Medical Marijuana: Are People Smoking Pot or Taking Medication?

| | Evidence Based Medicine, Utilization Review

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Medical Marijuana is coming to workers’ compensation. According to Mark Pew, senior VP of Prium, medical marijuana will be allowed in some form across all states within three to five years. 39 states have already legalized marijuana for medical use in some fashion.

Questions about medical marijuana continue, with few clear answers available. Before exploring a few of those questions, it’s important to dispel one big myth about medical marijuana.

What Medical Marijuana is NOT

Medical marijuana is not about perfectly healthy people inhaling carcinogens and getting stoned. To get clear and reasonable answers about medical marijuana in workers’ comp, we need to remove the stigma around marijuana use.

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What Medical Marijuana IS

It is a drug that is derived from several different parts of the plant and can be administered similarly to prescription drugs today.

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Medical Marijuana Uses

Medical Marijuana has been around for thousands of years, recorded as far back as 2700 BC, and continues to be used in many countries for medicinal purposes. However, only recently has it gained recognition in the United States medical field. In June 2015, the Journal of the American Medical Association published one of the most comprehensive studies to date around medical uses for cannabinoids. The study included 79 trials, involving more than 6,400 participants. All 79 trials were randomized controlled studies, and the routes of administration in most studies were through cannabinoid medication, not inhaling marijuana. Below are a few key findings from those studies that raise hope among medical marijuana advocates who believe cannabinoids may provide more treatment options:

  • Nausea and vomiting from chemotherapy: A significantly greater proportion of patients experienced complete relief from their symptoms than did the placebo group.
  • Chronic pain related to cancer, diabetes-related nerve damage and fibromyalgia: Cannabinoids significantly improved pain (with less subjective pain reported) in a greater proportion of patients compared to placebo.
  • Spasticity from multiple sclerosis or paraplegia: Compared to placebos, cannabinoids were associated with greater improvement in spasticity symptoms. These results were not statistically significant to draw clear conclusions, so further research is needed.

Over 100 million people suffer from chronic pain, approximately three times more people than suffer from heart disease, diabetes and cancer. The Institute of Medicine estimates that chronic pain costs the health care industry up to $635 billion per year with almost half of those dollars representing lost productivity.

According to Dr. Malik Burnett, opioid therapy by itself is problematic in treating chronic pain. As the body develops a tolerance to the medication, the dosage has to increase in order to provide relief. Eventually, patients receive little or no relief from the medication.

When opioids fail to ease pain, some doctors are looking to medical marijuana for possible solutions to reduce, if not eliminate prescription medications. The New Mexico courts were the first to say medical marijuana treatment was reasonable under workers’ comp; others will probably follow. With legalization in more states, much needed research will become easier to conduct and results from studies more reflective of real-world situations.

How will Utilization Review Respond?

In performing utilization review (UR) for workers’ comp, UR providers must follow medically appropriate guidelines within each state’s requirements. In states that require UR, companies that use evidence-based guidelines to make treatment determinations will be looking for better evidence that could support medical marijuana. But until there is clear evidence to show the treatment is medically necessary and until the states support it, UR companies will be challenged to determine its medical appropriateness.

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