Recent Developments in Workers' Compensation Pain Management

A look at efforts to reduce opioid dependency, make marijuana prescriptions reimbursable, and legalize psychedelics for medical use.

Tapering Opioid Use. Opioids have often been a mixed blessing in workers compensation treatments since they were introduced over 20 years ago. The main problem with these pain relievers is their addictive nature, often leading to overdoses. The Centers for Disease Control and Prevention (CDC) reports that nearly half a million people died from opioid overdoses for the ten-year period ending 2019.
With greater awareness of the problem, the workers comp medical community has enacted policies that have reduced the number of legal opioid prescriptions. But only slightly — since opioids are still an important pain management tool. The aim now is to control the severity and magnitude of the opioid crises through better drug management.
The focus is on “tapering.” Tapering gradually reduces the quantity of opioids given to a patient in a way that minimizes withdrawal symptoms. The CDC suggests several situations that warrant tapering:

Patient requests dosage reduction. Patient is taking strong opioid medications without meaningful improvement. Patient exhibits discernable signs of overdose, such as aberrant behavior, “inconsistencies in urine screenings, breaking the ‘pain contract’ — an agreement with one’s treating physician — or using recreational drugs such as cannabis while on opioids.”

Some concerns have been raised about tapering. A study by University of California, Davis, indicated a 68% increase in overdoses and twice the number of mental health crises among patients tapering. That report, however, has been criticized for limitations in its population, consideration of comorbidities and sample size.

Although tapering offers the potential to help people reclaim their lives by defeating opioid addiction, it’s important to proceed with caution. The CDC stresses the importance of making regular clinical assessments when initiating a tapering plan, taking into consideration adjustments appropriate to the patient.

Making Marijuana Reimbursable. Thirty-six states and the District of Columbia have now passed laws allowing marijuana use to some extent. At the same time, attitudes about the use of marijuana in the treatment of certain illnesses have become increasingly favorable. This is despite how cannabis remains a federally regulated Schedule 1 substance, meaning that according to law it has no medical value.
The medical community seems to mostly support the use of medical marijuana. According to a study published in the American Journal of Industrial Medicine by six separate comp-affiliated research organizations, “cannabis treatment for work‐related health conditions that are unresponsive to conventional medical treatments may increase as more workers petition state courts and administrative agencies for cannabis (workers compensation insurance) reimbursement.”

The issue now is whether marijuana treatment under workers compensation is reimbursable. A report from the National Council on Compensation Insurance found that only six states explicitly allow reimbursement for marijuana expenses related to workers compensation injuries (Connecticut, Minnesota, New Hampshire, New Jersey, New Mexico and New York). In addition, six expressly forbid it, 14 don’t require reimbursement and ten states and the District of Columbia have not taken a position.

Psychedelic Effects. Like marijuana, psychedelic drugs are Schedule 1 controlled substances and federally illegal. According to some medical professionals, however, like Craig Prince, clinical pharmacist for Mitchell Pharmacy Solutions, psychedelics “offer the potential of better treatments for disorders such as clinical depression, persistent anxiety, addiction disorders and PTSD.”

So far, only Oregon, the District of Columbia and select municipalities in California and Colorado have decriminalized psychedelic substances to some extent, especially psilocybin, the main active ingredient in “magic mushrooms,” for mental health treatment in supervised settings. But earlier this year a report for the Departments of Labor, Health and Human Services, Education, and Related Agencies (LaborH) contained language stating that the epidemic of veteran suicides necessitates an evaluation of alternative treatment options, including psychedelics.

“There have been many recent studies and clinical trials demonstrating the positive impact of alternative therapies, including psychedelics, for treatment resistant post-traumatic stress disorder (PTSD) and major depressive disorder, particularly for veteran participants,” it says. “In light of growing interest in this area, the Committee encourages [the National Institutes of Health] and other relevant Federal agencies to undertake, and where appropriate expand, research to evaluate the effectiveness of psychedelic therapies in treating PTSD, major depressive disorder, and other serious mental health conditions.”

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