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Focus on Comp: Pot for Pain?
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Focus on Comp: Pot for Pain?

Let's begin the new year with a contemporary conundrum: the potential role of medical marijuana in the management of workplace injuries.

New Mexico is the first state to link medical marijuana to the workplace: a three judge Court of Appeals has ruled that employers must pay for pot when it is medically prescribed by an injured worker's doctor. The state is beginning to develop policies to implement this program. Minnesota is on the verge of approving the use of medical pot for chronic pain. As the legalization of pot rolls from state to state, workers comp insurers, employers and interested by-standers (count me in!) will witness a fascinating and unprecedented spectacle.

Let's begin with the 900 pound gorilla in the room: under federal law, marijuana is, pure and simple, illegal, a schedule I drug. So states that endorse its use are in violation of federal law. While states place marijuana on formularies for approved medications, the feds may decide to lock you up for selling, buying or using it. Given that the prospect of a federal decriminalization is pretty remote, this conflict will likely play out in state and federal courts.

Medicinal Use

It is generally - but not universally - accepted that pot can be a useful and unique tool in the control of pain; one could certainly argue that it is a lot safer and dramatically less addictive than opioids. That being said, the first dilemma from a medical viewpoint is dosage: how would a prescription read? Medicine prides itself on exactness, but how can you possibly control the amount of medication in a joint or, for that matter, a brownie? How much should you take at a given time, how often, for how long? Take three tokes and call me in the morning?

New Mexico is preparing to add pot to its comp fee schedule: they have proposed paying $12.02 per gram (bring your pennies!) and would allow injured workers to be reimbursed for up to 226.8 grams - half a pound - every three months. Wouldn't you love to be in meetings with state bureaucrats hashing out these details!

Here's yet another and by no means the final complication: many employers have implemented policies prohibiting drugs in the workplace. What happens when workers test positive for pot while on full or modified duty? In the limited number of cases so far, these workers have been fired. It's hard to envision a court ordering an employer to keep an employee who tests positive for pot to remain on the job. Job safety will trump pain management every time.

As is our custom, we will keep you posted.

Jon Coppelman

Senior Workers Compensation Consultant

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