Up In Smoke: Medical Marijuana – The Latest Research and How Will It Impact Injured Workers?

By Robert G. Rassp, Esq.

Marijuana is used medicinally or recreationally once a year by at least 128 million people in the world since 2012 according to global epidemiology studies. Growing up in California means easy access to marijuana from elementary school through college and beyond. The “high” from marijuana brings on feelings of euphoria, laughter, great creativity, and deep philosophical conversations about nothing. Finally, there are the “munchies.” Does any of this sound familiar to you?

The use of medical marijuana has been legal in the State of California since 1996 when the California legislature approved legislation allowing for it. [See Health and Safety Code Sections 11362.7 through 11362.83]. Since then, no regulations have been implemented state wide to control the cultivation, quantity, quality, or distribution of medical marijuana. It wasn’t until the close of the legislative session in 2015 that a state agency was created by the legislature to regulate medical and eventually recreational marijuana. The Medical Cannabis Cultivation Program under the State of California Department of Food and Agriculture was passed by the legislature and effective February 1, 2016. See California Health and Safety Code Section 11362.77. Up until new regulations are promulgated by the new state wide regulatory agency that specifically addresses marijuana, regulations have been inconsistently implemented by cities and local jurisdictions.

Add to the mix the fact that four states and the District of Columbia have legalized recreational use of marijuana and many more states are in the process of enacting legalization for recreational use, including one or more ballot initiatives in the 2016 election cycle. California is one of those states where polls indicate it is likely that at least 55% of the electorate will vote to allow recreational use of marijuana. As of late 2015, 25 states and the District of Columbia allow medical use of marijuana. The State of Colorado was the first jurisdiction in the world that legalized the recreational use of marijuana.

What are the implications for the legalization for recreational use of marijuana? What research has been conducted on the medical use of marijuana? How does the legalization movement affect the rights and obligations of injured workers, employees in general, and employers? How much do we know about impaired driving for a person who is high on marijuana? This article will discuss these and many more issues in the context of what we currently know about the medical use of marijuana and the social, occupational, and personal effects on legalization for recreational use. For example, has Maximus Federal Services allowed the use of medical marijuana in a California workers’ compensation claim? The answer is “yes” and will be discussed later in this article.

Believe it or not, there is very little reliable research on the medical or recreational use of marijuana despite the fact that the weed has been used for over 5,000 years! The problem is in the federal Controlled Substances Act [21 U.S.C.S. 812] which identifies marijuana as a Schedule I controlled substance—the same level as cocaine, heroin, and methamphetamine. Under federal law, a Schedule I controlled substance is considered to have no medical use, is subject to abuse, and is illegal to manufacture, sell, possess, or distribute. The National Institutes of Health (NIH) has one marijuana growing operation that is strictly regulated with limited access to researchers. As far as NIH is concerned, until Congress passes legislation that declares marijuana something other than a Schedule I controlled substance, there will always be limited federally funded research.

The reason marijuana was designated by Congress to be a Schedule 1 controlled substance is because of the illegal importation of thousands of kilograms (in bricks of 2.2 lbs.) from outside the United States, creating interstate transport of marijuana in an uncontrolled, unregulated, and illicit underground economy that originated from Central and South America. Foreign drug cartels have been the primary source for illicit importation of marijuana with very little domestically grown and processed in comparison.

In fact, most public and private university research institutes do not even apply for grants involving marijuana research for fear of losing funding for all federally funded medical research. That’s right, public and private institutions have a fear of losing federal research funds if research is conducted on a Schedule I controlled substance. Congress is slow to act on the need to reclassify marijuana so that proper research on marijuana can be conducted without the fear of losing federal funding for other research. As you will see in this article, much research on marijuana has been conducted outside the United States and the validity and reliability of the research can easily be questioned.

As of the current state of affairs, marijuana remains a Schedule I controlled substance. If a person grows 100 or more marijuana plants, he or she is guilty of a serious federal felony for which punishment is 5 years in federal prison (there is no time off for good behavior in a federal prison sentence). Therefore, marijuana is a cash industry—banks in the United States are federally chartered and can lose their charter if deposits are made from sales of a Schedule I substance. So how does a claims administrator in a workers’ compensation case pay reimbursement for medical marijuana for a chronic pain patient who has a recommendation for treatment from his or her physician? It cannot be paid by check to the dispensary by the claims administrator.

What We Do Know About Marijuana

Marijuana consists of 400 compounds, some of which are psycho-active and others are not. The psycho-active component of marijuana is Delta-9 tetrahydrocannabinol (“THC”) from the female cannabis sativa hemp plant that causes the “high” associated with marijuana use. By smoking marijuana, the psycho-active effect begins in less than 10 minutes and lasts about four hours before it wears off. If a person eats an “edible” the effect begins in 30 minutes after ingestion and lasts up to six hours. Generally, edible marijuana causes a stronger high that is more intense than smoking it. A person cannot die of an overdose of marijuana but emergency rooms are seeing an increase in patients who have ingested too much and have severe symptoms.

In addition to THC, marijuana has about 100 cannabinoids, some of which may have some medicinal value. Of the cannabinoids, there are two types—cannabidiols and cannabinols. Marinol is one synthetic form of THC and is one of a few cannabinoids that is legally prescribed in the United States for medical use. Marinol is prescribed for HIV and cancer patients to enhance their appetites that are suppressed by the disease process itself or by chemotherapy, and for children with severe epilepsy or for people with severe spinal cord injuries that cause paralysis and spasticity. Medical marijuana other than Marinol cannot be “prescribed” by a physician in the United States—a physician can only “recommend” marijuana. The distinction between prescribing and recommending medical marijuana avoids problems with the federal Drug Enforcement Agency (DEA) which licenses physicians to prescribe scheduled substances. If a doctor recommends medical marijuana in California, he or she will not run afoul of federal law and regulations that would put at risk their DEA license to prescribe scheduled drugs for patients.

In addition to Marinol, marijuana in medical form are cannabinoid (CBD), Dronabinol, Nabilone, and Ajulemic Acid (a non-psychoactive component of marijuana just approved by the FDA in February 2015 for inflammation from scleroderma). The FDA has approved these forms of marijuana for medical use and can be prescribed by a physician, as opposed to being “recommended.”

Marijuana use as medicine in a workers’ compensation claim is not in any state’s Medical Treatment Utilization Schedule (MTUS) and its use as a medicine is not yet considered evidence-based. However, marijuana as a drug is well tolerated by people in terms of adverse side effects (e.g. it does not affect the heart, respiration, or any other vital signs; you cannot die from an overdose), there are virtually no known drug to drug adverse interactions, and there is no strong evidence of harm with long term use. But at the same time, there are no randomized clinical trials (RCTs) that compare marijuana with concurrent use of opioids, benzodiazepines, or hypnotics. In fact, there are no randomized clinical placebo controlled trials comparing inert marijuana with psychoactive marijuana for medical use.

Anecdotal evidence exists that marijuana helps people who suffer from chronic pain. However, there is no randomized clinical trial that compares the effects of marijuana with psychoactive THC and marijuana without THC. Any study that holds any scientific weight would have to be sponsored by the National Institutes of Health rather than from the marijuana industry or from any other interested sources (including but not limited to pain management physicians). There has not been any significant study where chronic pain patients only use medical marijuana or a placebo and no other medications.

So far, we know very little about how marijuana that ends up being sold in a dispensary was cultivated. We do not know what pesticides and herbicides were sprayed on the marijuana crop. We do know that it takes lots of water to grow marijuana and in most cases, the water quality used to grow the crop is unknown and unregulated. Hypothetically, medical marijuana is supposed to be grown in small quantities by a cooperative or by individuals for individual use. But anyone who walks into a marijuana dispensary will not know how or where any given pot was grown.

Since there are no regulations on the production or distribution of medical marijuana, we do not know the strength or “dose” of any given marijuana, nor is there any quality control over the type of marijuana one can obtain through a dispensary. Something may be labeled “sativa” or “indigo” but there is no quality guarantee over exactly what a patient is buying. If legalization for recreational use passes, perhaps state-wide regulations will cure this lack of quality control from seed to distribution. There would have to be genetic and other confirmation of type and quality of medical marijuana in terms of purity, dose specific, and type of psychoactive effect. After all, when you take a pain pill, aspirin, antibiotic capsule, and other medication that is under the jurisdiction of the FDA, you have certain built in assurances that what you are taking is what is intended and indicated. There is consistency, uniformity, and quality assurance for the dosage, chemical composition, bioavailability, and quality of a given medication.

Not so with medical marijuana. The problem with marijuana is that there is absolutely no therapeutic drug on the market that is administered by smoking. Virtually every medical society and substance abuse group are against the utilization of smoking marijuana as a means of obtaining a therapeutic benefit because of the lack of uniformity, consistency, and quality of the dosage obtained. The American Society of Addiction Medicine and the American Cancer Society are two of the most vocal organizations who are against smoking marijuana as a medicine. Most addiction medicine researchers still believe marijuana can be a gateway drug, especially for children under the age of 17. In fact, current research is demonstrating that early frequent use of marijuana by children under 17 years of age affects development of the endocannabinoid system in children’s brains. That discussion is given in more detail later in this article.

In the meantime, without strong regulations on where, how, when, and what quality marijuana is produced for medical and recreational use, the market determines the societal reactions to its presence. In Colorado and Washington states, there are signs of increased emergency department visits due to marijuana ingestion. Generally, one bite out of an edible produces enough of a dose of THC to cause a six hour high. Many emergency visits are by children who see an unwrapped cookie or “gummy bear” and eat it resulting in severe psycho-active symptoms. The same is true for adults who end up in an emergency room by eating too much edibles at one time. Recently, a university study in Colorado showed that 20% of emergency room visits after a motor vehicle collision involved a driver who was impaired by marijuana use. That is an alarming statistic if it becomes true where ever recreational marijuana is legalized.

However, there are anecdotal reports that marijuana is not as addictive as alcohol and is not as addictive as opioids, benzodiazepines, or hypnotics. In fact, some data is emerging in Colorado and Washington states that people who are using marijuana for pain relief or for sleep are showing less use of opioids, sedatives, and sleep medications. Also, marijuana is not considered a “gateway” drug like it was in the 1960s and 1970s. However, it is considered by addiction specialists to be a gateway drug if a child under 17 years of age begins regular use of marijuana. This is because the brains of children are still developing and there is some research that shows a slowing of brain development in children under 17 years old who regularly smoke or ingest marijuana. Interestingly enough, addiction researchers are adamantly against legalization of marijuana either for medical use or for recreational use due to the paucity of controlled studies on the short and long-term effects of marijuana use on adults and children.

Another difficult issue that is emerging is the question of medical marijuana, recreational marijuana and drug use policies of employers. Logically if employers prohibit employees from showing up to work while drunk on alcohol, it is not unreasonable to prohibit employees from working while high on marijuana. In fact, many employers have a “zero tolerance” anti-drug policy for employees, especially employers who have federal grants, military defense contractors with the federal government, government employers, or teaching institutions.

So if an employee works for an employer with a zero tolerance drug policy, doesn’t that policy interfere with the employee’s civil rights concerning his or her activities off the job, especially in states which have legalized recreational marijuana use? The metabolites of cannabis can last weeks and longer in a hair sample drug test. These issues will have to be addressed as the liberalization of marijuana use becomes more widespread.

One thing has to be emphasized at this point—marijuana has a variety of effects on each individual. Some people do not “appear” high at all, while others appear like they are in outer space. The “high” can affect one’s judgment, reaction times, concentration, and the pace of performing tasks. If pot is strong enough it can produce psychotic features and hallucinations. There is no uniformity of effect on a given person who is high on marijuana.

There is growing consensus that a blood level of greater than or equal to 5 nano-grams (ng) per deciliter is the threshold of impaired driving and impairment of judgment (i.e. a person is “high”). This standard may become the similar standard that .08 mg alcohol per deciliter of blood determines presumed liability for a DUI conviction.

However, detecting the metabolites of cannabis in the urine is problematic. If a person drinks lots of water before a drug test for THC or its metabolites, the readings will fall well below the threshold of 5 ng/dl. Besides, detection of marijuana in the urine can only last for one to five days for occasional users. For people who use marijuana three to five times a week, urine will test positive for marijuana for up to six weeks. But these tests do not show that an employee showed up to work while high on marijuana – it is just evidence that the person ingested it at some time in the recent past.

Can an employer force an employee to have a blood test in a random drug testing program? Probably not since a blood test is an invasive procedure (with some risk of an infection) while a urine test is totally non-invasive. A saliva test which is also non-invasive has been developed to determine whether a person has recently used marijuana.

The problem with marijuana is that the metabolites of THC and other cannabinoids stay in the body for weeks, mainly stored in the liver and detected by blood testing. So companies with a zero tolerance for drugs will present a problem for employees who partake use of marijuana while off duty. In many states (at least in Arizona, California, Colorado, Delaware, Minnesota, Washington, and Oregon), a medical marijuana card is an affirmative defense for possession of marijuana. The immunity from criminal prosecution does not mean anything to a zero tolerance employer.

In fact, there is case law that allows an employer to terminate an employee who was under the influence of medical marijuana while at work, even though some states allow medical and recreational use. It is probable that a zero tolerance for marijuana in the work place will still hold up, even in California, since employers are encouraged to promote a drug free work environment for safety, productivity, and customer service considerations.

Can a claims administrator be legally responsible for paying for medical marijuana for a work related injury? So far, in California, the answer is “maybe” but in New Mexico, the answer is “yes.” In Vialpando v. Ben’s Automotive Service (2014) 331 P.3d 924, cert. denied 331 P.3d 975, the New Mexico Court of Appeals held that the New Mexico Compassionate Care Act [NMSA 1978, Sections 26-2B-1 to 7] includes a product or service from a supplier that is reasonable and necessary for an injured worker’s treatment. The court held that a primary treating physician’s recommendation for marijuana use for chronic pain is equivalent to a prescription. The court rejected the employer’s contention that the employer would violate federal law for paying the costs of medical marijuana and the court found that reimbursement for medical marijuana is no different than paying reimbursement for medical supplies or equipment. (Note: It remains to be seen if New Mexico legislation in 2016 will overturn this decision. See HB 195/SB 245.) Marijuana is a cash business since the banking industry is federally regulated and money that is deposited from marijuana transactions would violate the banking laws and could be subject to federal seizure. So a workers’ compensation claims administrator in New Mexico can only pay the injured worker reimbursement for his or her purchase of medical marijuana at a dispensary.

In California, the Medical Marijuana Act prohibits insurers of any kind to be liable for payment for any medical marijuana. California Health and Safety Code Section 11362.785(d) specifically prohibits payments by insurers for medical marijuana, stating: “Nothing in this article shall require a governmental, private, or any other health insurance provider or health care service plan to be liable for any claim for reimbursement for the medical use of marijuana.” It is doubtful this law will change even if legalization for recreational use passes in 2016. However, like in New Mexico, claims administrators may be forced to pay the injured worker reimbursement for his or her purchases of medical marijuana that is reasonably necessary for the cure and relief of the effects of the industrial injury pursuant to Labor Code Section 4600 in connection with a workers’ compensation claim that is accepted. Case law is developing to determine if a workers’ compensation claims administrator is a “governmental, private, or any other health insurance provider or health care service plan.” The statutory provision seems to apply only to general health care plans as opposed to treatment for work related injuries by a claims administrator, who by definition is not a health insurance provider or health care service plan.

Has the UR/IMR process [Labor Code Sections 4610 and 4610.5] in California ever authorized the use of medical marijuana as medically necessary? The answer is “yes.” In IMR Case Number CM14-0026456, a utilization review denial of medical marijuana was overturned by the Independent Medical Reviewer. This case involved a 43-year-old male who developed traumatic and anoxic [loss of oxygenation] brain injuries from an electrocution injury on September 15, 2001. He has significant white matter changes on MRI scanning in addition to frontal lobe dysfunction on EEG studies. He has been diagnosed with hypoxic encephalopathy, subcortical dementia and frontal lobe dysfunction. He is reported to express anxiety, irritability, disorientation, frequent headaches and orthopedic back pain and knee problems. He has been treated with extensive outpatient and inpatient interventions. His medications include Prozac, Gabapentin [Neurontin], Fioricet, and Viagra. His headaches and irritability are not well controlled.

The question presented was whether marijuana use for aggression and anxiety is medically necessary and appropriate. The Utilization Review physician found that medical marijuana was not appropriate since based on the MTUS [Medical Treatment Utilization Schedule] Chronic Pain Guidelines, Cannabinoids, there is not enough evidence to justify the use of marijuana for chronic pain and marijuana is a Schedule 1 controlled substance under Federal law. The IMR physician overturned the denial citing Non-MTUS Other Medical Treatment Guideline or Medical Evidence: “Effect of Marijuana Use On Outcomes In Traumatic Brain Injury” Nguyen et. al. [http://www.ncbi.nlm.nih.gov/pubmed/25264643] also citing “The Endocannabinoid System: A Key Modulator of Emotion and Cognition” Patrixia Camolongo, [http://ncbi.nlm.nih.gov/pmc/articles/PMC3490098]. ”

The IMR reviewer then stated:

“MTUS and ODG Guidelines do not address the issue of cannabis use for emotional effects of anoxic and/or traumatic brain injury. This is not being requested in the context of chronic pain. There is good evidence that Cannabinoids are neuroprotective from injury and there is established evidence that cannabis can impact anxiety/anger disorders with improvement or worsening depending on the individual. Given the nature of the medical diagnosis there are no quality evidence based studies. However, under these unique circumstances a trial of marijuana is medically reasonable as its known mechanism of action may be beneficial in this setting. If it is not clearly beneficial, long term approval should be re-reviewed.”

In this case, the Applicant has to purchase his medical marijuana directly from a licensed dispensary and then seek reimbursement from the workers’ compensation claims administrator. This IMR is the first known medical necessity decision that authorizes the use of medical marijuana as reasonable and necessary treatment. Notice that the IMR reviewer specifically stated in his or her decision that marijuana use in this case is for modulation of emotions from brain damage and is not being prescribed for chronic pain. It remains to be seen in other cases whether medical marijuana can be justified in a work injury for treatment of chronic pain by utilization and IMR reviews.

JAMA and NEJM Medical Marijuana Research Reviews

Other than five thousand years of anecdotal evidence, what legitimate medical research exists to date on the medical benefits, if any, of marijuana? As stated earlier in this article, no large scale randomized, placebo controlled trials (RCT) involving human participants have been conducted due to fear of losing federal grant money. Some small studies show promising results for use of marijuana for chronic pain but the results are conflicting. Some emerging studies, also with too small number of participants, showed a synergistic effect when using marijuana with an opioid which lowered opioid use and abuse. These studies show fewer side effects from marijuana use than from opioid use. Formal research needs to be conducted to see if marijuana can be an effective treatment for substance use disorders. After all, no one has ever died from an overdose of marijuana while over 28,000 people have died from opioid overdoses in the last year in the United States.

There is some evidence that marijuana can be effective for some patients who have neuropathic pain [such as in causalgia, cauda equine syndrome] and some indication of effectiveness for patients, including children, who have severe spasticity [from Multiple Sclerosis, paralysis, epilepsy, or stroke]. Also, there is some empirical evidence that marijuana causes appetite improvement for patients on chemotherapy from cancer treatment and patients who have weight loss due to active AIDS.

The effectiveness of cannabinoids including Delta-9 THC on patients with seizure disorders are mostly anecdotal and a survey of studies demonstrate a need for double blind, placebo controlled random clinical trials to determine whether psychoactive or non-psychoactive marijuana provides effective treatment. A review of existing studies in the United States and abroad shows how inconclusive the medical evidence is on whether or not marijuana can be effective in the treatment of certain seizure disorders. See Friedman and Devinsky, Cannabinoids In the Treatment Of Epilepsy, New England Journal of Medicine, September 10, 2015, 373, 11, 1048-1058. In this article, the authors point out that 30% of patients who have a seizure disorder do not respond to anti-seizure medications that are on the market. In addition, they indicate that there is evidence that marijuana has been used to treat seizures since 1800 B.C.E. in Sumeria.

The authors’ review of existing studies show so far that use of marijuana for certain seizure disorders is promising but the medical evidence is too weak. The neurologist-authors express their concern about the effects of marijuana on the human brain at page 1051:

“Much of the available data regarding the safety and side-effect profile of cannabinoids, especially with long-term use, come from studies examining the effects of recreational use [citing Solowij, Adverse Effects of Cannabis, Lancet 1998; 352: 1611-6; Volkow, et. al. Adverse Health Effects of Marijuana, NEJM 2014; 370: 2219-27]. The short-term side effects of cannabis use may include impairment of memory, judgment, and motor performance. High levels of Delta 9 THC are associated with psychosis and an increased risk of motor vehicle accidents. With long-term use there is a risk of addiction, which occurs in 9% of long term users. Other effects of long term use include cognitive impairment, decreased motivation, and an increased risk of psychotic disorders.”

The authors go on to warn on page 1052 that there is emerging evidence that cannabinoids affect the endocannabinoid system development in childhood and adolescents and early exposure to Delta 9 THC may lead to cognitive and behavioral changes. Brain imaging studies are showing that there are “altered structure and function in long term adult users, including impaired connectivity of the prefrontal cortices and precuneus and decreased volume in the hippocampi and amygdalae; long terms use of cannabis in childhood may be associated with lower than expected IQ scores but socioeconomic status may be a confounding factor.”

In the Journal of the American Medical Association, June 23, 2015 edition there is an article entitled, “Cannabinoids For Medical Use, A Systematic Review and Meta-Analysis,” by Whiting et. al. 313(24) 2456-2473 which summarizes the existing medical research on medical marijuana. The authors evaluated 79 trials with 6,462 human participants where only four of the studies had a low bias. A “bias” means that the quality of the study results are compromised due to having too small sample size, the selection of study participants had a selection criteria that affected the neutrality of the study, there are incomplete outcome measures, or the study design itself skewed the results. The authors point out that only four of the clinical studies had a strong design that was double blind, placebo controlled, and randomized with four to six arms. However, most of the studies did have a control group who were given a placebo.

The studies were mostly conducted outside the United States with some that were conducted here. The studies involved derivatives of cannabinoids including Ajulemic acid [approved by FDA on 2/10/15 in the United States as non-psychoactive synthetic cannabinoid oral capsule for treatment of inflammation of scleroderma], Dronabinol [synthetic THC for treatment of anorexia from AIDS, cancer weight loss], Levonantradal [not in use, synthetic version of Dronabinol], Nabilone [synthetic THC for chemotherapy induced nausea approved by FDA in 1985], Nabiximols [combination of THC and cannabidiol not approved in US but used in Europe for spasticity from multiple sclerosis], ECP002A [98% pure THC, not used in US oral tablet for spasticity], Cannabis [THC smoked three cigarettes a day with potency 2.5% to 9.4% active, or oral capsule, or vaporized form, pain, Tourettes syndrome].

The studies were ranked based on strength of evidence that is used in the research community and in evidence-based medicine. So a high quality study has a large sample size, placebo controlled double blind four arm random clinical trial with minimal or no bias, and replicated in the scientific community with a peer reviewed publication. A very low quality study means the results are promising but you cannot put any weight on the results to apply to the general population.

The results of the authors’ review of the existing marijuana studies show that there is moderate quality evidence to support the use of cannabinoids for the treatment of chronic cancer or neuropathic pain or spasticity [multiple sclerosis patients or paraplegics for example]; low quality evidence that suggested that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain for AIDS infection, sleep disorders, and Tourette syndrome. There is insufficient evidence of improvement in symptoms of depression with marijuana use. In addition the studies indicated that use of cannabinoids resulted in an increased risk of short term adverse effects including dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination.

Most of the studies reviewed by the authors did not involve the study participants smoking marijuana—most of the studies involved the participants being given oral capsules of Delta 9 THC or Nabiximols, or a placebo equivalent. The chronic pain patients were either cancer patients or had documented neuropathic pain and the marijuana seemed to improve pain scales by 30% compared to placebo groups. The authors caution that any positive result must be weighed by the fact that none of the studies were pristine. For example, there is no way to tell what component in the marijuana, if any, was effective in reducing pain by 30% or in reducing spasticity for multiple sclerosis or paraplegic patients.

If you read this JAMA article, you come away from it concluding that better quality research on the effects of marijuana on chronic pain, spasticity, depression, multiple sclerosis, anxiety, nausea/vomiting, sleep disorders, epilepsy, depression, Tourette’s syndrome, and Glaucoma are needed. Most of the studies reviewed in the JAMA article were performed in England and Canada.

There is quite a bit of anecdotal evidence that regular use of marijuana helps reduce muscle spasms, reduces pain levels, increases appetite, reduces anxiety, reduces the frequency and severity of seizures, and assists in getting and staying asleep. These anecdotal beliefs need to be formally studied especially if recreational marijuana use is legalized.

Back to the Workers’ Compensation Community

As medical marijuana transforms itself from vague “medical use” to recreational use by legislation in many states, including California, we will hopefully see science catch up with anecdotes. First and foremost, Congress needs to pass legislation that redefines marijuana and Delta 9 THC as a Schedule II controlled substance. As of the date of publication of this article in 2016, US Senate Bill 683 the CARERS Act [Compassionate Access, Research Expansion, and Respect States Act of 2015] is pending in Congress to declare marijuana a Schedule II controlled substance, fund research, and to modify federal banking laws. This transformation will allow federal funding by the NIH, NIDA, and the CDC to study marijuana and its compounds to see what real medical benefits or risks are involved. This will result in the quality control for dosing and type of marijuana that the public may purchase for effective medical use, if any exist.

In the meantime it looks like even California is moving towards allowing medical marijuana to be authorized for treatment of work related traumatic brain injuries in order to reduce anxiety and modulate emotional effects of documented brain damage. It is a matter of time that medical marijuana may be the least of all evils for treatment of chronic pain, compared to the severe potential consequences of long term use of opioids including dependency, addiction, and overdose. Before any of this happens, better controlled research needs to be conducted where the compounds of cannabis can be isolated and tested to see what components of marijuana actually has health benefits. In technical terms, we do not know what the pharmacodynamics are for the psychoactive and non-psychoactive cannabinoids in marijuana. We don’t know to what extent marijuana can serve as a medicine and how specific dosages and types of marijuana can be processed with uniform consistency, potency, safety, and efficacy.

We cannot ignore the fact that marijuana use is creeping into the workers’ compensation arena and we need to discover its role, whether prescribed or not, and how marijuana use affects injured workers who are also taking prescribed opioids, benzodiazepines, muscle relaxants, and hypnotics. We do not know the synergistic affect marijuana may have on injured workers who are taking narcotic pain medications, anti-anxiety medications and or sleeping medications. Conversely, perhaps injured workers would improve functioning, experience pain relief, and become less dependent on prescribed potentially addictive medications such as these in favor of a few joints per day instead, with only a 9% risk of addiction to marijuana.

Something to think about while you don’t bogart that joint, my friend, and pass it over to me; roll another one, just like the other one…[Fraternity of Man, Country Joe and the Fish; Easy Rider, 1969].

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