CannaTrials adheres to evidence-based medicine – making statements based on medical evidence.
This page is excerpted and quoted from the National Academies of Science, Engineering, and Medicine. A Committee of over 40 experts, researchers, and reviewers in The Health and Medicine Division published a 486 page report in 2017 entitled “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.”
If you would like to access the entire report you may do so by clicking this link.
Medical Marijuana and Occupational Injury
“The Bureau of Labor Statistics reported that 4,821 fatal occupational injuries occurred in the United States in 2014, or about 3.4 fatal injuries for every 100,000 full-time equivalent workers (BLS, 2016). Private industry and state and local government employers reported another 3,486,400 nonfatal occupational injuries in the same year (BLS, 2015). The economic impact of these injuries is considerable. Leigh (2011) estimated that the average medical costs per nonfatal and fatal injury in 2007 were $5,369 and $55,595, respectively. Nationally, the medical and indirect costs of occupational injuries (fatal and nonfatal) totaled $191.83 billion in 2007 (Leigh, 2011). Marucci-Wellman et al. (2015) estimated that in the United States the direct workers’ compensation cost of the most severe, nonfatal occupational injuries was over $51 billion in 2010.2
Concurrent with this economic and public health burden is the increasing prevalence of cannabis use among employed U.S. adults ages 18 and older (Azofeifa et al., 2016). In 2015, 14.4 percent of U.S. adults ages 18 and older with full-time employment reported using cannabis during the previous year (CBHSQ, 2016, pp. 246–247). Among those employed part-time, the proportion was higher, at 17.8 percent (CBHSQ, 2016, pp. 246–247).3
Determining whether an association exists between cannabis use and occupational injury is the subject of ongoing research. According to the 1994 National Research Council and IOM report Under the Influence?: Drugs and the American Workforce, evidence on the relationship between employee drug use and accidents in the workplace is mixed (NRC and IOM, 1994, p. 144). This section updates these findings with a review of the current evidence on cannabis use and occupational injury.
Although Wadsworth et al. (2006, p. 11) concluded that their findings “suggest a detrimental impact of cannabis use on safety that is apparent both in and out of the workplace,” they also list several limitations of the study and recommend caution in interpreting its results. Data on cannabis use was derived from self-report and did not measure duration or frequency of cannabis use nor the timing of cannabis use in relation to accidents or injuries. Furthermore, the study may not have completely controlled for the effect of potential confounders, which may work independently of, or interactively with, cannabis use to modify the risk of occupational injuries or accidents. Finally, the risk for occupational injury posed by cannabis use may be attenuated by processes of self-selection in which cannabis users choose on average to work in lower-risk occupations and nonusers choose to work in higher-risk occupations.
Findings from Hoffmann and Larison (1999) also have several limitations. First, the study did not distinguish between work-related accidents resulting in damage to property and those resulting in injury. Second, the study did not determine whether cannabis use took place while at work; consequently, this type of cannabis use could pose a risk for occupational injury, even if current or former cannabis use in general does not. Third, it is not possible to determine from the NHSDA data whether cannabis use occurred proximate to the injury or whether it preceded or followed an occupational accident.
Shipp et al. (2005) note that the scarcity of research on the association between substance abuse and occupational injuries in adolescent populations prevents the comparison of their results with those from other studies. Because the students who were absent from school on the day of the survey may have had a higher or lower risk of injury compared to students who completed the survey, the potential for selection bias exists. Other limitations of the study include the inability to determine whether cannabis use occurred during work hours or at another time, whether cannabis use preceded or followed the injury, or how closely in time the two events occurred.
In Price (2014), urine samples were collected from men and women of different ages living in different states and employed in a variety of industries with unequal levels of safety sensitivity. The analysis did not control for these variables or determine whether they affect the risk of occupational injury. Furthermore, the study results could not be used to distinguish between recent and remote cannabis use or to determine the chronicity of cannabis use or the extent of an individual’s tolerance for cannabis.
Results from Dong et al. (2015) were limited to those participants who reported working in construction and do not address the potential association between cannabis use and the risk of occupational injury in other industries. Participants who stated they had experienced an occupational injury during a specific time period were not asked how many such injuries occurred. As a result, the study may have underestimated the true number and risk of occupational injuries. Finally, the reference period for survey questions were long and changed over the course of the study, creating the possibility for recall bias.
In addition to these limitations, the studies were extremely diverse in terms of the characteristics of study participants and their occupations, the specificity and scope of data on cannabis use and occupational injuries, and the extent to which the authors effectively controlled or accounted for potential confounders or effect modifiers. In light of the diversity among and limitations of these studies, it was not possible to determine whether general, nonmedical cannabis use is associated with a clearly increased risk of occupational accidents and injuries across a broad range of occupational and industrial settings in the absence of other important risk factors.
CONCLUSION 9-2 There is insufficient evidence to support or refute a statistical association between general, nonmedical cannabis use and occupational accidents or injuries. “
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