Episode Transcript
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(00:18):
Good morning everyone, Welcome to episodefive of comp Conversations, that podcast developed
through dri to explore topics relating toworkers' compensation, including work injuries and the
resulting litigation, as well as futuretrends in every aspect in between. My
name is Steve Armstrong and I'm anattorney licensed in the state of Kentucky.
And enjoining me with meet today isShane Dawson, an attorney licensed in Ohio.
(00:42):
We're excited to introduce our speaker today, doctor Scott Rosenthal, who is
a pain management physician who is goingto discuss medical marijuana for patients who have
suffered work injuries. Good morning,doctor, Good morning, Shane, Harry,
you all today, Good morning,good and so doctor can you doctor
rosendaalg can you tell us a littlebit about your practice, where you work,
(01:04):
where you live, Where did yougo to medical school. I practice
in the state of Pennsylvania, allthroughout the state. We have offices in
Philadelphia as well as into Central Pennsylvania, and we treated many, many work
injured patients. I am a anesthesiologistwho completed a fellowship in pain management and
(01:29):
I've been in practice treating pain patientsand work injured patients. Since nineteen ninety
nine, and I was involved inPennsylvania with the legislation to get medical to
get cannabis to be medically available.And I was also a investor and medical
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director of a medical cannabis company thatopened a growth facility as well as dispensaries
in central Pennsylvania. And that companywas now sold to Cresco Lapse, which
is a public company in Canada.Okay, and that's impressive. We want
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to talk to you about medical marijuanafor workers compensation patients, people injured at
work. Do you treat patients forwork injuries with medical marijuana? Yes,
I do. I will recommend itin the state of Pennsylvania. You recommend
it and then they have to applyor they have to sign on to the
(02:46):
state website and register themselves and thenwe can certify them. And we do
recommend it for those patients who arework injured, who suffer from europe hathic
pain, have sleep difficulty, depressionand if that is something, if it
(03:07):
is a medicine, it will beuseful for them. We do recommend it.
So, doctor, can you walkus through that that process that you
follow specifically, so when you havea patient who comes to you with a
diagnosis and you want to make arecommendation or you're you're looking at them as
(03:30):
possibly making a recommendation to use medicalmarijuana as a treatment. How does how
does that work from the standpoint ofyou making the diagnosis and then moving through
with the recommendation. Well, weuh, we perform a full consultation,
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get the history, examine them,get all the medical records that are pertinent,
and we make a diagnosis. Andif that diagnosis is one of the
ones that is acceptable in the stateof Pennsylvania for medical cannabis use, then
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we recommend it. We have towe go on to the state website electronically
and approve that patient to be ableto go to a dispensary and buy the
medicine. Okay, so you saidapproved diagnoses. So who in Pennsylvania determines
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which diagnoses are going to be eligibleto have medical marijuana as a as a
treatment the state? The state maintainsthose diagnoses. It is on the state
website. And if the patient andand chronic chronic intractable neuropanthic pain is one
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of those conditions that the State ofPennsylvania YA has listed on their website,
doctor, what are other conditions thatthe state lists as conditions that are available
for medical marijuana. Oh, theremust be twenty or twenty five on the
website. But they range from chronicpain, depression, seizures, I forget
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the rest. But there there aremany, many diagnoses and who develops this
set of diagnoses. Is there aboard with the state of Pennsylvania. Yes,
there is, there are there are, there are, Yes, there
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is a committee of people on thestate that maintain and update the list of
acceptable diagnoses. So, doctor,you mentioned intractable chronic europe hathic pain being
one of those, and I'm surein a lot of workers' injuries we see
that come up. Are there aset of criteria that, at least in
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Pennsylvania, that they require, whetherit be from you know, objective findings
and things that have to be documentedbefore you can make that diagnosis. No,
it's not that rigorous of a process. It's like ordering an MRI or
anything. If the doctor has conducteda history and physical and has come up
with that diagnosis, the doctor isputting his license on the line in making
(06:35):
the recommendation, just like writing aprescription for any other drug. It's really
the liability is then on the doctor. I see, so, doctor in
Pennsylvania, are you able to writean actual prescription for patients or is that
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still something that you just have tomake the recommendation for because you recommend it,
we recommend it, which is ineffect the prescription. And then they
go to a dispensary and speak tothe pharmacist at the dispensary about their type
of pain and which form they wouldlike to use a capsule like tincture of
(07:18):
vape a flower and they can buyup to a certain amount every month from
the dispensary. Okay, are thedispensaries in Pennsylvania? Are they state run
or are they private? They are? They are privately owned. However,
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there are only so many that arelicensed, and to obtain the license to
open a dispensary is a very costly, rigorous process. And also the locale
where the dispensary is has to bemeat very street criteria. Can't be near
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a church, a school, abar, a many it is very difficult
to find a location that meets thestate's criteria. So, doctor Rosenthal,
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when if you have somebody, thenwhere they've the recommendation has been made,
you know, they've they've started beingable to utilize medical marijuana. Are there
you know, you said there's alimit on what they can they can receive
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over a period of time. Arethere? Are there are there any other
limits that the state has put onthose using medical marijuana in terms of,
you know, the length of timethat they can utilize this. Is it
something that has to be renewed periodically? The rect the license is only good
for a year, and at theend of the year they have to pay
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the fee again, which is Ithink only fifty dollars, and there are
some exclusions that you can get itfor free or for less if you meet
certain criteria, and then we haveto see the patient at least once a
year and re certify them doctor.As I understand that there are differences in
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CBD oil or CBD and THC.Do you prescribe one or the other or
both. CBD is available without theneed to get the license or without the
ability for the patient to sign upand be approved. You can buy CBD
anywhere, gas station, target anything. The products they're buying at the dispensary
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contain some amount of THCs as wellas the CBD. Okay, and from
a pain receptor standpoint. You know, not being a scientist, not being
a doctor, I don't know muchabout that. What is it about h
THHC or CBD that works with painreceptors. Well, the the THC is
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the controlled substance part of the medicalof the cannabis, and that helps to
unlock more of the medicinal properties ofthe CBD. CBD alone without the THC
doesn't have the full potential on thereceptors in the body. The THC makes
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it more bioavailable to the body andthat's why it's more effective. But also
it can be uh, it workson the receptors that that uh cause euphoria,
and that is why it's a controlledsubstance. So, doctor Rosenthal,
you mentioned about how it you know, the impact that this then has and
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how it might be helpful. Arethere particular types of injuries, like classes
of injuries that you've seen in yourpractice where the medical marijuana has been most
effective. Yeah, medical marijuana ismost effective in the severe injuries where there's
loss of a limb or major injuryto a part of the body. Where
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a worker's hand may get stuck ina machine and there be multiple fractures requiring
multiple surgeries in skin grafting, grafting, and there's a lot of nerve damage
in those types of injuries. It'sit's particularly effective. A lot of work
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injured patients have sleep disturbance. It'seffective for that as well as the post
traumatic stress disorder associated with some ofthese injuries. Okay, I know in
Ohio we've seen, you know,that there was an explosion of opioids,
particularly to treat conditions like chronic regionalpain syndrome, and you know, in
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the aftermath of all of that,there's been attempts to you know, pull
back from the use of long termopioids. Is something like medical marijuana,
something that can try to fill thatgap for some of those patients that are
dealing with those issues. Absolutely,And do you see that in in Pennsylvania
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where practitioners as well as kind ofthe the workers' comp community are are looking
at that as a viable alternative.Yes, yes, actually yes, patients
in need of relief of their neuropanthicpain or their severe pain look for an
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alternative to the opioids. Where opioidsare under such scrutiny, and it is
a very viable alternative. Doctor itseems to me that medical marijuana for workers
compensation for people with work injuries iskind of a new frontier. Are medical
schools teaching medical marijuana yet? Toyour knowledge? I believe so. I
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believe that I know that I wasinvolved in our company called Laurel Harvest Labs
in order our license was what partof the state's clinical registran program where Temple
University was a partner with our company, and we gave product, well,
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we had product available as well asfunds that went to the medical school for
research on the medical cannabis. SoI do believe that it is part of
the pharmacology curriculum. In the firsttwo years of medical school, and tell
us it was Temple were they doingclinical trials? They were doing bench research
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on the actual drug. What doesthat mean? Were they were studying the
plant and the effects of the cannabinoidsand terpenes and other chemicals in the plant
and the effect at the very basicscience level, not on patients yet,
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So it sounds like at least universitiesare starting to do some clinical research and
do some science on this topic.Yes, doctor, along that same vein,
what are if anything, are likemedical journals and treatises or any of
those kind of delving into medical marijuanaand kind of the efficacy of it.
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Yes, yes they are. It'sit's in the literature. I would say
on the workmen's compensation front, well, it's not a challenge. I think
it is not something that any insurancecompany can pay for, including a workman's
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compensation insurance company, because it isstill federally illegal. It's it's tolerated on
the state level, but it's stillfederally illegal. So any any licensed insurance
company may not cover medical marijuana.So while they may not be able to
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cover the actual medical marijuana itself,can they can they reimburse practitioners like you
who are who are treating people andthis might just be part of that treatment
regimen. Can they pay for theoffice visits? And well, the office
visit is not for medical cannabis.We're treating these people for their injury and
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and the medical cannabis prescription is justpart of their treatment. So our visit
is compensable to work comp because it'swe're treating. We're treating them. They're
not coming to us just to obtainthe medicine. They're coming to us for
treatment of their injury. Okay,so the pain for the medical professional that
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can still be covered under a claim. But we're saying that the medical marijuana
itself is not being reimbursed through throughthe claim or under the insurance. Is
that right? Yeah, that's correct? Okaycher, Do you know are any
of the providers, they or theinsurance companies, are they able to reimburse
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any of the out of pocket coststo any of these injured workers associated with
medical marijuana or is it completely barredfrom any type of reimbursement. Well,
they can't reimburse the injured worker forthe product, nor I don't think they
can reimburse them for the yearly statefee to have the license to have the
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card, the medical cannabis card.Okay, assume doctor in Pennsylvania least is
there there's probably not a medical feeschedule for medical marijuana yet, is there?
Now? There's no medical fee schedule. Each dispensary creates their own strings
and their own products, and theycharge whatever they wont in the dispensary.
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And how does your state do withutilization review with medical marijuana and for workers
comp claims, you've got utilization review. Well, they're not paying for it,
so it's not part of it.You are they only utilization review things
that they're paying for. They're notpaying for the medical cannabis. Okay,
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okay? And doctor, do yousee medical marijuana for injured workers increasing in
the future or staying the same orhow do you see that? I see
it increasing, doctor. I knowwe're getting towards the end of our time.
But in the event that marijuana wasno longer illegal at the federal level
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and it opened it up to beavailable for workers comp insurance and a worker's
compensation claims, do you see thisas something that the medical community, and
at least your involvement in seeing theinsurance community, that they would embrace and
enlarge this. Yes. Do yousee this being something that then would become
(19:19):
more mainstream in terms of the justthe regular treatment of injured workers in the
event that we got a lift onthat DEA classification. Yeah, I think
it would become more mainstream as timegoes on and more people use it and
there's more research. Yes, Ithink there'll be less stigma, It'll be
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accepted more by employers and this statein general. There are limitations that some
patients are worried about at the statelevel. For example, does having a
medical marijuana card restrict their ability tocarry a licensed firearm? As soon as
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they register in the state of Pennsylvaniaas a medical cannabis user, you cannot
buy a new firearm. If yougo to a store to buy a new
gun, they will check you outand it will show that you hold a
medical marijuana license and they will notsell you a new gun. Interesting,
(20:37):
I had no idea. Doctor.Thank you very much. This has been
a great help to us in understandingthe future in the present really of medical
marijuana for work injuries. We can'tthank you enough, and thank you again
for appearing with us today. Okay, about about