Doctors who are given the option under state law to prescribe medical marijuana are prescribing fewer drugs approved by the Food and Drug Administration (FDA) for pain and other conditions treatable by marijuana than before the law was implemented, University of Georgia researchers have found.
The study analyzed prescriptions filled for Medicare Part D enrollees between 2010 and 2013. Compared to doctors in other states, doctors in states allowing medical marijuana prescribed an average of 1,826 fewer daily doses of FDA-approved pain medications per physician for conditions eligible for marijuana treatment, states the study, published by Health Affairs in July.
Prescription rates for medications to treat ailments other than pain also were reduced when marijuana was a treatment option.
In September, Ohio became the 25th state to permit patients to use marijuana to treat qualifying medical conditions.
Saving on Drug Money
Study coauthor David Bradford, a professor of public administration and policy at the University of Georgia, says prescribing fewer FDA-approved drugs to Medicare Part D enrollees reduces the program’s cost.
“The reduction in prescriptions for Food and Drug Administration-approved drugs when states approved medical marijuana use resulted in an estimated decrease in expenditures of $165.2 million per year for Medicare Part D and enrollees,” Bradford told Health Care News. “If all states had approved medical marijuana, we estimate there would have been savings equaling about one-half of a percent of all Part D spending.”
Freeing more physicians to prescribe marijuana could save taxpayers money, Bradford says.
“I’m not saying cost savings is a sufficient reason to adopt legislation for use of medical marijuana, but policymakers should consider the stressed financing of health care and opportunities to free up funds in one area to use elsewhere,” Bradford said. “One-half of a percent of Medicare Part D funds could go a long way elsewhere.”
Prescribing marijuana to treat ailments traditionally treated with opioids could help prevent patients from becoming opioid abusers, Bradford says.
“[The study] suggests that marijuana, a Schedule I drug under the Controlled Substances Act, could be useful for diverting patients away from opioids, and possibly away from a path of … addiction, and death,” Bradford said. “In other research on states where medical marijuana laws include the use of dispensaries, researchers have noticed a positive beneficial opioid effect.”
Federal and state restrictions make it difficult to collect data to test whether medical marijuana deters users from abusing opioids, Bradford says.
“We need to combine claims data with patient characteristics and patient survey findings to actually see if medical marijuana leads to changes in substance abuse,” Bradford said. “We can’t really begin to have these conversations until marijuana is rescheduled by the FDA. We need to build evidence about efficacy using peer-reviewed and double-blind studies.”
Potential for Abuse
Dr. Stuart Gitlow, an addiction medicine specialist and a past president of the Board of Directors of the American Society of Addiction Medicine, says the average legal marijuana user in Rhode Island, his home state, “is a 30-year-old male with no major medical history but does have a history of addictive disease.”
Patients who use marijuana may have less pain, just as they might if they were drinking alcohol, but risks could outweigh the health benefits for some users, Gitlow says.
“In both cases, it is possible that they would use less opiates and other FDA-approved pain medications,” Gitlow said. “However, we do know marijuana has a fairly significant psychoactive result similar to alcohol, and just like alcohol, there are significant negative consequences to daily use.”
Hazy Pros, Cons
Gitlow says marijuana’s full potential is largely unknown and unevaluated, but he says it could benefit certain patients.
“There is no medicine in marijuana, but there may be value in some of its components,” Gitlow said. “It would be similar to the way willow bark was broken down and the salicylates found to have clinical application with the production of aspirin.”
Lawmakers should consider medical marijuana separately from recreational use, Gitlow says.
“Making it available generally is telling society it is a safe product, when medically we know it isn’t safe,” Gitlow said. “There are over 400 molecules in a marijuana plant, and we don’t know what several hundred do or if individual components have value over and above the risks and available [FDA-approved] medications.”
Laws Prevent Research
Congress should change the law to allow researchers to weigh marijuana’s potential health benefits and hazards, Gitlow says.
“The legislated marijuana system of scheduling medications is political, and a change to the system is warranted,” Gitlow said. “Amending the schedule to create a Schedule I subcategory of ‘uncertain benefit’ could make it easier to research.”
Under current federal law, medical researchers and state lawmakers cannot evaluate medical marijuana’s prospective benefits to patients and taxpayers and apply them widely, Bradford says.
“Reforms to medical marijuana policy by the states are constrained by marijuana being designated as a Schedule I drug under the Controlled Substances Act,” Bradford said. “This limitation means we are maybe a decade away from even contemplating the impact medical marijuana might have on cost savings in other settings, such as hospitals, rehabilitation, nursing, or other facilities.”
Christina Thielst ([email protected]) writes from Santa Barbara, California.
Tony Corvo, “With Ohio, Half of All States Now Approve Medical Marijuana,” Health Care News, The Heartland Institute, September 2016.