The Ohio BWC Removed Oxycodone from the List of Approved Medications. Is Marijuana a Possible Replacement?

Late last month, the Ohio Bureau of Workers’ Compensation “BWC” announced that starting on July 1, 2019 Oxycodone was being removed from its formulary list.  According to BWC Chief Medical Officer Terry Welsh, Oxycodone is being replaced with “an equally effective but harder to abuse drug” named Xtampza ER.  According to Welsh, “Xtampza is a sustained-release form of Oxycodone, like OxyContin, but it utilizes a unique abuse-deterrent technology that makes it difficult to manipulate — crush, snort or inject — for aberrant use,”  For more about the new BWC policy change see the attached article in WorkcompWire.  

The article made me think about an article I recently read: “Health plans don’t want patients on opioids.  So what are they doing for the pain?”  The article discusses how, despite the fact that insurers are becoming justifiably more and more reluctant to pay for opioid pain medications, they are also being accused (perhaps unfairly) of being unwilling to pay for alternative ways to deal with pain.  The article included this quote from Caleb Alexander, co-director of Johns Hopkins University’s Center for Drug Safety and Effectiveness: “No one ever died of an overdose of physical therapy.”  I’ve posted about this several times in the past, most recently last month, so I will not go into a lot of detail about that issue again here.  However, it made me think about another “topic du jour”, medical marijuana.

As I’m sure most of you know, in January 2019 Ohio’s medical marijuana dispensaries opened for business.  Ohio’s medical marijuana law lists 21 conditions that make a patient eligible to receive a recommendation from a doctor to use medical marijuana. The conditions most relevant to workers’ compensation claims are: spinal cord disease or injury; pain that is either chronic and severe or intractable; traumatic brain injury; and post-traumatic stress disorder.

Ohio’s medical marijuana law doesn’t allow growing marijuana at home or smoking it.  The marijuana must be used in vapor form or as oils, tinctures, patches, edibles, or plant matter. Eligible patients are allowed to possess up to a 90-day supply of medications.  In order to obtain a prescription, a patient must obtain a written recommendation for use from a physician, which will then be submitted to the Ohio State Board of Pharmacy. After paying a $50 registration fee the patient will receive an Ohio medical marijuana card.  However, carrying a medical marijuana card does not immunize an employee for workplace discipline if they test positive for marijuana. Those fired for marijuana violations will be ineligible for unemployment compensation.  For more about Ohio’s medical marijuana program, see this article in the Toledo Blade “Medical marijuana: Five things you should know.”

So, what does this mean for workers’ compensation claims in Ohio?  First of all, marijuana is still covered by Ohio’s “rebuttable presumption” law.  If a workplace injury is found to be the result of medical marijuana usage, the injury would not be covered under the workers’ compensation system.  With regard to reimbursement for medical marijuana for injured workers, the Ohio Administrative Code limits drugs covered by the BWC to those approved by the U.S. Food and Drug Administration.  Marijuana has not been approved for medical use by the FDA, so it will not be reimbursed by the Ohio BWC. Marijuana is also not on the BWC’s formulary list of approved medications. So, for now, medical marijuana is not an option for Ohio workers’ compensation claims.  For more information about the Ohio Bureau of Workers’ Compensation’s position on the medical marijuana issue, see this pamphlet from the BWC.