Of all the states, who would have guessed that New Mexico would be the hotbed of medical marijuana court decisions? Between the Vialpando v. Ben’s Auto. Servs., in May and the Maez v. Riley Industrial case, handed down earlier this month, New Mexico’s Court of Appeals appears to be one of the most pro-marijuana courts in the nation.

Back in May, when I first wrote about this issue, I wondered why the reasonableness and the necessity of the marijuana treatment was not questioned and our corporate counsel told me that surely there would be additional case law to clarify this issue.

Sure enough, the Court in Maez decided to take on the issue of the reasonableness and necessity of the marijuana treatment. Maez suffered from an industrial accident and was being treated by Dr. Reeve. Dr. Reeve had prescribed a variety of medications including several opioids and, as required for patients on long-term opioid therapy, performed regular urine drug tests. During one of those tests, Maez tested positive for marijuana. Typically, recreational marijuana use, or the use of any illicit substance, raises red flags with the prescriber. But not Dr. Reeve!

Dr. Reeve informed Maez that if he was going to use marijuana, he needed to have a medical marijuana license. Luckily for Maez, Dr. Reeve was happy to provide him with one. According to Dr. Reeve, “patients are going to use cannabis either one way or the other ... if a patient requests that I sign [a license], I will sign it ... but I’m not recommending ... or in any way advocating for the use of medical cannabis.” Dr. Reeve also considers the use of medical marijuana to be the patient’s decision “as it’s private and voluntary and it’s not overseen by a physician.”

So the guy ended up on a medical marijuana regimen due to a failed drug test. That should be sufficient for the court to find in favor of the payer, right?

Nope. And it gets worse.

The court went on to rationalize and interpret Dr. Reeve’s actions as reasonable and necessary stating that “[Dr. Reeve] adopted a treatment plan based on medical marijuana.  He would not have done so if it were an unreasonable treatment.” Imagine if that logic was applied to all work comp medical treatment. The doc says it’s reasonable … so it is. State statutes and regulations have been evolving for over a decade to specifically counter this argument. But not in New Mexico.    

And it gets even worse.

To take this determination one step further, since the physician said that it is Maez's decision to use medical marijuana, the court, by default, has determined that the self-directed use of marijuana by this injured worker is reasonable and necessary because the physician signed off on it. This is patient-directed care at its absolute worst.

So, to recap what led to this decision: Illicit drug use, perpetrated by the injured worker, condoned by the doctor and supported by a court of law.

I wish I could tell you that marijuana should be the least of your concerns, but if this is the specious logic to which we’re beholden … we’ll need better guidelines, better tools and better lawyers.

Michael Gavin is president of Prium, a managed-care provider for the workers' comp industry. This column was reprinted with his permission from the firm's Evidence Based blog.