Addressing Medical Marijuana in Claims

With the approval of marijuana as a treatment for medical conditions in 23 states, plus Washington D.C., and the legalization of recreational marijuana use in two states (Colorado and Washington where its legal medically and recreationally), there are several factors an adjuster should consider when handling an injury claim involving legalized marijuana use.

Recently, Bernyce Peplowski MD, senior vice president National Medical Strategy and Innovation with US Health Workers Medical Group, presented on the topic of ethics of medical marijuana for casualty claims during the annual Combined Claims Conference held in Orange County, California.

According to Dr. Peplowski, who was previously with State Fund, adjusters handling liability injury claims with subrogation and workers’ compensation claims need to be cognizant of the states with legalized marijuana laws and with pending regulations in 15 more states.

Though medical marijuana may be legal in certain jurisdictions, it doesn’t mean a patient should use it for treatment, Dr. Peplowski said. That’s because none of the treatment guidelines recommend medical marijuana.

She noted that marijuana has been found to benefit those with seizure disorders, as an anti-inflammatory for IBD, and in place of opioids as it lessens deaths from overdoses.

Some risks, according to Dr. Peplowski, include psychosis, anxiety, panic attacks, depression, increased effects when mixing with alcohol, cyclic vomiting syndrome and flash burns that may occur during marijuana extraction.

Marijuana has 400 chemical components, she said, with THC being the most psychoactive. It’s considered a schedule I drug by the FDA, under the Controlled Substance Act – the same as heroin and LSD – because it has a high abuse potential. And there have been no large, blind randomized studies or human trials.

It’s currently illegal for a physician to write a prescription for medical marijuana, he or she can only recommend it for treatment. There are currently websites that push doctors to refer patients towards medical marijuana treatment. The doctors that do so run the risk of a medical malpractice claim, she said.

Some of the FDA’s questions related to medical marijuana include:

1. How should it be dosed, i.e., THC levels?
2. Dose-response effect?
3. How much toxin is harmful?
4. Side effects?
5. Best/worst routes to administer – smoke, ingest, pills, spray?
6. Contraindications with other drugs?

It is illegal under federal law for anyone to sell or use marijuana, and though this law supersedes state laws, the U.S. attorney general granted jurisdiction to states in October 2009.

She described dosing thresholds as:

• 10-30 mg THC – intoxication
• 100 mg in adult – delirium or psychotic
• 100 mg in child – respiratory arrest

A single cookie or pack of gummy bears equals about 100 mg. Though child-proofed until opened, there are currently no instructions or warnings on packaging. The Denver Post conducted a test on several cookies and found THC ranging from 0-146 mg.

The route of administration matters, said Dr. Peplowski. It will last in the body longer if it is ingested. Clinical effects will occur in 30 minutes, peaking in three hours and clearing out in 12 hours. Smoking it is the fastest method – effects begin within 10 minutes, peaking in 30-90 minutes and clearing out of the system within four hours.

According to Rob Shatsnider, vice president of CompWest Insurance, another presenter on the topic, it is easier to review bills on liability claims since treatment has already occurred. The main issue is med pay.

Payors or claims handlers evaluating bills relating to medical marijuana should:

• Consider the medical necessity;
• Evaluate other approved treatment;
• Determine if a step protocol been considered/completed;
• Obtain a signed contract between the patient and physician;
• Schedule urine drug testing.

He said that adjusters don’t have to do anything with Medicare Set Asides because the government doesn’t currently recognize marijuana as a medical treatment.

He noted that there are varied risks in paying for medical marijuana treatment. These include the possibility of delayed return to work, the possibility that a claimant under medical marijuana could contribute to a motor vehicle accident, psychosis and addiction.

Shatsnider pointed to a case in New Mexico where the appellate court mandated a workers’ comp insurer cover medical marijuana as treatment for an employee’s chronic pain relating to a workplace injury. The case is currently pending a decision by the Supreme Court.