The idea of looking to natural substances to alleviate medical ailments and cure disease is ages old. Long before we learned how to synthesize medicine in a lab, we discovered that certain plants, herbs and oils can be used to treat various symptoms or illnesses. However, while many natural substances provide some health benefits, that doesn’t mean we can assume that something natural is safe and without risk.

While marijuana is the current plant of controversy, it is by no means the first. In the early 19th century, Friedrich Serturner, a young pharmacist, was the first to isolate morphine (an opiate) from the opium plant.1 While many believed there could be medicinal benefits in opium poppy juice, it was also known that the substance was deadly and addictive. It has taken centuries for us to better understand both the benefits and, of course, the dangers of morphine and the other natural substances produced by the poppy plant.   

The poppy juice evolution offers a lesson. In the case of medical marijuana, we must be thoughtful in our approach. When considering marijuana as a treatment option for work-related injuries, we all should consider these three things – clinical evidence, recent legislation and regulations, or the lack thereof.

Clinical evidence

While there is much discussion around marijuana as the next pharmaceutical option for the treatment of pain, the clinical evidence is not strong. 2,3,4 Some of the studies that have been proposed as evidence for chronic pain are actually surveys and would not qualify as evidence-based research.5,6

Cannabis has two primary chemical components, tetrahydrocannabinol (THC) and cannabidiol (CBD). Because CBD is always present along with THC in medical marijuana, it is not always clear what symptoms are being relieved by either component or a combination of the two.

CBD is believed to provide some relief as it relates to anxiety and, therefore, can also cause relaxation. Additionally, CBD has been shown to have a great impact in the prevention of certain types of seizures. Recently, the Food and Drug Administration (FDA) approved a formulation of CBD for the treatment of two forms of childhood seizures.

Legislation

In 2018, the U.S. saw the introduction of more than 20 state and federal pieces of legislation specifically related to hemp, and medical and recreational marijuana. In McNeary v. Freehold Township, a New Jersey judge ruled that Freehold Township is required to pay for an injured employee’s marijuana use as part of his workers’ compensation claim. This is the first time a public entity has been required to fund marijuana use through workers’ compensation. In another case, Bourgoin v. Twin Rivers, the Maine Supreme Court ruled that a company’s workers’ compensation fund can’t be forced to pay for medical marijuana, citing the supremacy of federal law over state law as the basis for its decision.

Lack of FDA regulations

As more and more products come to the market in states that have legalized marijuana in some way, there is a need to ensure product integrity. Whether it’s a topical ointment, edible gummy bear or CBD vape oil, these products are not regulated by the FDA and therefore lack the proper review as it relates to product safety.

A pragmatic and thoughtful response

One thing is clear –payers are seeing an increasing number of requests for the use of medical marijuana by physicians and claimants. Sedgwick recently formed a team of claims, clinical and compliance leaders who are collaborating to research the various developments related to medical marijuana. As more clinical evidence or products are brought to market and as the legal landscape evolves, we will continue to ensure our approach is based on what is best for injured workers and our clients. 

Currently, the Official Disability Guidelines and any other clinical guidelines do not recommend cannabis for pain or any other indication. However, in states where marijuana is allowed, and case law and/or regulations may require reimbursement, a specially trained team of nurses reviews the request and provides a detailed review so that consideration is given to the risks based on the clinical evidence and fact pattern of the individual case.

As the various states and entities look to marijuana to be the potential savior from the opioid crisis, it’s important that our approach is based on valid evidence and includes a thorough review of the entire claim and the legal issues that are involved. As it is with any other form of medical treatment, the answer is rarely black and white.

To learn more, join me in the RIMS Wellness ZENter on Monday, April 29 at 11:30 a.m. where I will answer the burning questions: When is marijuana a substitute for opioids? Are you high?

References:

1. Krishnamurti C, Rao SC. The isolation of morphine by Serturner. Indian J Anaesth. 2016;60(11):861-862.
2. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015;313: 2456-73.
3. Boychuk DG, Goddard G, Mauro G, Orellana MF. The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. J Oral Facial Pain Headache 2015; 29: 7-14.
4. Jensen B, Chen J, Furnish T, Wallace M. Medical marijuana and chronic pain: a review of basic science and clinical evidence. Curr Pain Headache Rep 2015; 19: 50.
5. Reiman A, Welty M, Solomon P. Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report. Cannabis Cannabinoid Res. 2017;2(1):160-166. Published 2017 Jun 1. doi:10.1089/can.2017.0012
6. Northwell Health. "Medical marijuana could reduce opioid use in older adults: Study shows up to 65 percent of older adults who use medical marijuana significantly reduced their chronic pain and dependence on opioid painkillers." ScienceDaily. ScienceDaily, 1 May 2018. www.sciencedaily.com/releases/2018/05/180501085137.htm