Bringing Change to Workers’ Compensation – Opioids vs. Medical Cannabis
The term “Thought Leader” has come to mean a person that demonstrates a level of expertise around certain issues and pushes the conversation surrounding those issues forward in an attempt to facilitate change and progress. These individuals are driven by passion, are knowledgeable, and can articulate information in a way that is interesting and informative. Mark Pew is such an individual. His work is focused on “the intersection of chronic pain and appropriate treatment.” With his signature tagline, “Educator and Agitator”, Mark aims to bring change to the workers’ compensation sector regarding the over-prescription of opioids. He sees medical cannabis as not only an inevitable alternative but potentially the best.
Opioid Crisis
The opioid crisis may not be at the forefront of the minds of the American people with all the issues gripping the world today, but it is still wreaking havoc in communities across the nation. Overdose deaths have been on the rise for years in the United States, with opioids being responsible for the majority of those deaths. The chief medical officer at Phoenix House substance abuse treatment centers in New York said that “people who become addicted to opioids and are having trouble maintaining a supply of painkillers are likely to switch to heroin if they live in an area where it is available.[1] Prescription opioids can be a gateway to heroin. Therefore, appropriate prescribing practices, regulations, and alternatives are essential when it comes to workers’ compensation. Opioids have been irresponsibly prescribed to workers’ compensation claimants, often without being educated about the types of treatment available to them, including opioid alternatives. With the number of states legalizing cannabis increasing, insurers question whether prescribing cannabis is a safer alternative to opioids like Oxycodone and Morphine. It has been found that when given access to cannabis, individuals currently using opioids for chronic pain decrease their use of opioids by 40-60% and report that they prefer using cannabis to opioids.[2]Armed with the information from thousands of pages of medical records and hundreds of thousands of drug transactions, Mark sees not only the issues fueling the opioid epidemic but also a glimmer of hope as research on the medicinal properties of cannabis continues.
Mark is an advocate for the BioPsychoSocialSprirtual treatment model, which proposes that suffering, disease, or illness involves a host of factors with biological, environmental, and spiritual origins. It aims to treat the person and not just the symptom. It also takes into consideration the many factors that contribute to a patient’s subjective experience of chronic pain. Keeping in mind that with chronic pain can also come depression, fear, anxiety, feelings of hopelessness, suicidal ideations, and overall psychological crisis. Long-term care can include a list of medications like prescription opioids (Oxycontin, Percocet, Hydrocodone), NSAIDs (Celebrex, Mobic, Motrin), and Anti-anxiety (Xanax, Valium, Ativan), muscle relaxant (Soma, Flexeril, Zanaflex) antidepressants (Cymbalta, Zoloft, Wellbutrin). But wait, there’s more. Many if not all these medications come with potential side effects, including but not limited to Opioid-Induced constipation, insomnia, excessive sleepiness, dry mouth, stomach ulcers, etc. And with these symptoms, comes more medications. It’s easy to see how costly and messy a workers’ compensation claim can get. Costly for the Insurer, and messy for the quality of life of the claimant and potentially their loved ones. And while continued research is needed on the efficacy of medical marijuana in the treatments of anxiety, depression, and chronic pain, Mark believes if the use of cannabis reduces the dosage or eliminates the need for pain management drugs (and their side effects) and it’s generally less expensive, then the question becomes what works for that individual’s condition(s) and what’s allowed in that specific state.
Because Mark’s work is focused on the intersection of chronic pain and appropriate treatment, the misuse of opioids and the emergence of cannabis are two focal points. “The primary use for both prescription opioids and cannabis is for analgesia. Currently, 90% of patients in state-level medical cannabis registries list chronic pain as their qualifying condition for the medical program.”2 In fact, many of Mark’s followers from various social networking platforms are injured workers or people with chronic pain. Working people and everyday individuals are seeking treatment for pain but do not want to become dependent on highly addictive substances. Employers want their employees fit to return to work coherently and within an appropriate amount of time. Insurance carriers, employers, and employees would all prefer to avoid opioid dependence, which can be an unintended consequence of a workplace injury/claim. Mark aims to provide digestible information to nonprofessionals as a self-proclaimed “laymen’s vessel” for what he considers to be the best practices and standards of care.
One point that should be kept in mind is that opioid use is not inherently wrong. What is wrong is the misuse of opioids, their over-prescription, and the lack of education surrounding them and their alternatives. “Clinical and pre-clinical data suggests that analgesic synergy produced by co-administered cannabis and opioids could be harnessed to achieve clinically relevant pain relief at doses that would normally be sub-analgesic. This strategy could have significant impacts on the opioid epidemic, given that it could entirely prevent two of the hallmarks of opioid misuse: dose escalation and physical dependence.”2
Mark has been keeping an eye on medical cannabis since 2014. His article, featured in the publication ‘Claims Management’, outlined the various complexities insurers, employers, and legislators would face as more and more states considered legalization. “Have legal counsel analyze the legislative landscape, medical directors examine the physiological and pharmacological aspects, and risk managers weigh in on worksite safety issues to lay the groundwork for organizational policy.”[3] As if assigning homework, the RxProfessor laid out a framework indicating tasks each sector should address.
Mark’s goals have led him into various fields of study, including the psychotherapeutic theory of Cognitive Behavioral Therapy. CBT has been demonstrated to be effective for a range of issues including depression, anxiety disorders, alcohol and substance abuse, and many others. Numerous research studies suggest that CBT leads to a significant improvement in functioning and the quality of life. Some studies even show CBT to be as effective as, if not more effective than, psychiatric medications.[4] Mark has also explored eastern modalities like the various practices of yoga and acupuncture to further his understanding of internal healing.
Because Mark’s work has been recognized as industry-leading, he’s been the recipient of several prestigious awards. He received the 2016 Magna Comp Laude, the second-highest award from WorkCompCentral. In 2017 he was awarded IAIABC’s Samuel Gompers Award for thought leadership. His blog has been recognized three years in a row as a WorkersCompensation.com’s “Best Blog”. All that we can ask is that he keeps doing what he’s doing. The goal of alleviating chronic pain is to improve the quality of life. A study showed that medical cannabis can improve quality of life and pain outcomes in patients with chronic pain. That same study demonstrated significantly reduced opioid consumption when medical cannabis was used. Additionally, it showed a decrease in monthly analgesic prescription costs, due to a reduction in the number of oral opioids and fentanyl patches. Applying these ideas to the workers’ comp sector could mean workers alleviating pain quicker, claims being closed faster and more savings for insurers.
At present, 37 states, four territories, and Washington D.C. have laws that allow for the medical use of cannabis with qualifying conditions. Of those, only 6 are requiring workers’ compensation insurers to reimburse medical marijuana. They are Connecticut, Minnesota, New Mexico, New Hampshire, New Jersey, and New York. Although these states allow reimbursement, does not mean it is an easy process. Injured workers will still need to have one of the qualifying conditions required by that state’s medical cannabis registry. Chronic pain, 90% of patient-listed qualifying conditions, is typically defined as pain persisting longer than 12 weeks. In this case, a claimant would also have to provide proof that other pain management strategies like physical therapy were ineffective before cannabis can be prescribed. Keeping the opioid discussion in mind, a push for cannabis prescription and reimbursement before considering opioids would benefit society. There are still many hurdles to overcome before this becomes a seamless transaction. Some states, like Florida, specifically state that medical cannabis is not reimbursable under workers’ compensation statute. There are still many hurdles to overcome. With the increase in legal medical use, what happens when an employee who consumes medical cannabis is injured on the job? These are reasonable concerns that lead to in-depth analysis and conversation surrounding the issue. Twelve states have explicitly chosen to either bar or allow the reimbursement of medical marijuana. The other 25 states and D.C. are either not requiring reimbursement or choosing to wait silently as progressive legislation rolls out.[5] As the long-held stigma surrounding cannabis fades and the efforts that lead to legalization continue, researchers are publishing studies that dismantle the fears believed by many. The findings of these studies may contain insights that will allow lawmakers to rest assured knowing that cannabis is the way to go.
[1] “More Comp Claimants Turning to Heroin: Efforts to Limit Opioid Addiction Are Leading to Heroin Abuse.” https://riskandinsurance.com/more-comp-claimants-turning-to-heroin/
[2] Wiese, Beth, and Adrianne R Wilson-Poe. “Emerging Evidence for Cannabis’ Role in Opioid Use Disorder.” Cannabis and cannabinoid research vol. 3,1 179-189. 1 Sep. 2018, doi:10.1089/can.2018.0022
[3] Quote from “Are You Ready For Medical Marijuana? Understanding the Medical, Legal, and Liability Implications for Insurers.” Publication: Claims Management. Author: Mark Pew
[4] https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
[5] https://riskandinsurance.com/6-states-require-workers-comp-insurers-to-reimburse-medical-marijuana-is-your-state-one-of-them/
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