Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

Welcome to the WOEMA WINDOW, our e-newsletter sent to members by email on a monthly basis. The newsletter links to this page. Below are the items that appeared in the November 2017 issue.

Cast your Vote in the ACOEM Elections




WOEMA encourages all members to vote before the December 15 deadline. There are two WOEMA candidates running: current WOEMA President Dr. Robert Blink, and former WOEMA President Dr. Paul Papanek.



FREE CME WOEMA Webinar Series 
Thursday, December 21 • 12:00 PM PST



The use of cannabinoid agonists in medical therapeutics has suffered from the persistent federal classification of cannabis as Schedule I substance.

The fact is that there are cannabinoid receptors distributed throughout the CNS and periphery, affecting hedonic tone, satiety, analgesia, anti spasm effects, inflammatory modulation and even immune status.  But herbal Cannabis has suffered a very different  reputation; at times even being equated to cocaine and heroin as a drug of abuse.  Clearly there is a regulatory disconnect between governmental control and societal perception.

 This talk will examine the importance distinction between herbal cannabis, with its’ complex alkaloid chemistry in terms of medical utility and it’s use as a recreational intoxicant.   As well, attendees will be able to make a reasoned discussion between getting pulled into this political debate and having a healthy interest in ongoing research into this very interesting class of compounds.

Objectives: Upon completion of this educational activity, participants will be able to:

  • Examine the complex pharmacology of this class of drug
  • Define the difference between pharmaceutical cannabinoids and herbal cannabis
  • Make an informed decision as to how far into the ‘medical marijuana’ issue they might want to go and at what personal as well as professional risks they incur

Dr. Douglas Gourlay did his medical training at McMaster University, completing his fellowship in Anesthesiology in 1990.  Following a fellowship in addiction medicine, he has focused his practice to the assessment and management of risk in the treatment of chronic pain. He has written extensively and speaks on the topic of patient-centered strategies in the management of risk. He is the Former Director, Pain and Chemical Dependency Division, Wasser Pain Management Centre, Toronto as well as the Director of Lab Services, Center for Addiction and Mental Health, Toronto, Ontario. He currently is an educational consultant, writing and speaking on the subjects of Risk Management and Drug Testing.


WOEMA Resolutions Adopted at ACOEM House of Delegates



The 103rd session of the ACOEM House of Delegates was held at ACOEM Headquarters in Elk Grove Village, IL on November 3. WOEMA was well represented by six Delegates: Robert Blink, MD, Robert Orford, MD, Anthony Biascan, MD, Jerald Cook, MD, Stephen Levit, MD, Derek Gagnon, MD; and three Alternates: Rupali Das, MD, Chang Na, MD and Leslie Israel, DO.

WOEMA submitted two resolutions that were adopted by the House of Delegates. The first resolution entitled: “Position Paper on Appropriate Elements for Workers’ Compensation Systems in any Jurisdiction,” WOEMA proposed that ACOEM undertake a study of the structure of workers’ compensation systems, to identify those aspects deserving comment, and issue a position paper offering our views on the appropriate elements for workers’ compensation systems in any jurisdiction. The point of the resolution is that there may from time to time be opportunities for jurisdictions to modify their WC systems. When this happens, it would be well that there be some guidance from a competent authority as to what minimum standards should be met by a WC system, as well as what optimum features to strive for.

Although opportunities for such improvements are infrequent, nationwide there are several states that make changes to their systems every year, and by having a signpost with ACOEM’s name on it this can be useful to the process and to ACOEM members seeking to influence the outcomes.

Examples of currently known deficiencies include:

  • A state where no care is available to an injured worker unless he/ she has private insurance or pays out of pocket, until the claim is accepted (NY);
  • A territory where the total expenditures on a WC claim are capped so low that the worker is virtually uninsured for all but the most minor injuries (PR);
  • Some jurisdictions where care may be denied without needing a physician to determine that it is not medically necessary;
  • Multiple jurisdictions where peer-to-peer calls regarding care are so poorly implemented that such calls are much less common than should be the case;
  • Jurisdictions where the employer has very little input into medical care decisions by any method (IL);
  • Jurisdictions where legislative fiat has specifically excluded certain kinds of injuries from consideration as being work-related, regardless of the evidence;
  • No other professional organization has the competency and standing to issue recommendations on acceptable standards for such systems.

The second WOEMA resolution adopted by the House of Delegates was entitled: “Position Paper on Endocrine Disrupting Chemicals” proposing that ACOEM develop a position paper on EDCs to provide awareness, education, and a call for solutions from health professionals, the public, and regulators. As a leading authority on occupational and environmental medicine issues, ACOEM has the authority and responsibility to address this growing global public health concern.

Members interested in serving as a delegate or alternate at the next meeting which will be held during the American Occupational Health Conference (AOHC), April 29-May 2, 2018 in New Orleans, please contact WOEMA Executive Director Kerry Parker at: kparker@woema.org or call 415-764-4918.

New CWCI Study: Opioids in Workers’ Comp

Despite the Risks, Most WCMSA Plans Include Funds for Long-Term Opioid Use

Oakland – Nearly 70% of federally mandated and approved Medicare settlements for injured workers require funding for decades of opioid use, often at dangerously high levels and in conjunction with other high-risk drugs. Such a requirement exceeds federal and state clinical guidelines and places patients at high levels of risk.

Workers’ Compensation Medicare Set-Aside (WCMSA) plans are required to set up reserves to cover Medicare beneficiaries’ future medical care for injured workers who are or will soon be Medicare eligible. A new California Workers’ Compensation Institute (CWCI) study examines data from 7,926 California WCMSA plans completed, submitted and approved by the Centers for Medicare and Medicaid Services (CMS) in 2015 and 2016. Authors Alex Swedlow and Dr. David Deitz found that on average, insurers allocated $103,393 at the time of the injured workers’ settlements to cover the future medical expenses associated with their work injuries, with $48,986 (47%) of that amount set aside to pay for prescription drugs. Opioids were the number one type of drug included in WCMSAs, found in 69.4% of the approved plans, and overall, opioids accounted for 27.7% of all WCMSA prescriptions – more than twice the proportion of any other drug category. In terms of costs, the study found that with an average allocation of $33,113, opioids accounted for almost 1/3 of the total dollars reserved for prescription drugs. The opioid combination drug Hydrocodone-Acetaminophen (generally known as Vicodin® or Norco®) was the most common opioid found in the WCMSAs (44% of the opioid prescriptions in the plans, 20.7% of the dollars allocated for opioids), followed by Tramadol HCI and Oxycodone HCI, though even more powerful Fentanyl, linked to more than 20,000 deaths in 2016, accounted for 2.2% of the opioids and 6.6% of the total amount allocated for opioids in the approved plans.

Comparing opioids found in WCMSAs to a case-matched control group of closed workers’ comp permanent disability claims for similar injuries, the authors found that the WCMSAs called for much stronger opioids, as average cumulative morphine milligram equivalents (MMEs) allocated to WCMSAs with opioids were 45 times the level used in the control group during the life of the claim. Likewise, approved WCMSAs with opioids required funding for an average daily dose of 54.7 morphine equivalents (MEDs) for a period of 20.9 years, while 1 in 10 had allocations for a daily dose of 90 MEDs, a marker for elevated risk to the patient. In addition to requiring funds for long-term opioid use, many of the WCMSA plans also included reserves for simultaneous, long-term use of other potentially risky medications. For example, 14.5% of the WCMSAs with opioids also had reserves for sedativehypnotics, and nearly 5% had allocations for sedative-hypnotics, muscle relaxants, and opioids. Additional details from the study are available in a CWCI Report to the Industry, “Opioids in Workers’ Compensation Medicare Set-Asides.” CWCI members and subscribers can access the report at cwci.org and others can purchase it at the CWCI Store


WOHC 2017 Resident Scholarship Poster Competition




In September, 15 resident physicians from all over the US came to Maui to attend WOHC 2017 and present posters on their occupational and environmental medicine research projects. Nancy Ngoc Giao Ly, MD from the University of Cincinnati was one of the prize winners in the poster competition for her project: “Identifying the Health and Safety Exposures for Hispanic Construction Workers: Survey Study in an Urban Midwest City”. The abstract for Dr. Ly’s research can be viewed below:

Identifying the Health and Safety Exposures for Hispanic Construction Workers: Survey Study in an Urban Midwest City

Introduction: The construction industry is among the most dangerous, low-wage and Hispanic construction workers are at particularly high risk. The work-related injuries of this under researched population are also likely under-reported through traditional injury tracking methods (e.g. workers’ compensation and OSHA logs). This study’s purpose is to identify and characterize the safety risks and health exposures of Hispanic construction workers in an urban setting, and collaborate with the Cincinnati Interfaith Workers’ Center (CIWC) to develop a targeted educational intervention.

Methods: The Cincinnati Interfaith Workers Center (CIWC) distributed 21 occupational safety surveys to Hispanic workers in Spanish. The questions covered health and safety issues (i.e. lifting heavy objects, dust exposure, and personal protective equipment (PPE) availability). These surveys were completed in 30 minutes or less.

Results: The majority of the construction workers were male with Spanish as their first language (75%). There was a larger portion (56%) indicated they had worked in a job where they feared they might be injured. Providing safety equipment and personal protective equipment (PPE) was lacking for many (65% indicated no PPE provided and 60% never received training on how to use PPE correctly). Majority of workers (63%) reported that they always or frequently performed  manual lifting/carrying heavy objects but only 42% recalled receiving training to prevent injury during lifting. Fifteen participants responded that training on preventing work-related injuries would be useful.

Conclusions: While the sample was relatively small, there were several very interesting results that came from this survey. First, many Hispanic construction workers, particularly low-wage workers, are provided with very limited safety training and protection equipment. Second, as expected, many are exposed to heavy lifting and other exposures that place them at risk for occupational injuries. Third, these types of workers would be open to safety training. Overall, the results of this small study provided valuable insight into many additional health and safety concerns for low wage Hispanic construction workers. The results were the foundation of safety training modules that will supplement the Occupational Safety and Health Administration (OSHA) training that is being provided at the CIWC. Thus, the real impact of the study will be the training provided to construction workers enrolled in the programs at the CIWC. Future work will also focus on distribution of the safety training modules to region and national. The take home message from this study was that Hispanic construction workers have unique safety and health concerns that result from language barriers and lack of resources.

¹Department of Occupational and Environmental Medicine, University of Cincinnati, OH
²College of Nursing, University of Cincinnati, OH; National Institute of Occupational Safety and Health(NIOSH) Education and Research Center (ERC) Trainee
³Master in Industrial Hygiene candidate, University of Cincinnati, OH
⁴Department of Environmental Health, University of Cincinnati, OH

Dr. Ly is a PGY-3 Occupational Medicine resident at the University of Cincinnati, Ohio. She is a graduate of Ross University School of Medicine (RUSM). She completed an internship in General Surgery at SUNY Upstate, New York. She then served as a Clinical Medicine Junior Faculty at RUSM. She completed a postdoctoral research fellowship in cancer immunology at NYU Langone Medical Center. Her interests include population health with a particular focus on boosting safety and improving patient care quality. Presently, she is working on implementing a lead surveillance program for pregnant women in collaboration with the Cincinnati Department of Health. She enjoys going abroad on medical missions. Landscape watercolor and nature pastel paintings are her favorite hobbies.

Save the Date for WOHC 2018 in San Francisco




Mark your calendars! WOEMA is pleased to announce that the Western Occupational Health Conference will take place September 12-15, 2018 in San Francisco, CA. The conference will be held at the Park Central Hotel in the heart of downtown San Francisco.