Medical marijuana laws raise questions, concerns for employee health
Occ health groups trying to clear the smoke
Hospitals and other employers increasingly are concerned about the impact of medical marijuana laws on their staff. Nearly half of the country now allows use of medical marijuana, which is expected to soon force changes in the workplace.
For example, since marijuana use continues to be illegal nationally at the federal level, hospitals and other employers in states with medical marijuana laws still are allowed to hire and fire based on their own drug policies.
But lawsuits filed by employees who were fired for medical marijuana use might change this, particularly if courts believe it’s an Americans with Disabilities Act issue.
Even without clear guidance legally, hospitals in states with medical marijuana laws need to consider the implications of testing for marijuana use and any related health issues, as well. Through mid-2014, 23 states and Washington, DC have passed bills allowing medical marijuana. Florida, Ohio, and Pennsylvania have pending legislation or ballot measures. Colorado and Washington also permit recreational marijuana use. Occupational health nurses soon will receive guidance from two associations that have formed a task force to study the issue.
It’s because of the fast growth of medical marijuana laws 14 of which occurred in the last 10 years that recommendations and guidance are needed for employee health programs, says Jennan Phillips, PhD, MSN, RN, chair of the legislative affairs committee at the American Association of Occupational Health Nurses (AAOHN).
"We’re grappling with trying to develop recommendations for policies that employers can enact in their workplace," Phillips says.
Health aspects of marijuana
Some of the issues that concern AAOHN involve health aspects of cannabis use or misuse. For instance, the potency of current marijuana is five times greater than it was in 1960, and cannabis-related emergency department admissions rates are 23 times greater now than they were in 1991.1
Hospital employee health departments in medical marijuana states need to be concerned about the impact of worker marijuana use on the employees who use the substance and their co-workers, Phillips says.
However, employers will not know about medical marijuana use unless they subject workers to drug tests, she adds. "It’s protected medical information," Phillips says.
One action employee health offices can take even before there is a clear legal answer regarding medical marijuana use is to educate workers about the health problems when they smoke or ingest marijuana. These include cardiovascular and lung problems. Also, there are potential cognitive, neurological, and psychological impairments, including apathy, paranoia, confusion, delusions, hallucinations, amnesia, anxiety, agitation, and a decline in psychomotor functioning. Health care workers who have a drug use problem also might demonstrate inconsistent work quality, poor concentration, lowered productivity, increased absenteeism, carelessness, and disregard for safety, leading to accidents.
AAOHN and the American College of Occupational and Environmental Medicine (ACOEM) have formed a task force to study workplace health and safety issues involving marijuana use.
"What we want to do is explain all of the options that employers have," says Kathryn L. Mueller, MD, MPH, FACOEM, president of ACOEM and a professor in the school of public health at the University of Colorado in Denver, CO.
"A lot of our members email me and say they are being asked questions about medical marijuana, and they want a formal paper on it so they can tell their employers of all the choices," Mueller explains. "We would like to say, Here are your options and here’s what you should understand.’"
Hospital employee health can lead the way in educating hospital supervisors how to recognize the signs of workers who are impaired on the job due to marijuana use, she adds.
The task force will not provide legal guidance as each state and employer’s situation is different, Mueller notes.
"We don’t know what will happen legally," she says. "We can’t say there’s one national solution for you."
In Colorado there is a landmark lawsuit involving a quadriplegic man who was fired from a customer service job after testing positive for marijuana use. This case could change the legal landscape if it ultimately succeeds. In the case of Brandon Coats vs. Dish Network, Coats claims that he has been a registered medical marijuana user in Colorado since 2009 and that he needs the substance to alleviate spasms and pain. He claims to use the substance only when he’s off work, and he had informed his employer of his medical marijuana use when he was asked to submit to a drug test, according to Coats’ lawsuit filed with the Colorado Court of Appeals, which ruled against him in 2013. Coats has taken the lawsuit to the Colorado Supreme Court, after two lower court rulings that sided with Dish Network.
Task force attacking issue on several fronts
The task force will address the issue on several fronts, Mueller says.
• Show employers their various choices for handling medical marijuana use among safety-sensitive and non-safety sensitive workers.
• Ask employers to think about marijuana use in a similar way to other substances, including alcohol and medical drugs.
"If a drug is used for medical reasons, it’s a different question," Mueller says. "One type of use requires accommodation and the other does not."
No one has the complete answer yet to the question of whether medical marijuana is a treatment that is legally protected under the ADA, Phillips says.
Whether or not medical marijuana use requires accommodation will be up to the courts and the wording in medical marijuana legislation passed within each state, she adds.
• Write policies based on local context as much as is possible. "When they put their policy together they need to make sure they talk to legal counsel," Mueller says.
The task force has been reviewing studies related to performance issues and marijuana use, as well as policies that are in place, Phillips says.
What about the feds?
There is some indication that the federal response to medical marijuana might change. In May 2014, a bipartisan coalition of House members voted to restrict the purse strings of the Drug Enforcement Administration (DEA) when it targets marijuana patients and growers in states where medical marijuana is legal. In recent years, the DEA has raided marijuana dispensaries that complied with state laws, and the DEA still classifies marijuana as a Schedule I substance, denying it has any accepted medical use. The bill had not received a Senate vote as of July 2014.
"It seems very simplistic when a state passes a medical marijuana bill — you think people with serious health problems can have the medication they need to ease their suffering," Phillips adds. "But people like that usually are not in the workplace because they are in the last stages of life."
The dilemma involves dealing with employees who have less severe illness or disability, but who also believe marijuana is their best treatment.
"What’s happening is many people who are getting prescriptions for medical marijuana are using it to control chronic pain," Phillips explains. "They are coming to work with a prescription to smoke marijuana, and we don’t know how that will affect their performance."
Another big issue emerging in Colorado and Washington, where recreational marijuana use was legalized, is how to handle marijuana in edible form, such as marijuana candy, she adds.
"From what I understand, users who smoke marijuana can self-regulate the amount of high they receive, where when you eat it you may have reached an extremely high level before you realize it," she says.
Even worse, in Colorado, more than a dozen children have been treated in hospital emergency rooms after unintentionally ingesting candy or other sweets with marijuana.
One recommendation that the task force will likely make is to improve workplace education and training programs about medical marijuana and drug testing, Phillips says.
"You need a sound drug awareness program; supervisors need to know how to recognize whether an individual is impaired and what steps to take in reporting or acting on that information," she adds.
Hospitals might advocate a drug-free workplace, but no one knows how that might work from a legal point of view, Mueller notes.
"It’s clearly somewhat of a conundrum," she adds. "Knowing what employers are expected to do will depend on various state laws."
In states where even recreational use of marijuana is legal, employers could institute policies for identifying impaired workers, much as they do for alcohol use. The chief difference is that under standard drug tests marijuana can be detected up to 30 days from its use, while alcohol use cannot be detected even 24 hours later. The National Institute on Drug Abuse (NIDA) published a study last year that suggests a possible breath test for marijuana that would detect only marijuana use within the past 30 minutes to 2.5 hours.2
Another issue involves employers with workers in several states, particularly when federal contracts are involved. If a hospital system enacts one policy, basing the policy on one state’s law, it may have to form a separate policy for workers in another state or if one hospital has federal contracts and another does not, Phillips says.
"Medical marijuana is a huge concern across the nation," Phillips says. "Many in the community do not understand the impact on employers when states pass these medical marijuana laws and legalize marijuana."
- Meuleveld L, Murrell C. Beyond workers’ compensation: the implications of medical marijuana in the workplace. 2014; AAOHN Powerpoint presentation.
- Himes SK, Scheidweiler KB, Beck B, et al. Cannabinoids in Exhaled Breath following Controlled Administration of Smoked Cannabis. Clinical Chemistry September 2013 clinchem.2013.2074072013: http://bit.ly/Uw2fwk