure may increase from policyholders to provide coverage through health or workers' compensation insurance for certain situations.
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Patricia L. Harman
Patricia L. Harman is the editor-in-chief of Claims magazine, a contributing editor to PropertyCasualty360.com, and chairs the annual America's Claims Event (ACE), which focuses on providing claims professionals with cutting-edge education and networking opportunities. She covers auto, property & casualty, workers' compensation, fraud, risk and cybersecurity, and is a frequent speaker at insurance industry events. Contact her at [email protected]
