Joining us for episode 11 on ADJUSTED is RxProfessor, Mark Pew. This episode discusses medical marijuana and opioids in the workers’ compensation space: appropriate pharmaceutical treatment and education, action items for adjusters, and more.

Mark Pew, senior vice president of product development and marketing for Preferred Medical, is a passionate educator and agitator. Mark is a recognized thought leader in workers’ compensation and an award-winning international speaker, blogger, author, and jurisdictional advisor. Also known as the RxProfessor, he is focused on the intersection of chronic pain and appropriate treatment, particularly as it relates to the clinical and financial implications of prescription painkillers, non-pharma treatment modalities, and the evolution of medical cannabis. He is a strong champion for the industry to #PreventTheMess and #CleanUpTheMess with a specific focus on the BioPsychoSocialSpiritual treatment model.

Medical Marijuana

THE COVID PANDEMIC HAS EXACERBATED THE OPIOID CRISIS:  Prior to the Covid Pandemic, there was progress being made in regards to the opioid epidemic. Worker’s Compensation Carriers got in front of the issues early on, and the overprescribing of medications started to plateau. Now that progress is being reversed with the Covid Pandemic due to financial anxiety with vast amounts of unemployment, feelings of isolation, and depression. Some injured workers had necessary surgeries delayed or canceled, leaving them to self-medicate.  Illicit drug use has also increased during this time.

REMEMBER THAT WE ARE TREATING A PERSON; NOT AN INJURY:  It is very important to remember that each injured worker is different, and there isn’t a single treatment plan that will work for everyone. What works for one injured worker with a knee injury, may not work for another injured worker with a knee injury. Each injured worker comes with their own psychosocial issues, pain tolerance, religious beliefs, level of physical fitness, and physical comorbid conditions. These factors can impact the duration of disability and the outcome of the claim.

THINK OUTSIDE THE BOX: If you are going to deny an injured worker’s medication, be prepared to offer them an alternative solution. While the medication is denied, the pain the injured worker is feeling still remains. It is important to be open-minded and come up with a new plan for them. Have a discussion with your leadership team, and come up with a new plan of action. Think about possible alternatives: yoga, acupuncture, nutritionist, pain coaching sessions, CBT (Cognitive Behavior Therapy), and other tools that can be utilized.  It is extremely beneficial to refer to a Telephonic or Field Nurse Case Manager early in the claim when the claimant shows signs of possible opioid issues. It may appear to be costly to utilize these tools, but they can improve the claimant’s quality of life, which improves the outcome of the claim.

THE MEDICAL MARIJUANA QUANDARY: Many states have legalized medical marijuana, but it is still illegal on the federal level. There are very strong opinions for and against the federal legalization of medical marijuana. Some carriers are reimbursing claimants for their medical marijuana in the states where it is legal, and some carriers are refusing to because the Federal Government states it is illegal. There is confusion on whether the claim is compensable if an injured worker tests positive for marijuana since it stays in the system much longer than other drugs. Some injured workers get terminated post injury due to positive drug tests. All of these issues have caused an increase in lawsuits and litigation. This puts carriers and employers in a tough spot because state and federal laws are not in unison. Many carriers are fearful that while they follow state laws, they could be indicted for breaking federal laws.  Due to the recent political shift, it is very likely that federal legalization is coming. It is important to be prepared for this. If medical marijuana is seen as a medicine, then it should be treated as one when it is legalized. It is important to have controls in place. Instead of blanket reimbursement, there needs to be a focus on dosage amounts, the integrity of the product, and the appropriateness for the injury, and the injured worker’s pain complaints. It is important to follow evidence-based science and data analytics while making these decisions.

THE WORKERS COMPENSATION SYSTEM IS EVOLVING: There is a shift in attitudes regarding how to approach treatment for claimants. There is a new focus on being proactive, empathetic, and being open-minded.  Carriers are coming up with new ideas on how to increase claimant satisfaction, overall well-being, and reduce the litigation on claims. It is not going to happen overnight, but change is coming. It is important to be passionate about helping people and to keep educating ourselves on all of the latest new treatment options.