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Paduda: Opioid Use in Work Comp has Dropped — and Cannabis Does Reduce Chronic Pain

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Several states have seen precipitous decreases in the amount of opioids dispensed per claim. Kentucky, New York, Maryland and Michigan all saw reductions in excess of 35%.

Joe Paduda

Joe Paduda

In every one of the states Workers Compensation Research Institute studied, at least 30% of patients with opioid scripts also had a script for a central nervous system depressant. That’s just remarkable; the risk of adverse consequences goes up dramatically when patients take both drugs.

The good news is the percentage of workers who were prescribed this combination declined in most states, but the average decrease was a few percent. While there can and may well be good reasons for docs to prescribe these drugs for individual patients, the research indicates there are significant risks.

Some have said medical marijuana should be considered an alternative to opioids. If that’s a valid claim, that’s wonderful news indeed — and not just for growers, marketers, and pizza purveyors.

Dr. Dean Hashimoto reviewed the National Academies of Science’ report on all literature and evidence concerning the medical use of marijuana. The summary is here.

There’s conclusive support for cannabis’ ability to reduce chronic pain in adults, but at great risk of motor vehicle accidents, and the development of schizophrenia and other psychoses.

This is a big deal, as most patients using medical marijuana cite chronic pain as the reason for consumption. There’s a lot of evidence that medical marijuana is effective — evidence derived from well-controlled clinical trials. But little is known about efficacy, dosage, frequency, administration routes or side effects.

There was moderate support for better sleep outcomes, but at the price of impairment of learning and memory, and increased dependence on other substances such as tobacco and alcohol.

Interestingly, there isn’t enough data or research to associate non-medical cannabis use with occ injuries or accidents.

There’s more good news.

Two solid studies documented significant decreases in opioid overdose mortality rates and opioid addiction in states that allowed medical marijuana.

What does this mean for comp?

Well, 22 million Americans used cannabis in the last month. So it’s real, and it’s common. There’s no legal way to use the banking system to pay for medical marijuana, and there’s no guidance on dosage or other prescribing standards.

And there’s conflict between state regulations, case law and federal law.

We live in interesting times indeed.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column was reprinted with his permission from his Managed Care Matters blog.

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