Californian officials will accept public comments until mid-March about a proposal that would eliminate medical marijuana from the list of accepted treatments for workers compensation claims. It would be illegal for doctors to recommend marijuana, and any compensation paid out towards cannabis medicines.
California Division of Workers’ Compensation’s (DWC’s) change is based upon the recently revised guidelines of the American College of Occupational and Environmental Medicine. The ACOEM says that the cannabinoid treatment of acute, chronic or postoperative discomfort “is not recommended”. It also warns against its use for safety-critical employees.
ACOEM in an update earlier this year listed various health risks associated with marijuana use—including cannabis use disorder, motor vehicle crashes, schizophrenia and others—and further said that evidence shows that cannabis is ineffective or only minimally effective at treating various types of pain.
In response to the ACOEM updates, the workers compensation division has begun evaluating a possible change which would exclude marijuana and similar treatments from California’s Medical Treatment Use Schedule (MTUS), in cases of workers’ comp.
Cannabis reformers and workers’ rights groups oppose the proposal. The group says it is in conflict with other studies showing that marijuana could be an effective treatment for pain. It urges supporters to send written comments to DWC before a scheduled hearing on March 14,
The recommendation contradicts scores of studies, Dale Gieringer of California NORML said via email. “Including reports from the National Academy of Sciences as well California’s Center for Medicinal Cannabis Research. Plus the experience of countless Californian patients and doctors that have found medicinal cannabis useful for treating intractable, chronic pain.”
You can send written comments by fax, email or mail.[email protected]The official must receive the documents no later than 10 am on the morning of the Zoom hearing.
California Applicants’ Attorneys Association, a group of lawyers that represents state residents injured at work, also opposes the changes. They say ACOEM’s stance is “in conflict with research findings, and the common use of marijuana to relieve pain for cancer patients, and chronic severe pain sufferers”.
The group wrote in an email that doctors often recommend cannabis to patients as an alternative pain reliever and nausea reducer, while also improving their quality of life. ACOEM rejects these applications for lack of clinical evidence as well as potential workplace safety hazards.
CAAA has questioned the state’s officials about whether they should rely solely on ACOEM’s recommendations.
The association stated that while workplace safety was undeniably important, it raised questions about the exclusion of marijuana from treatment guidelines. Should California’s Workers’ Compensation System rely on ACOEM’s prohibitionist stance or acknowledge that the medical community has agreed cannabis is effective in some situations when other treatment options fail?
The proposal, it said, would “potentially impact” injured workers who are looking for alternative options to manage their pain.
However, while observers claim that medical marijuana in worker’s compensation cases is not typically recommended, they have also pointed out a previous determination made by the Workers’ Compensation Appeals Board which allowed it to be treated.
However, in 2022 the U.S. Supreme Court declined to review two workers compensation cases where the Minnesota Supreme Court found that state laws prohibiting the use of marijuana were preempted by federal law. This meant employers did not have to pay for this medicine.
The Controlled Substances Act, or CSA, does not prohibit employers from providing compensation to workers who are injured by marijuana. This is a claim made by plaintiffs, advocacy groups and other organizations such as Empire State NORML.
The Justice Department’s top lawyer was consulted after the cases had been appealed before the Supreme Court. In response, the solicitor general filed an amicus brief in which it recommended that the high court decline to take the case.
It was acknowledged in the filing that other state courts had weighed-in on this issue with different opinions. It said, however, that no case had “meaningfully examined all possible preemption grounds,” and therefore “no additional review at this time is warranted.”
In 2023, Pennsylvania courts ruled that an employer’s refusal to reimburse a worker’s costs incurred for the purchase of medical marijuana for treating a workplace injury was in violation of Pennsylvania’s Workers’ Compensation Act.
Recent research published on medical marijuana’s use for chronic pain has found it to be “comparatively more efficient than prescription medication” after three months. Many patients also reduced their opioid painkiller use while using cannabis.
The state’s Academic Clinical Research Program on Medical Marijuana funded the study, which was partly conducted by a federal scientist at the National Cancer Institute.
The report stated that despite some limitations in the method of analysis, “the use of medical cannabis for chronic pain, under the supervision and guidance from a physician, is as effective, if not more so, than prescription medication (nonopioid, opioid) in treating chronic pain.”
Separately, a recent federally funded study showed that legalization of marijuana in U.S. states is associated with reduced prescriptions for opioid pain medications among commercially insured adults—indicating a possible substitution effect where patients are choosing to use cannabis instead of prescription drugs to treat pain.
Authors of the report noted, “This suggests that cannabis substitution for traditional pain medicines increases as recreational marijuana availability increases.” Although there is a “small shift” when cannabis sales are legalized in recreational dispensaries, we notice a stronger effect once cannabis can be purchased at these stores.
This paper in Cannabis continues: “Reduced opioid prescription fills due to the legalization of recreational cannabis may help prevent patients from being exposed to opioids when they are suffering pain, as well reducing the rate of opioid addiction and harms associated with it.”
Recent research has also shown a drop in the number of fatal overdoses from opioids among jurisdictions that have legalized marijuana for adults. That study found a “consistent negative relationship” between legalization and fatal overdoses, with more significant effects in states that legalized cannabis earlier in the opioid crisis. The authors estimated that legalizing recreational marijuana “is associated” with a reduction of approximately 3.5 fatalities per 100,000 people.
The report concluded that, “Our results suggest that expanding recreational marijuana use could be a way to combat the opioid crisis.” The report stated that “previous research shows marijuana can be used to reduce prescriptions for opioids and may reduce overdose deaths.”
The effect of earlier implementation is greater. [recreational marijuana legalization]This relationship appears to be relatively stable over the years,” said it.
Another recently published report into prescription opioid use in Utah following the state’s legalization of medical marijuana found that the availability of legal cannabis both reduced opioid use by patients with chronic pain and helped drive down prescription overdose deaths statewide. The study concluded that cannabis has an important role in the management of pain and reduction of opioid usage.
Yet another study, published in 2023, linked medical marijuana use to lower pain levels and reduced dependence on opioids and other prescription medications. And another, published by the American Medical Association (AMA) last February, found that chronic pain patients who received medical marijuana for longer than a month saw significant reductions in prescribed opioids.
About one in three chronic pain patients reported using cannabis as a treatment option, according to a 2023 AMA-published report. A majority of this group claimed to have used cannabis in place of other pain medicines, including opioids.
Other research published that year found that letting people buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 percent to 8.1 percent fewer opioid prescriptions.
A 2022 research paper that analyzed Medicaid data on prescription drugs, meanwhile, found that legalizing marijuana for adult use was associated with “significant reductions” in the use of prescription drugs for the treatment of multiple conditions.
A 2023 report linked state-level medical marijuana legalization to reduced opioid payouts to doctors—another datapoint suggesting that patients use cannabis as an alternative to prescription drugs when given legal access.
Researchers in another study, published last year, looked at opioid prescription and mortality rates in Oregon, finding that nearby access to retail marijuana moderately reduced opioid prescriptions, though they observed no corresponding drop in opioid-related deaths.
Cannabis may also be an alternative for opioids to manage pain, according to other recent studies.
A report published recently in the journal BMJ Open, for instance, compared medical marijuana and opioids for chronic non-cancer pain and found that cannabis “may be similarly effective and result in fewer discontinuations than opioids,” potentially offering comparable relief with a lower likelihood of adverse effects.
Separate research published found that more than half (57 percent) of patients with chronic musculoskeletal pain said cannabis was more effective than other analgesic medications, while 40 percent reported reducing their use of other painkillers since they began using marijuana.
In Minnesota, meanwhile, a new state government report on chronic pain patients enrolled in the state’s medical marijuana program said recently that participants “are finding a noticeable change in pain relief” within a few months of starting cannabis treatment.
A large-scale survey of almost 10,000 patients found that nearly one quarter of them who took other drugs to relieve pain reduced their use after trying medical marijuana.
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