Colorado tests out medical marijuana on workers’ comp

Hurting your back at work is one of the most common ways to develop an opioid addiction. It’s also one of the largest contributors to lost work productivity, at over $5 billion per year.

Could cannabis really help curb these issues?

A small state-run program in Colorado attempted to see how a registered medical marijuana patient could obtain insurance compensation for dispensary purchases after sustaining a work-related injury. Although the evaluation was small, working with just one patient, those behind the initiative within the Colorado Department of Labor and Employment are hopeful that studies like these will help spur more honest discussions between doctors and patients, and, in the long-run, potentially help combat the chances of opioid addiction while recovering from injuries.

Medical marijuana is now legal in some form in over 40 states and considered a Schedule III substance under the federal government. On top of medical marijuana reform, recreational cannabis has been legalized in 25 states and Washington, D.C., since 2012, with Colorado being the first. The Drug Enforcement Administration is currently hearing arguments for the potential rescheduling of recreational cannabis, as well.

Yet “there’s not really any availability” for cannabis under workers’ compensation across the country, according to Dr. Ethan Moses, medical director for the Colorado labor department’s Division of Workers’ Compensation.

“The current answer is, ‘Well, you can go down the street to one of the dispensaries and use it as you see fit,'” he says.

States regulate their own workers’ comp programs, but they still have to work with insurance companies, which have been slow to adopt medical marijuana reform. In Colorado, health insurers are protected from having to pay for claims involving cannabis thanks to language in the state’s medical marijuana initiative, Amendment 20, approved by voters in 2000.

Moses wanted to see if someone could weave through the process of obtaining medical marijuana through workers’ comp in Colorado without being stuck with the bill. He worked with the state Attorney General’s Office and Colorado Department of Public Health & Environment to procure a small amount of funding, and then set out to find an injured worker willing to give it a shot. The participant had to be a medical marijuana patient who was using opioids when the study began, according to Moses, who “went into this as sort of a skeptic.”

“The medical literature is really quite mixed on the efficacy of cannabis for lots of health conditions, and one of the things I learned is there’s good reasons for that,” he says, pointing to federal restrictions around cannabis research before rescheduling. “It makes sense that it’s difficult to come to conclusions. We don’t get a lot of training, or any training, on cannabis in medical school — certainly not when I went through it.”

But Moses says the goal of the workers’ comp study wasn’t to further assess the medical efficacy of cannabis as a form of pain management. Instead, the project was intended to see if the plant could make it through the insurance gauntlet and lessen the frequency of the participant’s opioid use. The study included medical marijuana reimbursement for the patient, who suffered from hand and back injuries, as well as care coordination among multiple doctors and “robust clinical oversight” over a year-long span.

“The question was whether we can make these safer and easier to access for injured workers in Colorado,” he says.

And it did, at least, in the case of the one person they worked with, according to the published research. On top of successfully working their way through the insurance system, “the patient reported meaningful reductions in pain, improvement in function, increased quality of life and psychosocial stability,” the study’s conclusion says. “A modest reduction in opioid use was observed.”

Moses doesn’t see insurance companies lining up to compensate injured workers for medical marijuana just yet, nor does he expect employers to stand up for their employees in this instance. The man who participated in the workers’ comp study was unemployed after his injury, and the state had to communicate with the insurance company before the claim was submitted.

Colorado doesn’t have any laws protecting off-hour cannabis use by employees, keeping a lot of workers and patients silent about their cannabis use. Although some states have laws protecting off-hour cannabis use, Moses thinks insurance company policies can be a major factor in erasing the stigma

When an injured worker receives medication paid for under workers’ comp, that “information flows from the treating provider to the insurer, which can then flow to the employer,” he explains.

If cannabis continues to show potential as a treatment alternative to opioids and a way to curb opioid addiction — and opioid-related court settlements — Moses is hopeful that insurance companies will see the value.

“There is no way in which we can require insurance companies to do this. That’s why having this program be voluntary was key for the patient, insurance company and primary caring physician,” he says. “When compared to opioids, I think some insurance companies would be interested in medical cannabis. They may want to consider medical cannabis in order to offset the costs of settlements.”