Officials in California are taking public comments on a proposal to eliminate medical marijuana as a recognized treatment for injured workers in workers’ compensation cases until the middle of March. The modification would essentially stop physicians from recommending marijuana in these situations and stop paying for cannabis prescription drugs.
For patients seeking alternative treatment options, accessing a medical cannabis card online remains a viable way to obtain medical marijuana legally, even as the state considers restricting its use in workers’ compensation cases.
The recent revisions to the American College of Occupational and Environmental Medicine’s (ACOEM) guidelines, which state that cannabinoids are “not recommended” for the treatment of acute, chronic, or postoperative pain and specifically advise against their use by safety-critical workers, are the basis for the change that the California Division of Workers’ Compensation (DWC) is considering.
In an update earlier this year, ACOEM listed a number of health risks linked to marijuana use, such as schizophrenia, motor vehicle crashes, and cannabis use disorder. The organization also stated that there is evidence that cannabis is either ineffective or only slightly effective at treating different types of pain.
The worker’s compensation division is considering removing marijuana and related treatments from California’s medical treatment utilization schedule (MTUS) in workers’ compensation cases as a result of the ACOEM update.
Workers’ rights organizations and proponents of cannabis reform are opposing the plan, arguing that it contradicts multiple other studies showing that marijuana can effectively treat pain. They are also urging supporters to submit written comments to DWC before a hearing is scheduled for March 14.
In an email, California NORML director Dale Gieringer stated, “The recommendation flies in the face of scores of scientific studies, including reports by the National Academy of Sciences and California’s Center for Medicinal Cannabis Research, plus the experience of countless California patients and doctors who have found medical cannabis valuable for treating intractable chronic pain.”
ACOEM’s position “conflicts with extensive research findings and common medical use of cannabis to alleviate pain in cancer patients and severe chronic pain sufferers,” according to the California Applicants’ Attorneys Association (CAAA), a trade association for attorneys who represent state residents injured on the job.
The group wrote in an email to supporters that “physicians often recommend cannabis as an effective alternative for pain management and nausea reduction while enhancing patients’ life quality during chemotherapy.” “These applications are rejected by ACOEM’s guidelines due to a lack of clinical evidence and possible workplace safety hazards.”
CAAA questioned whether state officials should be solely depending on ACOEM recommendations, even though DWC is legally required to make evidence-based decisions about which treatments to permit in workers’ compensation cases.
“The complete exclusion of cannabis from the treatment guidelines raises questions, even though workplace safety is unquestionably a priority,” the association stated. “Should California’s workers’ compensation system accept the wider medical consensus that cannabis can offer relief in specific situations where other treatments fail, or should it rely only on ACOEM’s prohibitive stance?”
If approved, the proposal “may potentially impact injured workers seeking alternative pain management options,” the report stated.
Despite stating that medical marijuana is generally not advised in workers’ compensation cases, observers cited a previous ruling by the Workers’ Compensation Appeals Board that allowed it as a treatment.
However, the U.S. Supreme Court declined to consider two cases involving workers’ compensation claims in 2022. In these cases, the Minnesota Supreme Court held that state law was superseded by federal law that forbade marijuana, which meant that employers were not required to cover the cost of the medication.
At the time, plaintiffs and advocacy organizations like Empire State NORML contended that the Controlled Substances Act (CSA) did not preempt employers from simply paying workers’ compensation for marijuana because they are not required to possess, manufacture, or distribute cannabis in violation of federal law.
The top Justice Department attorney was consulted by justices after those cases were appealed to the Supreme Court. After that, the office of the solicitor general filed an amicus curiae brief suggesting that the high court not take up the case.
The document recognized that a number of other state courts have expressed varying opinions on the matter. However, it stated that “no further review is warranted at this time” because none of those cases have “meaningfully considered all of the possible grounds for preemption.”
In a different case, a Pennsylvania court ruled in 2023 that an employer had violated the state’s Workers’ Compensation Act by refusing to pay for a worker’s out-of-pocket medical marijuana expenses to treat a work-related injury.
Meanwhile, recently released studies on the use of medical marijuana for pain discovered that, after three months, it was “comparatively more effective than prescription medications” in treating chronic pain, and that many patients cut back on their use of opioid painkillers while taking cannabis.
The state of Pennsylvania’s medical marijuana Academic Clinical Research Program provided funding for the study, which was partially carried out by a federal researcher at the National Cancer Institute (NCI).
Using causal inference techniques, the analysis “was able to determine, despite certain methodological limitations, that use of medical marijuana for chronic pain under medical supervision is at least as effective and potentially more effective in relation to patients with chronic pain treated by prescription medications (nonopioid or opioid),” according to the report.
Separately, a recent federally funded study found that among adults with commercial insurance, legalization of marijuana in U.S. states is linked to fewer prescriptions for opioid painkillers, suggesting a potential substitution effect in which patients choose to use cannabis rather than prescription medications to treat pain.
There “appears to be a small shift once recreational cannabis becomes legal, but we see stronger results once users can purchase cannabis at recreational dispensaries,” the report’s authors wrote, adding that “these results suggest that substitution of cannabis for traditional pain medications increases as the availability of recreational cannabis increases.”
The study, which was published in the journal Cannabis, goes on to say that “reductions in opioid prescription fills stemming from recreational cannabis legalization may prevent exposure to opioids in patients with pain” and “lead to decreases in the number of new opioid users, rates of opioid use disorder, and related harms.”
In states where marijuana was legalized for adults, other recent studies also revealed a decrease in lethal opioid overdoses. Legalization and fatal overdoses were found to have a “consistent negative relationship” in that study, with the effects being more pronounced in states that legalized cannabis earlier in the opioid crisis. Legalization of marijuana for recreational use “is associated with a decrease of approximately 3.5 deaths per 100,000 individuals,” according to the authors’ estimation.
According to that report, “our findings suggest that expanding access to recreational marijuana could help address the opioid epidemic.” “We find that marijuana may successfully reduce overdose deaths, and previous research largely indicates that marijuana (primarily for medical use) can reduce opioid prescriptions.”
Additionally, it stated that “this effect increases with earlier implementation of [legalization of recreational marijuana],” suggesting that this relationship is largely stable over time.
The availability of legal cannabis decreased the use of opioids by patients with chronic pain and contributed to a decrease in prescription overdose deaths throughout the state, according to a recent report on prescription opioid use in Utah that was released after the state legalized medical marijuana. “Cannabis has a substantial role to play in pain management and the reduction of opioid use,” according to the study’s overall findings.
In 2023, a different study found that medical marijuana use was associated with less pain and less reliance on opioids and other prescription drugs. Another, released in February by the American Medical Association (AMA), discovered that patients with chronic pain who were treated with medical marijuana for more than a month experienced a notable decrease in the number of opioid prescriptions.
A 2023 American Medical Association report found that approximately one in three people with chronic pain used cannabis as a treatment option. Among that group, the majority reported using cannabis instead of opioids or other painkillers.
According to other studies that year, legalizing the purchase of CBD dramatically decreased the number of opioid prescriptions, which decreased by 6.6% to 8.1 percent.
However, legalizing marijuana for adult use was linked to “significant reductions” in the use of prescription drugs for the treatment of various conditions, according to a 2022 study that examined Medicaid data on prescription drugs.
Another piece of evidence that suggests patients use cannabis instead of prescription drugs when given legal access is a 2023 report that connected state-level medical marijuana legalization to lower opioid payouts to physicians.
In a different study that was released last year, researchers examined Oregon’s opioid prescription and mortality rates and discovered that while local access to retail marijuana somewhat decreased opioid prescriptions, they did not see a decline in opioid-related fatalities.
According to other recent studies, cannabis may be a useful alternative to opioids for the treatment of pain.
For example, a recent study comparing medical marijuana and opioids for chronic non-cancer pain in the journal BMJ Open concluded that cannabis “may be similarly effective and result in fewer discontinuations than opioids,” possibly providing similar relief with a lower risk of side effects.
According to a different study, 40% of patients with chronic musculoskeletal pain reported using fewer analgesic drugs since they started using marijuana, and 57% of them said cannabis was more effective than other analgesic drugs.
Participants in Minnesota’s medical marijuana program for chronic pain patients, on the other hand, “are finding a noticeable change in pain relief” within a few months of beginning cannabis treatment, according to a recent state government report.
Nearly a quarter of patients who were taking other painkillers decreased their use of those medications after using medical marijuana, according to the extensive study of almost 10,000 patients.
An extensive study of nearly 10,000 patients found that almost a quarter of those using other painkillers reduced their reliance on those medications after incorporating medical marijuana into their treatment. Despite potential restrictions, individuals can still explore legal cultivation options, such as obtaining a license to grow 99 plants in CA, allowing for large-scale personal or caregiver cultivation under specific medical marijuana regulations.
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