By Robert Howell, M.D.
The marijuana plant contains more than 80 different compounds, collectively referred to as cannabinoids. Among these, the main psychoactive compound is tetrahydrocannabinol (THC). It exerts its euphoric effect through activation of the CB1 receptor found within the central nervous system. Another cannabinoid, Cannabidiol (CBD), binds weakly to the CB1 receptor and does not produce euphoria or intoxication.1
The movement toward legalization of medical marijuana dates back to 1996. Between 1996 and 1999, eight states gave approval for the use of marijuana for medicinal proposes. Now 23 states and the District of Columbia have passed some version of medical marijuana legislation. Colorado and Washington were the first to move all the way to legalization, followed by Oregon and Alaska.
The legalization movement in Georgia has taken a piecemeal approach. The decriminalization on “Low THC oil” for medical use was first proposed to the Georgia legislature in 2014. The bill did not pass the Senate but did pass the House. The following year, Haleigh’s Hope Act (HB 1) passed and was signed by Governor Nathan Deal in 2015.
The law allows a patient with cancer, ALS, seizures (uncontrolled), multiple sclerosis, Crohn’s disease, mitochondrial disease, Parkinson’s disease and sickle cell disease (SCD) to register with the Department of Public Health for a waiver. That allows the patient (or caregiver) to possess up to 20 fluid ounces of “low THC oil” without prosecution. “Low THC oil” is classified as containing a THC concentration of up to 5 percent.
In 2016, additional legislation was proposed in the Georgia House. Muscle spasms, Epidermolysis bullosa, terminal illness, PTSD, intractable pain, autism spectrum disorder, Alzheimer’s disease and “any other medical condition or its treatment approved by the commissioner” were to be added to the list of conditions approved to receive medical marijuana. The legislation did not pass the Senate.
The workers’ compensation system in Georgia has yet to be involved with the issue. The diagnoses that are covered simply are very uncommon in worker’s compensation. However, if other states are an indication, the Board will be involved soon.
In Colorado, there is an Employers Clause within Amendment 64 (which legalizes marijuana) that reads :“Nothing in this section is intended to require an employer to permit or accommodate the use, consumption, possession, transfer, display, transportation, sale or growing of marijuana in the workplace or to affect the ability of employers to have policies restricting the use of marijuana by employees.” This language was copied almost word for word into the Georgia law.
The most likely diagnoses to be applied to treatment of injured workers in Georgia are spasms, pain and seizures. The problem with all of these diagnoses is that there is very little quality research into the usefulness of marijuana. The Drug Enforcement Administration (DEA) lists marijuana as a Schedule I drug, which is defined as a drug with no currently accepted medical use and a high potential for abuse. This designation makes research into the potential risks and benefits of medical marijuana difficult.
The courts so far have sent a somewhat mixed message with respect to this issue. In Coats v. Dish Network, the Colorado courts ruled that the employer had the right to fire an employee for marijuana use even though he was registered to use medical marijuana. In a similar case, Garcia v. Tractor Supply, the court ruled that an employee could be fired for legally using marijuana for a medical condition.
However, the New Mexico Workers Compensation Administration has ruled multiple times that the insurer must pay for medical marijuana and include it in the pharmacy fee schedule. A state law to clearly prevent an employer from paying for marijuana did not pass last year in the New Mexico legislature. Evidently this issue remains a moving target.
What do we know about the cost of marijuana to employers? Undeniably, it will present a financial burden: compliance, safety, productivity, flexibility and litigation will all be costly.
What do we know about the health benefits of medical marijuana? High-quality research is sparse. It has clearly been shown that CBD, which does not have hallucinogenic properties, decreases the number of seizures in patients with uncontrolled seizures. Pure Cannabidiol (Epidiolex) is available in Europe. Sativex (CBD and THC in equal concentrations) is approved in much of Europe for the treatment of muscle spasms associated with multiple sclerosis.
There has been very little quality research into the treatment of PTSD, chronic pain, autism or Attention Deficit Disorder and even less research that tries to separate out the effects of THC versus CBD.
Locally, look for issues on two fronts. The Georgia state legislature will take up revisions and or additions to the Haleigh’s Hope Act again this year. It’s expected to add autism and PTSD and possibly Alzheimer’s disease to the list. It may try and increase the legal THC concentration from 5 percent despite the fact that 5 percent is already one of the highest limits in the country.
Also, expect the first medical marijuana case to go before the State Board of Workers’ Compensation soon. No matter what the outcome, expect for it then to be appealed to a higher court.
Medical Marijuana in Georgia
Total doctors registered: 274
Total patients registered: 819
Multiple sclerosis 11%
Mitochondrial disease 5%
Crohn’s disease 8%
Sickle cell disease 3%
Parkinson’s disease 2%
Source: Georgia Department of Public Health
1.Volkow, ND, National Institute on Drug Abuse, NIH. The Biology and Potential Therapeutic Effects of Cannabidiol. Testimony to Senate Caucus on International Narcotics Control, June 24, 2015.
Robert L. Howell, M.D.
Dr. Robert Howell is board certified in both plastic surgery and general surgery and holds a Certificate of Added Qualification in Surgery of the Hand. He is a Clinical Assistant Professor of Plastic Surgery at Emory University. Dr. Howell is past chairman of the Medical Advisory Committee for the Georgia State Board of Workers’ Compensation and current chair of a subcommittee investigating implications of medical marijuana in the Workers’ Compensation System.