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Marijuana Moves Forward in Comp Despite Shortage of Evidence: Top [2017-08-16]

Evidence is lacking on the effectiveness of marijuana for treating chronic pain, according to a new report that reviews 27 previous research studies, but some

say the findings shouldn’t stop the use of marijuana for treating injured workers.

The report, published Tuesday in the Annals of Internal Medicine, found low-strength evidence that cannabis alleviates nerve pain, but insufficient evidence that it is effective for other types of pain, including fibromyalgia or rheumatoid arthritis.

The authors, from the VA Portland Health Care System and Oregon Health & Science University, also found insufficient evidence that marijuana relieves post-traumatic stress disorder. The PTSD findings appear in a separate article in the same edition of Annals of Internal Medicine.

Workers’ comp medical treatment guidelines also note the lack of evidence to support marijuana as a treatment for pain and don’t recommend its use. Still, at least six states — Connecticut, Maine, Massachusetts, Minnesota, New Jersey and New Mexico — have accepted marijuana as a compensable treatment for injured workers.

While evidence is lacking to show the effectiveness of medical marijuana in treating pain, Paul Sighinolfi, executive director of the Maine Workers’ Compensation Board, said the results have been dramatic in some individual cases.

“Anecdotally, there are some folks who are getting significant benefit,” Sighinolfi said.

One of those is Gaetan Bourgoin, who suffered a work-related back injury in 1989 while working for Twin Rivers Paper Co. After a variety of narcotics to treat his pain were ineffective, Bourgoin received a medical marijuana certification in 2012, according to court documents. Since then, marijuana use has reportedly reduced his pain and allowed him to sleep better.

Sighinolfi said Bourgoin hasn’t made a claim for opioids in five years, and medical expenses in the case have dropped dramatically.

“The quality of his life has improved,” Sighinolfi said.

In August 2016, the Maine Workers’ Compensation Board’s Appellate Division upheld administrative law judge orders for reimbursement of Bourgoin’s medical marijuana expenses, as well as for a claimant in a separate case. Bourgoin’s case has been accepted for review by the Maine Supreme Judicial Court, where oral arguments are scheduled for Sept. 13.

In New Mexico, three Court of Appeals decisions in 2014 and 2015 affirmed that an injured worker’s use of medical marijuana can be deemed “reasonable and necessary care” under the Workers’ Compensation Act. The state added marijuana to its workers’ comp fee schedule effective Jan. 1, 2016, allowing reimbursement to workers for the cost of medical marijuana deemed necessary in workers’ compensation claims.

Nineteen claimants were reimbursed a total of $46,800 for medical cannabis use associated with their workers’ compensation claims in 2016, with an average per claim of $2,465, according to a New Mexico Workers’ Compensation Administration annual report.

The claimants were predominantly male, and about 80% of the claims involved a sprain, strain or tear, the report said.

Some have expressed concern that injured workers in New Mexico would seek the maximum allowed reimbursement for marijuana, which is 920 units of about a gram each per year, at $12.02 per unit, for an annual maximum reimbursement of $11,058. But during 2016, the average marijuana reimbursement of $2,465 was far less than the maximum.

Chiropractor Allen Miller of Doctors Cannabis Consulting in Pasadena, California, sees the potential for a greater role of cannabis in treating injured workers. Miller said he is successfully treating patients with cannabinoid extracts.

“The anecdotal evidence was so strong, that what did we have to lose?” said Miller, who used cannabis himself to overcome an opioid addiction following several injuries.

Miller is now working with a workers’ comp third-party administrator to make the products available to injured workers. Miller said the extracts he uses minimize the presence of THC, the psychoactive component of marijuana.

Work Loss Data Institute’s Official Disability Guidelines, or ODG, say that cannabinoids are “not recommended for pain.”

“New JAMA reviews have highlighted the lack of evidence to support medical marijuana in most indications, and there are also legal implications for doctors prescribing this,” ODG says. The legal implication relates to the fact that marijuana is still illegal at the federal level, despite its approval for medical use in many states.

Colorado, which writes its own workers’ comp medical treatment guideline, says in a new draft guideline for chronic pain that marijuana use is illegal under federal law and “cannot be recommended for use in this guideline.”

Between 45% and 80% of those who use medical cannabis do so for pain management, according to the authors of the Annals of Internal Medicine articles. And among those who are prescribed long-term opioid therapy for pain, as many as 39% also use cannabis, they said.

“Physicians will increasingly need to engage in evidence-based discussions with their patients about the potential benefits and harms of cannabis use,” they said. “However, little comprehensive and critically appraised information exists about the benefits and harms of using cannabis to treat chronic pain.”

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