Many Injured Workers seek alternative medical treatments for their industrial injuries. Some of those seek the use of cannabinoids to do so. In order to obtain such treatment, these Injured Worker’s Treating Physicians must request such treatment.
Treatment Requests go through an Insurance Company’s Utilization Review (UR) to approve or deny the request. If the treatment request is denied, then it is subject to the State of California’s Independent Medical Review(IMR) process. IMR has the ability to “overturn” an UR decision. If the IMR overturns the determination, the Injured Worker can obtain the treatment.
There has been two IMR determinations which have overturned a request for the use of cannabinoids. This article will discuss these two IMR determinations which have overturned the denial of cannabinoids as form of treatment for an industrial injury.
What Are Cannabinoids?
“There are over 480 natural components found within the Cannabis sativa plant, of which 66 have been classified as “cannabinoids;” chemicals unique to the plant. The most well-known and researched of these, delta-9-tetrahydrocannabinol (Δ9-THC), is the substance primarily responsible for the psychoactive effects of cannabis. The effects of THC are believed to be moderated by the influence of the other components of the plant, most particularly the cannabinoids.
The cannabinoids are separated into subclasses. These are as follows: Cannabigerols (CBG), Cannabichromenes (CBC), Cannabidiols (CBD), Tetrahydrocannabinols (THC), Cannabinol (CBN) and Cannabinodiol (CBDL), Other cannabinoids (such as Cannabicyclol (CBL), Cannabielsoin (CBE), Cannabitriol (CBT) and other miscellaneous types).” ADAI
What Are Treatments for Which Cannabinoids Have Been Used?
Per Barth Wilsey, MD, a Pain Medicine Specialist at the University of California Davis Medical Center, pain is the main reason people ask for a prescription. The pain can be headaches, cancer, glaucoma or nerve pain. It can also be used to treat muscle spasms caused by multiple sclerosis, nausea from cancer chemotherapy, poor appetite or weight loss from chronic illness such as HIV or Nerve Pain. It can be used to treat Seizure Disorders or Crohn’s Disease. Medical Marijuana may be smoked, vaporized, eaten or taken as a liquid extract. Again, as noted above the FDA has also approved THC, a key ingredient in marijuana, to treat nausea and improve appetite. It’s available by prescription Marinol (dronabinol) and Cesamet (nabilone). See WebMd.
What Are the IMR Decisions Which Have Overturned and Approved of Cannabinoids?
Dronabinol: CM18-0064228: NAUSEA
The rationale for overturning the utilization review determination was that the medical records on the case reported nausea. The IMR determination noted that Harrison’s principles of medicine supported dronabinol for treatment of nausea. Dronabinol was found medically necessary. In the matter, the Injured Worker was post-back surgery and was taking a multitude of medications to dealing with her chronic back pain.
CBD Oil: CM18-0082382: CHRONIC PAIN ON A TRIAL BASIS
The rationale provided was that the Guidelines, at the time, did not address this specific issue. They noted that CBD oil is a legal hemp extract that has soft evidence for pain control. It noted that it is legal in California and if utilized the best recommendation is for it to be supervised by a physician who is familiar with its sources and potential problems. It was noted that it was considered very safe. Further, it noted that similar to other treatments such as TENS, ACU, and Medications, with soft evidence for use. Therefore, a limited trial would be trial would be reasonable. It stated that if the one bottle or month trial did not provide significant pain relief and functional benefits, this ongoing use would not be appropriate. Under those circumstances, the IMR found that the one bottle of CBD Oil on a trial basis was medically necessary.
In this matter, the Applicant was suffering from knee and back pain. The Injured Worker had gone through one surgery and a variety of procedures to treat their pain. The Injured Worker was viewed as one suffering from “chronic pain.”
What If I Want This Type of Treatment?
If you desire to try Cannabinoids to treat for your industrial accident, you must get your Treating Physician to make the request. Further, the request must relate to a condition for which there is a medical basis for its use. In the two IMR decision that were positive, nausea and “chronic pain” on a trial basis were found to be acceptable. It is important to note that pain itself was not a basis for the decision. It was “chronic pain” which was the basis. “Chronic Pain” mean pain lasting three or more months from the initial onset of pain.
What If I Need Legal Advice?
If you would like a “free” consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. for more information.
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