Marijuana has been in the news over the last couple of years. It
is not a new concern for workers' compensation, but it is a concern. Impairment
from marijuana will be a struggle for states and employers.
The interaction between federal prohibition and state non-enforcement will be
an ongoing complication. Employers will struggle with whether to employ those who use marijuana, as states become
more permissive and the federal government's interest perhaps continues to
wane. The issues are numerous and intriguing.
Marijuana has not been widely studied. There has not been a drive
or imperative to study the substance, because it is illegal. Not
"was" illegal, it "is" illegal. It is classified by the
United States government as a Schedule I. substance. It is a substance, by
legal definition, "with no currently accepted medical use."
"Medical marijuana is currently an oxymoron.
The Motley Fool, an investment prognostication group, recently
suggested though that actually We May Have a Marijuana Problem on Our Hands. You
think?
The acceptance of marijuana is briefly outlined by the Fool.
Illegal "in all states in 1995," to now being "legally sold in
23 states for medicinal purposes." ignoring that it has no "accepted
medical use." This contradiction is difficult to overcome or ignore, but
for our purposes, we have to move on. It is impractical to have the
"immovable object meets the irresistible force" argument on
this.
Despite the fact that it is illegal, has no accepted medical use and cannot be
legally prescribed, it is being recommended by medical doctors and supplied.
Despite the fact this violates United States law, the United States is neither
investigating or prosecuting those engaged in the marijuana enterprise. It is a
law the government has elected not to enforce. Just as it might one day elect
not to prosecute possession and distribution of cocaine, heroin, or opium, that
is the government's decision.
The Fool reports that with marijuana's popularity has come a
"push for experimentation into its possible medical benefits." The
story notes, however, a recent study published in the JAMA Psychiatry, which "subtly implies that
we may very well have the beginnings of a marijuana problem on our hands."
The study recognizes the existence of "marijuana use disorders, which are
defined as abuse or dependence on the drug."
Dependence may be only one of the issues this substance will bring
to the fore. What does marijuana do to the human body? There is anecdotal
evidence, and there are a plethora of perceptions and beliefs about marijuana.
But because it is illegal, there has perhaps not been the testing and research
seen with other substances.
Yahoo News reports on a recent study
conducted by Yale and Pennsylvania State universities that decries the
perception that marijuana produces "stoners" who are
"mellow." Instead, their "study found a positive short-term
correlation between marijuana use and hostile and impulsive behavior." In
short, study subjects "were more aggressive on days they used marijuana,
and the following day, than on days they didn't get high." Admittedly, it
was a small-sample study, over a short time period, but some believe it
supports further study.
Yahoo cites a 2012 study finding "that
weed can cause anxiety for regular users during periods of withdrawal and puts
those with genetic tendencies at risk for developing schizophrenia. It cites
another study published in the Psychology of Addictive Behaviors in September
that "showed that the drug had an indirect negative relationship with
grades among a cohort of college students." Those who used marijuana
experienced class-attendance issues, and lower grades. Might the same be true
for work-attendance?
As an industry, we are struggling with the path to destruction
that has been paved with hundreds of thousands of lives affected or ended by
the dispensing of opioids. A very interesting study recently concluded that
people who overdose on opioids are likely to receive, MORE OPIOIDS. That is intriguing.
People are dying from opioid use (direct effect) and we are told
that opioid have been the impetus for others to move on to heroin and other
street drugs with devastating consequences. When people abuse them, the medical
community tendency appears to be keep providing opioids. And these are drugs
that were extensively studied before they became a part of the marketplace.
If marijuana brings us addiction, anxiety, schizophrenia, and the
suspected indirect negative impacts, will the inclination of medicine likewise
be to provide more marijuana?
The JAMA-reported study encompasses data from
"face to face interviews" in two surveys. One of "43,093 adults
between April 2001 and April 2002, and the second" of "36,309 adults
between April 2012 and June 2013." These would both appear to represent
significant populations. The results demonstrating by comparing these groups?
"Marijuana use prevalence and marijuana use disorder prevalence had both
risen over the prior decade." This is an understatement, in fact the
"use prevalence" of marijuana "more than doubled to
9.5%."
The other factor, "use disorder" or "exhibiting
abuse of or dependence on" marijuana has demonstrated a decrease, in terms
of a percentage of users, in the studied decade. That is, fewer of the users
are suffering "use disorder." But, because the number of users has
increased so significantly, "the total number of users exhibiting a
marijuana use disorder as a whole is up over the prior decade." In short,
more people are using it and more people overall are demonstrating tendencies
of "abuse of or dependence upon" marijuana.
The conclusion is that we can expect addiction rates of about 30%
in marijuana users. The NY Times in 2003 noted that "most
people, including most physicians, understand little about what draws people to
drugs and keeps them hooked." In 2003, the statistics reported that
dependence rates were: tobacco 32%, heroin 23%, cocaine 17% and alcohol 15%.
marijuana was only 9%. A decade or so later, that rate for marijuana has
tripled.
Marijuana use is permitted for medicinal use in 23 states. Five of
these have also elected to not prosecute recreational use: Alaska, Colorado,
Oregon, Washington, and arguably the District of Columbia. About 47% of
Americans live in one of these 23 states. Less than half of the country has
access to "medical marijuana" and only about 6% have sanctioned
access to "recreational marijuana" and addiction has tripled in the
last decade. What effect will further state decriminalization or medical
recommending have?
The Fool suggests that this evidence will
support continuation of the federal prohibitions on marijuana despite various
state's rush to decriminalize. However, the Fool contends that a bigger
roadblock will be evidence of marijuana presenting a long-term safety risk to
those who consume it. The article concedes, contrary to the Schedule I label,
that there have been "numerous instances of marijuana providing medical
benefits." But, there are also "a mound of clinical studies stacked a
mile high detailing harmful side effects."
The Fool suggests that our future will include more studies.
Against a backdrop of decades of study focused upon marijuana's risks, recent
studies demonstrating benefits will likely become more prevalent. It notes that
the recency of "medical benefit" studies will also leave a
marketplace questioning whether benefits can be demonstrated to be long-term
versus short-term. Many of us remember when "the studies" supported
the efficacy and safety of opioids. We watched the medical-legal complex rush
to embrace it, and we now look back and many wonder "what if" we had
known then what we know now?
Yahoo concludes that some in law enforcement see marijuana as
"the biggest drug threat." But, that "as of 2014, no one had
died from marijuana use alone." Others take issue with that conclusion.
They note that as this conclusion is constructed, one might as easily say that
smoking does not kill people. The effects of smoking, such as cancer, obviously
and notoriously kill people and so the fact that smoking itself is not fatal
does not support a conclusion that it is safe.
The end result will be interesting to watch. Marijuana presents
potential benefits to patients and potential harm is also plausible, likely
probable, and perhaps inevitable. As states rush to embrace it, medically or
generally, for revenue benefits or otherwise, it will profoundly implicate
workers' compensation and the employer/employee relationship.
Houston, we may have a problem . . .
