Side effects may vary: Medical marijuana's unintended benefits to workers' comp
Marijuana legalization is complicating some matters in workers’ comp, but could it also be a cost-cutting tool?
Editor’s note: This is the second installment of a two-part series reviewing the unintended effects marijuana legalization has had on the U.S. workers’ comp sector. The first part of the series can be found here.
The use of marijuana to treat a range of physical and mental ailments is well seeped throughout human history, first getting some press in 2800 BC in the pharmacopeia of Emperor Shen Nung, who is considered the father of Chinese medicine.
Much like today, ancient cannabis practitioners believed it could be used to treat everything from arthritis and depression to inflammation and lack of appetite. Yet, a lack of thorough research on the matter makes it difficult to definitively say “Yes, marijuana is an exceptional medicine to fight pain, inflammation, depression, ect.”
Although its efficacy as a pain reliever is up in the air, many states with medical marijuana laws do accept its use as one. A 2017 study of U.S. medical marijuana users found that 42% reported using it for pain. Anxiety was the most common reason people turned to medical marijuana, cited by 49% of respondents, followed by insomnia.
In addition to its direct impact as a pain reliever, researchers are also looking at if THC or CBD could be combined with lower-dosage opiates to enhance the latter’s benefits and minimize its negative attributes.
One area where the science seems to be settled is the ability of THC to enhance the lives of those suffering from PTSD, according to Julie Schum, a partner with Quintairos, Prieto, Wood & Boyer, P.A. where she focuses on workers’ comp and cannabis practices.
“In the last few years we’ve seen a lot of focus on the ongoing psychological consequences of severe injuries such as anxiety, PTSD and concerns around returning to the workplace,” she said. “There are actual studies, for PTSD especially, there are actual studies with large sample sizes showing that there is a benefit to PTSD from cannabis use. So if a person who had a catastrophic injury at work has that problem, you might be able to return their whole life to them.”
Further, Schum noted that carriers “can make a huge reduction in opiate use” if an injured worker is a viable candidate for medical marijuana. It is also a significantly cheaper option.
In 2022, more than 30% of workers’ comp claims had at least one opiate prescription and 27% had more than one, according to the Centers for Disease Control and Prevention.
“I had a case when the MSA was $550,000. We transitioned the person to medical cannabis and the MSA dropped to $100,000,” Schum said. “We upped the settlement by roughly $50,000 to account for the cost of cannabis for the rest of their life. So $150,000 as opposed to $550,000.”
Turn on, tune in, get well?
Gaining more traction as of late has been the notion that psychedelic drugs might also serve as an alternative treatment for injury recovery as well as mental health issues. Moving this forward has been the legalization of some psychedelics, such as psilocybin, the primary psychoactive agent found in “magic” mushrooms.
Much like cannabis, the research on the potential uses for psychedelic drugs is scant and not very recent, explains Nikki Wilson, senior director of pharmacy services, Enlyte Pharmacy Solutions.
She said a broad range of research was conducted beginning in the 1950s. But as the counter-culture discovered and quickly embraced psychedelics, a stigma around the abuse of these substances led to federal prohibition in the late 1960s. With the change in legal status came a quick end to research on these substances.
“We have a handful of studies from that time period and now it is really getting picked back up in the clinical space,” Wilson said. “The primary information we have, and it is limited, is for a handful of mental health disorders, such as treatment-resistant depression, anxiety, addiction, PTSD, and some are looking at applications for pain.”
Most of the studies examining uses for pain management deal with cluster headaches, Wilson said, but a few are looking at whether psychedelics can help defeat chronic pain.
UC San Diego’s Psychedelics and Health Research Initiative (PHRI) is one institution conducting such research. Preliminary findings suggest that psychedelics can “produce significant, meaningful and lasting reductions of chronic pain conditions” for ailments ranging from complex regional pain to phantom limb pain, according to PHRI researchers.
Some researchers have posited that psychedelics, which have been shown to promote neuroplasticity, are in a way rewiring the brain to better manage and demote pain. Virtual reality is also showing promise as a drug-free pain management tool in much the same way.
Other researchers suggest that psychedelics might be working further down, and in some way hitting an internal reset button that helps modulate how the user experiences pain.
As with any emerging therapy, the full suite of risks from using psychedelics is unknown.
Starting with the caveat that psychedelics and other mind-altering substances will impact everyone differently, Brian Allen, vice president of government affairs for Enlyte, said most of the risks in psychedelic therapy are short term in nature such as headaches, elevated heart rates, and nausea and vomiting.
“A lot of it depends on the dosing and the psychological state of the person taking the drug,” he said, noting some evidence suggests hallucinogens can lead to permanent heart damage.
While a massive amount of research still needs to be done on both the potential benefits and risks of psychedelic therapies, Wilson said two things are established. Most psychedelics have low toxicity levels and the potential for abuse is limited.
While both marijuana and psychedelics are shedding some of their street-drug stigmas with new clinical applications, the latter is not expected to have as widespread of an impact on workers’ compensation. This is because psychedelics have limited recognized uses, Schum explained, adding: “The reason cannabis gets in the door is because it does have therapeutic uses. There is a contingent of people that cannabis helps that no other drug helps.”
Truly, time (and the research born during its passage) will tell all.
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