Part 4 in a 4-part series on the Opioid Epidemic
No one wants to simply “manage” their pain; they want to be rid of it altogether. Opioid drugs have been sold to the medical profession and the public as a cure-all for even severe, persistent pain. But serious problems are being experienced by patients across the country — addiction, overuse and even death.
That is no doubt affecting your employees as well as your organization. But what can you do to ameliorate the problem?
Can Medical Marijuana Replace Opioids?
Medical marijuana has the possibility to be one answer in the fight to relieve patient pain without the worry of opioid overuse, addiction and death. But, as it is still technically illegal on a federal level, it’s use has to be regulated at the state level wherever it has been deemed legal for medical use.
Studies have found that states which have legalized medical marijuana experienced a decrease in opioid-related deaths. But experts say more research is needed to ensure that these results are sustainable and repeatable, and that there are no long-term problems associated with using medical marijuana.
No matter how you feel about the issue, you need to at least understand what kind of impact the use of medical marijuana as a pain suppressant can have on your employees and your organization.
Does Marijuana Effectively Relieve Pain?
Neither opioids or medical marijuana have to be the only choices; there are many effective and safer drug and nondrug therapies. But scientific studies and anecdotal patient evidence suggests that medical marijuana does have pain-killing properties, by many accounts every bit as effective as opioids have been reported to be.
The Journal of Internal Medicine has recently published two studies that conclude that legalizing medical marijuana (or medical cannabis) has the potential to replace opioids as effective pain control medication and reduce opioid prescriptions. One study looked at Medicare Part D patient data and the other at Medicaid enrollee data.
The Medicare study found that opioid prescriptions fell in states that permit medical marijuana. Prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened.
The Medicaid study discovered that medical marijuana laws have the potential to reduce opioid prescribing for Medicaid enrollees, who at disproportionately high risk for chronic pain, opioid use disorder, and opioid overdose. The researchers found lower opioid prescribing rates where there were medical marijuana laws (5.88 percent lower) and adult-use marijuana laws (6.38 percent lower).
The studies also calculated the financial impact. The combined 2014 savings to Medicare and Medicaid were $1.04 billion for states that had legalized medical marijuana.
According to data published by the Minnesota Department of Health, 63 percent of patients known to be taking opiate painkillers were able to reduce or eliminate opioid usage after six months using medical marijuana.
Minnesota’s findings are not unique. In 2016, data was gathered from patients enrolled in Michigan’s cannabis access program which reported that marijuana treatment created a 64 percent decrease in opioid use.
Medical Marijuana Has Its Own Set of Challenges
For example, in at least one state, you need to register to acquire an ID card to purchase medical marijuana. The patient needs to have an ongoing relationship with a physician who is registered with the state and approved to prescribe medical marijuana. Medical marijuana is also most often approved for a very narrow list of medical conditions.
By the time you’ve waited several months and spent upwards of $800 plus tax, you’ll just have several doses of the cannabis. And just because a patient is approved for medical marijuana use in one state, it doesn’t mean they can legally purchase medical cannabis in other states.
It's True. No One Has Died From Using Medical Marijuana
Research is currently under review on the effect of medical marijuana legalization laws on opioid-related deaths, using data on all non-heroin opiate-related deaths for all 3,144 counties in the U.S. from 2000 to 2015. Early reports indicate a 20 to 30 percent reduction in deaths when patients used medical marijuana for pain control as opposed to opioids.
So, Why Isn't Medical Marijuana the Answer to the Opioid Problem?
While studies are promising, they are not definitive. Most show weak correlational evidence rather than conclusive proof. More importantly, there is even stronger evidence for other policy ideas that could help address the opioid epidemic but have not been implemented on a nationwide scale.
In other words, medical marijuana could help, but it’s almost certainly not the answer to the opioids epidemic and we shouldn’t lose sight of potentially better answers. For example, there are more than 200 non-opioid pain medications, not to mention nonpharmacological approaches. None of these have any addiction or legalization problems, and have not caused death.
Does Insurance Cover It?
Medical marijuana is currently not covered by health insurances. Cannabis in any form is still classified at the federal level as a Schedule 1 controlled substance, which can’t be legally prescribed. So, even though some states have approved the use of medical marijuana, patients have to pay for it out-of-pocket.
Health insurance companies also prefer to cover clinically researched drugs. Even though there are multiple studies concerning the benefits of medical cannabis, there is still a lack of firm clinical reports.
Low-income patients may suffer from lack of coverage the most, but there are a number of prescription drugs that the FDA has approved that contain ingredients derived from marijuana. Not every drug is approved for use in the United States, but several can be covered by health insurance companies as they have been approved by the FDA.
What About Workers' Comp and the ADA?
Laws about marijuana (medical and recreational) are different state to state, making questions about how medical marijuana applies to workers’ compensation even more confusing for employers. The best practice is to play it safe until workers’ comp legislation changes and insurance carriers change their current stance on medical marijuana.
You are not required to accommodate medical marijuana use under the Americans with Disabilities Act (ADA). Even though medical marijuana is legal in many states, under the federal Controlled Substances Act (CSA), marijuana is still illegal. The ADA expressly excludes people who use illegal drugs from its definition of “qualified individual with a disability.” However, as a best practice, you should still engage in the ADA interactive process if a request for a reasonable accommodation for medical marijuana use is made.
What Do You Do Next?
Marijuana can be an effective treatment for pain, greatly reduces the chances for addiction, and eliminates the risk of fatal overdose compared to opioid-based medications. Studies of some states with medical marijuana programs have found reductions in opioid deaths and opioid prescribing when medical marijuana is available. In fact, states with medical cannabis programs have lower rates of opioid overdose deaths than other states.
To learn more about the complexity of the Opioid Epidemic from our panel of medical, workers’ compensation, and benefits plan experts, listen to a recording of MMA’s “The Opioid Epidemic: A public health crisis” seminar, held on Sept. 18, 2018.