By Dr. Mary Frances Koester
Cannabis has been used medicinally for thousands of years yet it remains controversial across the field of medicine, law, and workplace. Despite overwhelming anecdotal evidence of the medical benefits of marijuana, there remains a paucity of research due to marijuana’s federal designation as a Schedule I drug, like heroin, deemed to be lacking in medical value and having a high potential for abuse.
While that may not change anytime soon, the FDA did approve two forms of marijuana to treat severe seizure disorders and increased research of the Endocannabinoids system continues to provide evidence supporting the use of marijuana for a number of medical conditions. The increased research comes as many states begin to legalize marijuana for both medicinal and recreational purposes.
Thus, access to and use of cannabis has increased dramatically over the past decade. A study in 2018 showed that 18% of full-time workers and 21% of part-time workers used cannabis. This has created challenges for both workers and employers alike.
Cannabis contains more than 100 different chemicals called cannabinoids which interact with the body’s Endocannabinoids system. This system is present in the brain, nervous and gastrointestinal systems of the body.
Deficiencies of endocannabinoids and their receptors have been implicated in multiple sclerosis, Huntington’s disease, Parkinson’s disease, depression, fibromyalgia, migraine, irritable bowel, and inflammatory bowel disease. The cannabinoid receptor type 1 (CB1) is expressed primarily in the central nervous system and in connective tissue and musculoskeletal tissues. CB2 is primarily associated with cells involved with immune function and inflammation. Cannabis activates these receptors thus has the potential to treat a wide range of conditions.
The two most prevalent and commonly referred to cannabinoids in marijuana (click here for the difference between marijuana and hemp) are THC and CBD. THC primarily acts on the CB1 receptors in the central nervous system and is the major psychoactive component of marijuana that causes the “high.” CBD works on both CB1 and CB2 receptors giving it a high potential for therapeutic use without the psychoactive component.
CBD has been shown to have anti-epileptic, anxiolytic, anti-inflammatory, and neuroprotective properties. However, together, CBD and THC may be more effective. This is called the entourage effect and may be potentiated even more by the terpenes present in the marijuana plant have what is called an entourage effect.
The legalization of medical marijuana has allowed for the optimization of THC and CBD ratios to customize treatment for a specific condition. For example, the ratio for someone looking to treat anxiety would be different than the person trying to treat nausea and pain associated with cancer treatment.
Marijuana is still considered a Schedule I controlled substance with no accepted medicinal use. This along with misconceptions about cannabis use as a gateway drug and users being labeled “potheads” has made transitioning from a vilified substance to one with therapeutic benefits controversial.
Emerging evidence of the efficacy of cannabis as a safe and natural treatment for many medical conditions in the wake of an opioid crisis has begun to alter the public and medical perception of cannabis.
Cannabis has been legalized for medical use in 35 states and other states are considering the change. Thirteen states permit the use of cannabis products that have low THC, high CBD content. The recreational use of cannabis is legal in 14 states and the District of Columbia. Thus, at the state level policies and permitted use vary greatly.
Each states’ marijuana laws are also continually evolving. Most states that have legalized medical marijuana protect users from criminal penalties, however, they do not protect users from workplace policies prohibiting the use of marijuana, medical or recreational.
When it comes to the workplace, legality is not necessarily the issue. An intoxicated employee can be both an economic and legal liability. While a breathalyzer or blood test can easily determine if an employee is intoxicated with alcohol on the job, determining whether an employee is using marijuana on the job is more difficult.
Unlike alcohol, a positive drug test does not indicate if used marijuana one hour ago or last week. To avoid potential issues, many companies find it easier to have a zero-tolerance policy on using drugs.
As mentioned, the medicinal uses of marijuana are now being documented and employees have a right to medically legal therapies. The number of employees using marijuana is on the rise and this has created a conundrum for many employers, especially those with a zero-tolerance policy on using drugs.
Understanding that using marijuana does not equate to poor performance some companies have stopped pre-employment testing or eased up on zero-tolerance policies. Still, for employees working for companies with these policies in place, they risk their job in order to experience the therapeutic relief and improved quality of life they get from medical marijuana. Companies can maintain their policies because marijuana is federally illegal. Other companies are required by federal law to enforce drug testing policies if they are a federal agency, engage in federal contracts, or employ truck drivers.
In Pennsylvania, the Medical Marijuana Act does provide some protections for registered patients. The law states that employers cannot “discharge, threaten, refuse to hire, or otherwise discriminate or retaliate against” patients’ “compensations, terms, conditions, locations or privileges” because of the status as a registered medical marijuana user. Basically, they cannot refuse to hire you or fire you solely based on your card status.
In summary, Pennsylvania law does protect you from being fired because you use medical marijuana. However, if your company has a drug testing policy, you can be terminated for testing positive for marijuana even if it is legal. While a few employees claiming medical necessity have been successful in court, others have not.
Determining if legal action and possible termination are actions you are willing to pursue are personal decisions. Drug testing and enforcement is a complicated situation for employers who want to protect their business but also realize the competitive benefit of hiring the best candidate who might use marijuana. As well, it creates a dilemma for employees who want to work but also rely on medical marijuana to treat a serious medical condition.
Mary Frances Koester, MD
Cannabis Care Consultants
Mary Frances Koester, MD graduated from Franklin and Marshall College and received her MD/MBA from Temple University School of Medical and Fox School of Business. She went on to complete her residency in Emergency Medicine. After seeing so many patients suffering from opioid and benzodiazepine addictions as well many suffering from untreated chronic pain or anxiety, she began her education in marijuana medicine. She believes in the benefits of medical marijuana and advocates its use as a safe and effective alternative to traditional medications. Her mission is to create a true medical practice that strives to provide ongoing and meaningful care for her patients.
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