Thursday, January 14, 2016

Marijuana May Be a Problem, You Think?

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 . . .

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