8/31/2016. Workplace Implications of Marijuana in the US. Goal

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Workplace Implications of Marijuana in the US Copyright 420 Medicated.

law Medical Marijuana Role(s) of the Provider(s) Evidence Based Practice Research Limits & Needs Current NYS Law &

1 Workplace Implications of Marijuana in the US Copyright 420 Medicated.com Goal Inform and provoke discussion about the future for patients, staff and employers in regard to this rapidly evolving and important topic... 2 Overview Marijuana in the US History Increasing acceptance recreational & medical Changing STATE laws vs FEDERAL law Medical Marijuana Role(s) of the Provider(s) Evidence Based Practice Research Limits & Needs Current NYS Law & Processes (patient & provider) NYS DOH Policy regarding practitioners Workplace Implications Productivity (absenteeism, illness/injury, work rate) Workplace drug testing occupational Evaluation of use & potential impairment Intoxication/Functional Impairment Employer Policy 1

2 History in US 1600s-1900s - Production of hemp encouraged to make rope, sails, & clothing Pure Food and Drug Act - Required labeling of cannabis in OTC remedies s Recreational use begins states had outlawed marijuana Uniform State Narcotic Act - Encourages states to deal with the problem Marijuana Tax Act effectively criminalized marijuana 1950s - Stricter Sentencing Laws 1960s Recreational use increases as the political and cultural climate change Controlled Sustances Act - Schedule I - same category as heroin and LSD Medical Use Legalized in California Source: Norml Website Federal Law Clear (as of August, 2016) Controlled Substance Act (CSA) establishes federal drug policy: Schedule I V I High Abuse Potential, no current accepted medical use II High Abuse Potential, current accepted medical use, severe dependence III Less Abuse Potential, current accepted medical use, less dependence IV Low Abuse Potential, current accepted medical use, limited dependence V Lower Abuse Potential, current accepted medical use, limited dependence Drug-Free Workplace Act of 1988 Applies to ALL Federal grantees (only organization that receives federal funds) Organizations must take comprehensive, programmatic steps for a drug free workplace. 5 PENDING FEDERAL ACTION S. 683: The Compassionate Access, Research Expansion, and Respect States (CARERS) Act. -- Passage of this measure would permit qualified patients, doctors, and businesses to engage in state-sanctioned behavior involving the production, sale, or use of medical cannabis without fear of federal prosecution. H.R. 5549/S. 3077: Medical Marijuana Research Act of Amend the Controlled Substances Act to make marijuana accessible for use by qualified medical marijuana researchers, and for other purposes. AUG 11 (WASHINGTON) - The Drug Enforcement Administration (DEA) announced several marijuana- related actions, including actions regarding scientific research and scheduling of marijuana, as well as principles on the cultivation of industrial hemp under the Agricultural Act of

PENDING FEDERAL ACTION The DEA and the FDA continue to believe that scientifically valid and well-controlled clinical trials conducted under investigational new drug (IND) applications are the most

3 PENDING FEDERAL ACTION The DEA and the FDA continue to believe that scientifically valid and well-controlled clinical trials conducted under investigational new drug (IND) applications are the most appropriate way to conduct research on the medicinal uses of marijuana. August 11, 2016 DEA Public Affairs 7 State Laws -- Vary Legal (a.k.a. recreational use) States AK, WA, CO, OR & DC Legal Medical (a.k.a. medical use) States AL, AZ, CA, CN, DE, HI, IN, MA, MD, ME, MI, MN, MT, NH, NY, NJ, NM, NV, OR, RI, VT, WI Four more states are voting in November AK, FL, OK, MT Possession Jurisdictions Alaska 1 st constitutional right to possess and use marijuana in private City Law - local ordinance approved possession & transfer of <1 ounce. 8 Legal Medical Marijuana 25 States & DC approve Colorado addresses the workplace 16 States specify cannabinol (vs THC) New York State signed July 5, 2014 Only Approved Conditions Smoking is not an approved method. Two Year Report released last month Workplace Implications - Laws don t require employers to permit drug use in the workplace or tolerate employees under the influence. Multiple sources. 3

NYS Law & Practice Medical Marijuana Current NYS approved medical uses.

sclerosis (ALS), Parkinson's disease, multiple sclerosis, damage to the nervous tissue of the spinal cord (with objective

Patients must also have [emphasis added] one of the following clinically associated or complicating conditions: cachexia or wasting

4 NYS Law & Practice Medical Marijuana Current NYS approved medical uses. Patients with severe, debilitating or life threatening conditions:[including] cancer, HIV infection or AIDS, amyotrophic lateral sclerosis (ALS), Parkinson's disease, multiple sclerosis, damage to the nervous tissue of the spinal cord (with objective neurological indication of intractable spasticity), epilepsy, inflammatory bowel disease, neuropathies, and Huntington's disease. Patients must also have [emphasis added] one of the following clinically associated or complicating conditions: cachexia or wasting syndrome, severe or chronic pain, severe nausea, seizures, or severe or persistent muscle spasms. 10 NYS Law & Practice Medical Marijuana Current NYS DOH administrative process of patient and providers

13 NYS DOH Recommendations NYSDOH recommends authorizing Nurse Practitioners (NPs) to certify New Yorkers for medical marijuana for patients diagnosed with qualifying conditions covered in the

Allowing NPs to issue certifications for medical marijuana would allow them to properly treat patients suffering from severe, debilitating or life threatening conditions NYSDOH will continue outreach

5 13 NYS DOH Recommendations NYSDOH recommends authorizing Nurse Practitioners (NPs) to certify New Yorkers for medical marijuana for patients diagnosed with qualifying conditions covered in the Compassionate Care Act. Allowing NPs to issue certifications for medical marijuana would allow them to properly treat patients suffering from severe, debilitating or life threatening conditions NYSDOH will continue outreach and education efforts to [all] practitioners in order to improve their understanding of the medical marijuana program and the availability of this additional treatment option for qualifying patients. 14 Pharmacology and Current Research Summarize evidence based treatment and need for future research. Potential medical research is limited research is aimed at understanding ABUSE. Discuss current research limitations. 15 5

6 Pharmacology 1. Mechanism of action is poorly understood -- related to CNS cannabinoid receptors. 2. THC is the most well understood and well studied of several cannabinoids in marijuana and is primarily responsible for the psycho-activity 3. Highly lipid soluble, easily crossing the blood/brain barrier, can be stored in adipose 4. Inhaled smoke passes quickly into the blood and then to the brain. 5. Ingested route is more slowly absorbed and may be more effective therapeutically. 6. Schedule I Drug Marijuana (natural THC) and Schedule II Cesamet/III Marinol. 7. Minimum Effective Dose, Therapeutic Range, Toxic/Lethal Dose -- not established. 16 Medical Uses 1. Principally used for palliative care, when no alternative therapy has been effective for relief of nausea related to chemotherapy, increase appetite, and reduce neuropathic pain. 2. Effective for multiple sclerosis symptoms (spasticity & nerve pain). 3. Only anecdotal evidence of benefit for many other advocated uses. Koppel, et. al., (April 2014). "Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the Guideline Development Subcommittee of the American Academy of Neurology". Neurology 82 (17): Medical Considerations - THC Increasing potency over the years [2-3% in the 1960s, 12-15% since 1990s] Can be stored in adipose until slowly released in blood & excreted in urine. Peak levels typically minutes following smoking, peak in 3-4 hours following ingestion. Short-term psychoactive effects include euphoria, relaxation, and sociability. Short-term physical effects and cognitive effects include a mild increase in heart rate and blood pressure, as well as some impairment in concentration, short-term memory, and certain psychomotor skills primarily decision-time and trajectory. 6

Workplace Impact A. Contrast the economic impact presented from various perspectives. B. Forensic testing for intoxicants. C. Differentiate use of intoxicants vs impairment. D. Strategies to maintain a safe workplace.

absenteeism, and illness. studies have found marijuana and alcohol pose comparable risks to productivity.

7 Workplace Impact A. Contrast the economic impact presented from various perspectives. B. Forensic testing for intoxicants. C. Differentiate use of intoxicants vs impairment. D. Strategies to maintain a safe workplace. 19 ECONOMIC IMPACTS Impact of marijuana use on job performance: inconclusive according to advocates Marijuana-impaired workers contribute to a decrease in productivity due to employee turnover, absenteeism, and illness. studies have found marijuana and alcohol pose comparable risks to productivity. Impact of marijuana on employee health: 55% more industrial accidents 85% more injuries 75% higher absenteeism In 2011, the National Drug Intelligence Center released a report that assessed $193 billion in annual losses due to illnesses, accidents, lost productivity, and crime resulting from illicit drug use. Source: THE ECONOMIC IMPACTS OF MARIJUANA LEGALIZATION, The Journal of Global Drug Policy & Practice, D.G. Evans, December ECONOMIC IMPACTS Potential positive economic impact: $10 Billion in commercial hemp sales $ Billion in taxes $6-9 Billion SAVINGS on drug enforcement Total SAVINGS [& tax revenue] to the government is up to $16 Billion 21 7

Forensic Drug Testing 1. All forensic urine drug panel components screen for MARIJUANA. 2. However, standard urine tests, in their current form, are not suitable for detecting acute impairment. 3.

8 Forensic Drug Testing 1. All forensic urine drug panel components screen for MARIJUANA. 2. However, standard urine tests, in their current form, are not suitable for detecting acute impairment. 3. Employers wishing to determine whether an employee is acutely under the influence of cannabis at work may wish to utilize postaccident testing of an employees blood or saliva rather than implementing random urine testing. Forensic Drug Testing 23 Source: Norml website. Forensic Drug Testing Pros Urine Reliable Established Screening Method Cons Private facilities Same gender observer Saliva (oral fluid) Good for screening Easy Needs follow-up confirmation Hair Very Specific Very Sensitive Long term Does not detect recent use Blood Only test that detects THC Invasive Limited time window of detection Notes Qualitative Metabolites Qualitative Metabolites Qualitative Metabolites Direct THC Quantitative 24 8

Detection Windows Source: A-check website.

decision-making Erratic cognitive function Diminished concentration

Drowsiness 26 Law Enforcement Impairment Assessment Standardized Field

9 Detection Windows Source: A-check website. 25 Assessing Impairment The most frequently signs of impairment: Delayed decision-making Erratic cognitive function Diminished concentration Distortions in time Visual distance tracking Impaired memory Paranoia Drowsiness 26 Law Enforcement Impairment Assessment Standardized Field Sobriety Testing (SFST) Advanced Roadside Impaired Driving Enforcement (ARIDE) Drug Recognition Expert School (DRE) 27 9

10 Strategies for Employers As a condition of employment & continued employment with the company, follow intoxicants in the workplace policy. Policy should use the term under the influence to be more clear to employees than simply saying impairment. What does an employer [and providers] do about new drug laws? Watch for impairment & be prepared to confront it as a safety issue. [emphasis added] 28 Strategies for dealing with marijuana in the workplace GET SMART Learn the latest from the street about what is available. Learn the likely impact on patients and employers. BE ALERT Be alert for impaired behavior when treating injuries, not just drug testing. 29 Summary Although legal in many states including NYS, for occupational health and safety reasons, the use of marijuana is not acceptable in the workplace. Workplace performance may be affected. The safety of employees and others may be affected. NYS Law offers no protection to employees who use marijuana if their workplace has a drug-free policy. 10

11 Occupational and Environmental Medicine 31 11

Smoke and Mirrors: Navigating Medical Marijuana in the Workplace

Smoke and Mirrors: Navigating Medical Marijuana in the Workplace Douglas P. Currier Elizabeth Connellan Smith dcurrier@verrilldana.com esmith@verrilldana.com (207) 253-4450 (207) 253-4460 Some Statistics