The New Mexico Court of Appeals has supported the use of medical marijuana after a work-related injury.
The timing was inconvenient. The ruling was announced on Monday, May 19. The state’s annual workers’ compensation convention was the previous week. I wish the ruling had been announced a week earlier, so that it could have been part of the conversation at the convention.
If you had heard what I heard at that convention, you might be cheering about this ruling. Though it is fraught with complications that cannot be minimized, the marijuana ruling is potentially good news. That is, if you believe marijuana is less of a problem than opioids.
The convention, sponsored by the Workers’ Compensation Association of New Mexico, was all about the opioid epidemic. A few years ago, I wrote that the overuse of opioid prescription medication was becoming a crisis in the workers’ compensation system. This year, the opioid epidemic is established fact and the Number One topic of concern. New Mexico is among the worst states for opioid addiction.
It is well established that workers who become depressed and despairing after an injury have far worse outcomes than those who adapt to their condition and either go back to work or look for new opportunities. There is now plenty of scientific documentation that the addition of opioid painkillers, except for the short term, makes things worse for most users. The medication stops working, the injured person wants more, the larger dose interferes with thinking and life functions and the pain increases. One presenter showed findings that these medications “reliably cause worsening of pain.”
Marijuana is not an opioid. Legal use of prescribed marijuana will have to be tested over time, but it’s probably a better option, along with alternative therapies like meditation and acupuncture. New strains of marijuana have been bred to be higher in pain-killing compounds and lower in the ingredients that make people high.
The continuing complication, both for marijuana and opioids, is the uncertainty about when it is safe for workers to work, drive, or do other activities when using these drugs. That’s significant when employers are trying to make their workplaces safer by getting rid of alcohol and drugs. It will probably never be okay for workers doing hazardous physical labor to work under the influence, legal or otherwise. Bringing people back to work is a major goal of the workers’ compensation system, and it contributes to recovery. So this is a critical issue.
Why are doctors still prescribing opioids for long-term use, when the data is so clear? One answer – heard commonly among workers’ compensation professionals – is that doctors would rather spend five minutes writing a prescription than 45 minutes counseling a recalcitrant patient on why his life will be better and his pain will be less if he toughs it out and gives up the drugs. The secondary answer is that claims adjusters don’t want to pay for that 45-minute counseling session.
What gets paid for in workers’ compensation is regulated. It may be time for New Mexico to change the rules to force the parties to deal with this. Perhaps the rules should require that every person who receives prescription opioids following an injury and wants to continue after – say – three weeks — must attend a counseling session on the effects and alternatives. Payers should be required to pay for those sessions.
This is not to say the drugs should always be discontinued. There are some people for whom they work well and provide a lifesaving benefit.
Most of us, however, would be well advised to use opioids rarely and for just a few days, whether for a workplace injury or a toothache. If financial compensation for an injury is a factor, don’t talk yourself into exaggerating your suffering just to make more money.
It remains to be seen whether medical marijuana will help. I am optimistic.
© 2014 NEW MEXICO NEWS SERVICES