www.prium.com Medical Marijuana and Opioids

Mark Pew, Senior Vice President, PRIUM 35+ years in P&C, 20+ years in Work Comp Created PRIUM’s award-winning Chronic Pain Intervention Program in 2003, Intervention Triage in 2010, Texas Closed Formulary turnkey in 2011, Centers with Standards in 2012, TaperRx in 2014 From March 2012 thru April 2017 … 413 presentations, 30,862 people, 40 states + DC 16 national webinars Published and quoted in CLM Magazine, Risk & Insurance, Business Insurance, WorkCompCentral, WorkCompWire, Insurance Thought Leadership, etc IAIABC Medical Issues Committee, SIIA Work Comp Committee, CompSense Pharmacy group in CA (chairman) & NY 2016 Best Blog and Magna Comp Laude recipient Blog: LinkedIn.com/in/markpew Twitter: @RxProfessor

But it’s illegal

But it’s accepted Per February 2017 Quinnipiac poll … 59% say marijuana should be legal 93% say medical marijuana should be legal 71% say federal laws should not be enforced https://www.mpp.org/wp-content/uploads/2017/02/Quinnipiac-Poll-Feb-2017.pdf

And opioids are bad 33K overdose deaths in 2015 20,101 from prescription pain relievers 18,893 in 2014 12,990 from heroin 10,574 in 2014 naloxone reversed 10k+ overdoses between 1996-2010 … how many since then?

Fixing the epidemic federal #turnthetide State mandated day supply caps PDMP connectivity / mandates Expanded access to Naloxone Lawsuits against Big Pharma work comp BioPsychoSocial model Battling physician dispensing Treatment guidelines Drug formularies Weaning Hearing process and cannabis …

Is marijuana medicine? Six states where reimbursement by work comp has occurred Connecticut Maine Massachusetts Minnesota New Jersey New Mexico

It’s about efficacy Minnesota ptp recommended cannabis for chronic pain and muscle spasms - carrier did not pay ime concurred that it was “reasonable and necessary” - carrier did not appeal - carrier paying $100/month

Typical qualifying conditions Most states agree on … terminal illness cancer / hiv/aids (nausea, wasting) seizures glaucoma als / ms / parkinsons / Alzheimer's ibs / crohn’s disease muscular spasticity ptsd and …

Chronic pain? National Academies of Sciences, Engineering and Medicine studied all research since 1999 10,000 scientific abstracts 100 conclusions in regards to chronic pain in adults … “The committee found evidence to support that patients who were treated with cannabis or cannabinoids were more likely to experience a significant reduction in pain symptoms” http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24625

Guiding principle American Society of Addiction Medicine “For every disease and disorder for which marijuana has been recommended, there is a better, FDA-approved medication.”

Should you test ‘em? Pre-employment / post-accident testing Workplace safety implications? Empty seats? RTW? Liability?

But presence <> impairment It’s complicated single use urine = 1-7+ days blood = 12-24 hours regular use urine = 7-100 days blood = 2-7 days hair = months 3.1-4.5 ng/mL (oral) and 3.3-4.5 ng/mL (smoked) plasma levels = 0.05 g% blood alcohol concentration (BAC)

So what next? Review your … Drug-free policy with explicit focus on marijuana pre-employment, post-accident testing policies medical use policy coverage (inclusion / exclusion?) reimbursement policy

Mark Pew, Senior vice president, Prium Blog: LinkedIn Mark Pew, Senior vice president, Prium Blog: LinkedIn.com/in/markpew Twitter: @RxProfessor