California officials are accepting public comment through mid-March on a plan that would remove medical marijuana as an accepted treatment for injured employees in workers’ compensation cases. The change would effectively prevent doctors in such cases from recommending marijuana and end any compensation to pay for cannabis medications.
The change being considered by the California Division of Workers’ Compensation (DWC) is based on recently updated guidelines from the American College of Occupational and Environmental Medicine (ACOEM) that say cannabinoids are “not recommended” for treatment of chronic, acute or postoperative pain and separately advising against cannabinoid use by safety-critical workers.
ACOEM in an update earlier this year listed various health risks associated with marijuana use—including cannabis use disorder, motor vehicle crashes, schizophrenia and others—and further said that evidence shows that cannabis is ineffective or only minimally effective at treating various types of pain.
As a result of the ACOEM update, the worker’s compensation division is weighing a change that would remove marijuana and related treatments from California’s medical treatment utilization schedule (MTUS) in workers’ comp cases.
Cannabis reform advocates and workers’ rights groups are pushing back against the proposal, saying it conflicts with numerous other studies indicating that marijuana can be effective for treating pain, and are urging supporters to file written comments with DWC ahead of a planned hearing on March 14.
“The recommendation flies in the face of scores of scientific studies,” Dale Gieringer, director of California NORML, said in an email, “including reports by the National Academy of Sciences and California’s Center for Medicinal Cannabis Research, plus the experience of countless California patients and doctors who have found medical cannabis valuable for treating intractable chronic pain.”
Written comments, which can be submitted by mail, fax or email ([email protected]), must be received by officials no later than the day of the hearing, which will be held on Zoom beginning at 10 a.m.
The California Applicants’ Attorneys Association (CAAA), a trade group for lawyers who represent state residents who are injured on the job, is similarly opposed to the change, saying that ACOEM’s stance “conflicts with extensive research findings and common medical use of cannabis to alleviate pain in cancer patients and severe chronic pain sufferers.”
“Physicians frequently suggest cannabis as an effective alternative for pain management and nausea reduction while enhancing patients’ life quality during chemotherapy,” the group noted in an email to supporters. “ACOEM’s guidelines reject these applications because of insufficient clinical proof and potential safety risks in the workplace.”
While DWC is required by law to make evidence-based decisions about what treatments to allow in workers’ comp cases, CAAA questioned whether state officials should be relying exclusively on ACOEM recommendations.
“While workplace safety is undeniably a priority, the full exclusion of cannabis from the treatment guidelines raises questions,” the association said. “Should California’s workers’ compensation system rely solely on ACOEM’s prohibitive stance, or should it acknowledge the broader medical consensus that cannabis can provide relief in certain situations where other treatments fail?”
It noted that the proposal, if accepted, “will potentially impact injured workers seeking alternative pain management options.”
While observers say medical marijuana isn’t typically recommended in workers’ comp cases, they also pointed to a past determination by the Workers’ Compensation Appeals Board that permitted it as a treatment.
In 2022, however, the U.S. Supreme Court denied to review a pair of cases involving workers’ compensation claims in which the Minnesota Supreme Court ruled that federal law prohibiting marijuana preempted state law, meaning the employers were not obligated to pay for the medicine.
Plaintiffs and advocacy groups, such as Empire State NORML, argued at the time that, because employers aren’t required to possess, manufacture or distribute cannabis in contravention of federal law, simply providing workers compensation for marijuana is not preempted by the Controlled Substances Act (CSA).
After those cases were appealed to the Supreme Court, justices sought input from the top Justice Department lawyer. The solicitor general’s office subsequently filed an amicus curiae brief recommending the high court not take up the matter.
The filing acknowledged that several other state courts have weighed in on the issue, with differing opinions. But it said that none of those cases have “meaningfully considered all of the possible grounds for preemption,” so “no further review is warranted at this time.”
Separately, in 2023, a Pennsylvania court held that an employer’s denial of reimbursement for a worker’s out-of-pocket costs for medical marijuana to treat a work-related injury was a violation of the state’s Workers’ Compensation Act.
In recent weeks, meanwhile, newly published research on the use of medical marijuana for pain found that it was “comparatively more effective than prescription medications” for treating chronic pain after a three-month period, and that many patients reduced their use of opioid painkillers while using cannabis.
The study was conducted in part by a federal researcher at the National Cancer Institute (NCI) and funded by the state of Pennsylvania’s medical marijuana Academic Clinical Research Program.
Despite some methodological limitations, the analysis “was able to determine, using causal inference techniques, that use of medical marijuana for chronic pain under medical supervision is at least as effective and potentially more effective in relationship to patients with chronic pain treated by prescription medications (nonopioid or opioid),” the report said.
Separately, a recent federally funded study showed that legalization of marijuana in U.S. states is associated with reduced prescriptions for opioid pain medications among commercially insured adults—indicating a possible substitution effect where patients are choosing to use cannabis instead of prescription drugs to treat pain.
“These results suggest that substitution of cannabis for traditional pain medications increases as the availability of recreational cannabis increases,” authors of that report wrote, noting that there “appears to be a small shift once recreational cannabis becomes legal, but we see stronger results once users can purchase cannabis at recreational dispensaries.”
“Reductions in opioid prescription fills stemming from recreational cannabis legalization may prevent exposure to opioids in patients with pain,” the paper, published in the journal Cannabis, continues, “and lead to decreases in the number of new opioid users, rates of opioid use disorder, and related harms.”
Other recent research also showed a decline in fatal opioid overdoses in jurisdictions where marijuana was legalized for adults. That study found a “consistent negative relationship” between legalization and fatal overdoses, with more significant effects in states that legalized cannabis earlier in the opioid crisis. Authors estimated that recreational marijuana legalization “is associated with a decrease of approximately 3.5 deaths per 100,000 individuals.”
“Our findings suggest that broadening recreational marijuana access could help address the opioid epidemic,” that report said. “Previous research largely indicates that marijuana (primarily for medical use) can reduce opioid prescriptions, and we find it may also successfully reduce overdose deaths.”
“Further, this effect increases with earlier implementation of [recreational marijuana legalization],” it added, “indicating this relationship is relatively consistent over time.”
Another recently published report into prescription opioid use in Utah following the state’s legalization of medical marijuana found that the availability of legal cannabis both reduced opioid use by patients with chronic pain and helped drive down prescription overdose deaths statewide. Overall, results of the study indicated that “cannabis has a substantial role to play in pain management and the reduction of opioid use,” it said.
Yet another study, published in 2023, linked medical marijuana use to lower pain levels and reduced dependence on opioids and other prescription medications. And another, published by the American Medical Association (AMA) last February, found that chronic pain patients who received medical marijuana for longer than a month saw significant reductions in prescribed opioids.
About one in three chronic pain patients reported using cannabis as a treatment option, according to a 2023 AMA-published report. Most of that group said they used cannabis as a substitute for other pain medications, including opioids.
Other research published that year found that letting people buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 percent to 8.1 percent fewer opioid prescriptions.
A 2022 research paper that analyzed Medicaid data on prescription drugs, meanwhile, found that legalizing marijuana for adult use was associated with “significant reductions” in the use of prescription drugs for the treatment of multiple conditions.
A 2023 report linked state-level medical marijuana legalization to reduced opioid payouts to doctors—another datapoint suggesting that patients use cannabis as an alternative to prescription drugs when given legal access.
Researchers in another study, published last year, looked at opioid prescription and mortality rates in Oregon, finding that nearby access to retail marijuana moderately reduced opioid prescriptions, though they observed no corresponding drop in opioid-related deaths.
Other recent research also indicates that cannabis may be an effective substitute for opioids in terms of pain management.
A report published recently in the journal BMJ Open, for instance, compared medical marijuana and opioids for chronic non-cancer pain and found that cannabis “may be similarly effective and result in fewer discontinuations than opioids,” potentially offering comparable relief with a lower likelihood of adverse effects.
Separate research published found that more than half (57 percent) of patients with chronic musculoskeletal pain said cannabis was more effective than other analgesic medications, while 40 percent reported reducing their use of other painkillers since they began using marijuana.
In Minnesota, meanwhile, a new state government report on chronic pain patients enrolled in the state’s medical marijuana program said recently that participants “are finding a noticeable change in pain relief” within a few months of starting cannabis treatment.
The large-scale study of nearly 10,000 patients also shows that nearly a quarter who were taking other pain relievers reduced the use of those drugs after using medical marijuana.
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California officials are accepting public comment through mid-March on a plan that would remove medical marijuana as an accepted treatment for injured employees in workers’ compensation cases. The change would effectively prevent doctors in such cases from recommending marijuana and end any compensation to pay for cannabis medications. The change being considered by the California Read More
