What employers need to know about "guided use" of cannabis

While much stigma and confusion around cannabis use still remains (especially for those who grew up in the 80’s “Just Say No” era), the fact is that cannabis is now legal in most states. Ninety-four percent of U.S. adults live in a state where medical cannabis is legal, and more than 50% live in a state where both medical and recreational use is legal.

For HR pros, that means most of your employees can use cannabis legally. That’s leading to changing societal views, and making some employer policies relating to cannabis use obsolete.

Now consider that overall legal cannabis sales in the U.S. are in the $33B range in total, and it is estimated that a third of those sales are for health and medical purposes. That’s $10B in spending annually, putting cannabis spend on par with the top non-COVID medications prescribed in the U.S. in 2022 (drugs like Humira, Keytruda and Eliquis). The biggest difference is that people are self prescribing cannabis. There is not a  clinician checking for multi-drug interactions or guiding patient use of cannabis use at all.

Cannabis use is increasing rapidly, especially among Gen Z and Millennials, who represent nearly half of the workforce today. Yet very few employers have programs in place to ensure guided use. Society’s use of cannabis is changing quickly, and employers need to recognize that and reconsider how to support employees who are either recommended cannabis or choose to use it on their own.

Here’s what employers need to know.

Physicians often believe cannabis may be helpful for specific medical conditions. Cannabis has been shown to provide clinical results across a number of conditions, including relief from cancer and treatment related symptoms, Parkinson’s, chronic pain, poor sleep and anxiety. Effective medicinal potential is one of the main reasons cannabis use is growing.

You don’t have to vape or smoke cannabis anymore. Vaping and smoking – which obviously physicians discourage – are declining in popularity. For health and wellness purposes, it’s become much more common to use cannabis oils, edibles or transdermal patches, which provide all the benefits of cannabis without inhaling anything into the lungs.

Many employer drug policies conflict with the broad legalization of cannabis in many states. We still see many employers with policies developed long ago when cannabis use was illegal in the U.S. These policies may be preventing employees from undergoing treatment (or conversely punishing employees for behavior that’s legal in their state).

Clinically unguided cannabis use can be dangerous. Too many people rely on Dr. Google or budtenders at their local dispensary for advice on which forms of cannabis are right for them. They don’t receive any true clinical guidance on dosage, frequency of use, or interaction with other medications they may be taking. And no one is tracking their use, to see whether or not it’s effective.

Employers (who are likely already providing health insurance for employees) have an opportunity to step up and fill a gap to ensure safe, guided use of cannabis for those who choose to use or for those who need to reduce their use for health and wellness reasons such as reducing the risk of cannabis use disorder. This benefit could take many forms, from merely providing access to guidance (that the employee then pays for) to underwriting the cost of that guidance.

Every day in my practice, I work with patients who have interest in using cannabis for health or wellness concerns, but often aren’t sure how to trial this safely. Some have experienced tremendous relief from the high burden of symptoms related to various chronic conditions through the use of cannabis. It’s possible to use cannabis and still stay safe in the workplace. The key is to provide guidance so that they understand when, where and what cannabis use is acceptable.

Brooke Worster, M.D., Medical Care Advisors at eo care and Director, Division of Supportive Oncology at Jefferson Health.