The use of cannabis as medicine is on the rise, and so, too, are efforts by patients to get reimbursed when that use is for a work-related injury or condition. But while nearly every state has legalized medical cannabis, it remains federally illegal, and therefore most insurances do not recognize it—or reimburse its cost.
A team led by the director of the National Institute for Occupational Safety and Health (NIOSH) found that, of the 36 states (and D.C.) with medical cannabis programs, six states explicitly allow for the costs of medical cannabis, used for a work-related condition, to be reimbursed, and six states explicitly do not. In fourteen states, it is up to the insurers, and the remaining ten states are “silent.”
This quagmire at the intersection of workers’ compensation insurance and legal medical cannabis programs is the focus of a review article recently published in the American Journal of Industrial Medicine, an effort that included the International Association of Industrial Accident Boards and Commissions, the Workers Compensation Research Institute, and the National Council on Compensation Insurance.
“As cannabis use becomes more accepted legally, and as more workers use cannabis for medical and/or recreational (adult) reasons, the more important it is to understand its effects on work. Right now, because of the classification of cannabis as a Schedule I substance under the Controlled Substances Act, it is difficult to study its effects on workers,” NIOSH director John Howard told Cannabis Wire in an email.
The team also looked into what led states to allow or forbid reimbursement, which typically came down to a court decision, a legislative effort, or an administrative rule. In Massachusetts, for example, a court determined that federal law preempts state law, and therefore ruled against reimbursement. In New York and New Jersey, on the other hand, courts ruled in favor of reimbursement.
“Anticipating the future trends in the United States and internationally, cannabis use in workers’ compensation is an emerging occupational health and safety issue that deserves research attention,” the authors wrote, pointing to the “descheduling of cannabis on the U.S. federal level” as one shift that “would likely accelerate” this trend.
They go on to identify specific research questions, including whether there are “any demographic or health condition differences” between those who get reimbursement and those who do not, whether those who are reimbursed “differ in their rehabilitation outcomes,” and whether reimbursement impacts “opioid overdoses and the risk of developing and opioid use disorder.”
This review article is the latest NIOSH output in a series of blog posts and webinars focused on cannabis and the workplace. In June 2020, for example, NIOSH published a blog post entitled “Cannabis and Work: Implications, Impairment, and the Need for Further Research,” and in January 2021, hosted a webinar entitled, “Cannabis and Workers’ Compensation—Now What?”