Medical marijuana is an oxymoron. While there may be (un)scientific “evidence” that the drug has some redeeming medicinal value, I think it’s more akin to alcohol. Then again, I swear by mom’s hot toddy to cure what ails ya.

The problem, especially for employers and workers’ comp practitioners, is the lack of any standards or guidelines. This likely won’t change much – if at all – unless and until the federal government legalizes marijuana. Until such time, we’re on our own, and that’s a scary thing.

Workers’ comp is all about costs and outcomes. In the case of medical marijuana, neither can be determined with any degree of accuracy.

First, there are the dangers of marijuana, something I, as a child of the 60s/70s, never thought I would see. But it’s real. Terms such as “dependency,” “addiction,” “ER visits,” even “deaths” are being associated with marijuana use. Why? Part of it is the fact that the weed of today is not the pot of yesteryear. Growers have become more competitive – and sophisticated. Rather than fields somewhere in South America (or someone’s backyard), it’s now grown indoors with expensive lighting and climate control to generate the perfect grass; i.e., more potent.

Part of the problem is the forms in which medical marijuana is dispensed, especially the edibles. In addition to smokable varieties, dispensaries also sell ingestible products – presumably for those who want to avoid potential lung damage. But instead of pills they sell them as gummy bears, Swedish Fish, cookies, and – of course – the old standby, brownies.

Edible marijuana presents a whole slew of problems. Unlike the smoking variety where the user can quickly judge the effects on his body, the edibles have a delayed reaction – often up to 90 minutes or more. The user, unaware of the effect the drug is having, may munch on more gummy bears.

A pill would make more sense. Oh, right! They have that. Marinol and Cesamet. Why can’t those suffice as "medical marijuana?" Why make a "drug" into a goodie? Not only are kids more likely to steal one of mom’s gummy bears, but many adults have control issues when it comes to sugared snacks. Take the case of Levy Thamba Pongi.

The 19-year-old college student jumped to his death from a 4th floor motel balcony in Colorado last March after eating a medical marijuana cookie. The coroner later ruled that marijuana intoxication was a “significant contributing factor to his death.” He apparently had a THC level of 7.2 nanograms in his blood, more than the 5 nanograms Colorado considers to be marijuana intoxication.

The story goes that Thamba Pongi got the cookie from friends who purchased it from a dispensary and were advised they divide the cookie into six pieces – one dose each. After 30 minutes and not feeling any effects, Thamba Pongi was said to have eaten the entire cookie.

If the ending wasn’t so tragic, the story would make for good late night TV. Seriously. He was supposed to only eat 1/6 of a chocolate chip cookie. Who does that? How does one even get 1/6 of a cookie?

Then there is the still-ongoing case of Richard Kirk, accused of killing his wife last year in Colorado. Toxicology tests determined he had a small amount of THC – apparently due to the marijuana-laced Karma Kandy Orange Ginger he had eaten earlier. While there were other factors at play, the case, along with Thamba Pongi’s, has drawn the attention of the Colorado Legislature. Bills signed into law last year called for an analysis of what rules should be implemented to make edibles more identifiable, and possible changes to dosing amounts. But the rules are not due until next year.

Among the biggest problems for employers and workers’ comp practitioners is impairment. Since current drug tests detect the presence of marijuana in the body anywhere from three days to six months after the fact – depending on the type of test – how do you know if a worker is actually impaired? In states that deny benefits when alcohol or drugs are determined to be a contributing factor, how do you determine if marijuana was actually a contributing factor?

There are also concerns about medical marijuana and driving, especially with motor vehicle accidents among the chief causes of occupational injuries. Separate studies from the National Highway Traffic Safety Administration and the University of Colorado School of Medicine found “dramatic” increases in the rate of marijuana-positive drivers involved in fatal motor vehicle crashes after Colorado legalized medical marijuana.

Then there is the cost. A case in New Mexico last year resulted in the insurer having to pay for medical marijuana. The amount the insurer would have to pay was being determined. How does a payer figure that? How does the insurer reserve for medical marijuana? Granted, these are not cases we are seeing a lot in workers’ comp, but the fact that there was one is disturbing – and means there could/will be another.

Questions about availability and dosage are also concerns. Say an injured worker is given a script for medical marijuana, and a court ultimately says the employer/insurer has to pay. In what form should the marijuana be distributed? And from whom? What if a particular strain of the drug seems to do the trick for said worker, but that strain disappears from the market. Is there a generic equivalent? And what about the dosage?

What is the right dosage and who determines that? Physicians "prescribing" medical marijuana don’t indicate the dosage on their prescription pads. Even if they did, how is that controlled, since it’s not in a pill form that has a specific measurement. Seems the medical marijuana users are at the mercy of the dispensary clerks for their best guesstimates. How did the one clerk come up with the 1/6 of a cookie dose? What about differences in, say, males and females? Or weight differences – what are the right dosages? And how do you measure those doses, especially when the different strains can obviously have different potencies?

Who controls the grower or supplier? What safeguards are there that the marijuana isn’t laced with something else?

What kind of outcomes can we expect from the injured worker who is on medical marijuana? Can he return to work as long as it’s for non-safety-sensitive duties?

Some say medical marijuana is a non-issue in workers’ comp. Until we get some standards, guidelines and guarantees, I hope so. I really do.