Those of us involved in the marijuana legalization movement have long assumed that those companies that produce and sell competing products — especially alcohol and tobacco — were working behind the scenes to try to maintain marijuana prohibition and to protect their duopoly for legal recreational drugs. These industries have lobbyists who regularly work with state and federal elected officials to keep legal marijuana off the market.
But we now see the pharmaceutical companies are also getting directly involved in political efforts to maintain marijuana prohibition, worried that legal marijuana will undermine their bottom line.
Pharmaceutical company joins the war on marijuana smokers.
Recently, we saw the first direct evidence that pharmaceutical companies are now working to defeat marijuana legalization efforts, acknowledging that their intent is to protect their market in synthetic opioid drugs.
Earlier this month, Insys Therapeutics Inc., an Arizona-based company, donated $500,000 to a group calling itself Arizonans for Responsible Drug Policy, a newly formed organization established to try to defeat Proposition 205, the marijuana legalization voter initiative that will appear on the ballot this November in that state.
Insys currently markets just one product, Subsys, a sublingual fentanyl spray, a synthetic opioid far more potent than heroin (fentanyl is the drug found in Prince’s system following his death in April). “Insys Therapeutics made $62 million in net revenue on Subsys fentanyl sales in the first quarter of this year, representing 100 percent of the company’s earnings,” according to The Washington Post. “The CDC has implicated the drug in a ‘surge’ of overdose deaths in several states in recent years.”
Survey data compiled from medical marijuana patients show that subjects often reduce their use of prescription drug therapies — particularly opioids — when they have legal access to cannabis. According to a 2015 RAND Corp. study, opiate-related abuse and mortality is lower in jurisdictions that permit medical cannabis access, compared to those that outlaw the plant.
Insys has come under scrutiny of law enforcement. According to The Washington Post, a number of states are currently investigating Insys for illegally paying physicians to prescribe their drug in situations in which it was inappropriate. Illinois Attorney General Lisa Madigan filed a lawsuit against the company, claiming the company’s “desire for increased profits led it to disregard patients’ health and pushed addictive opioids for non-FDA approved purposes.”
The smoking gun.
When the company first made its half-million dollar contribution to the group opposing the Arizona legalization initiative — the largest single contribution to the group by a factor of four — the company claimed that its reason for opposing the voter initiative was “because it fails to protect the safety of Arizona’s citizens and particularly its children.”
But when the company filed a legally required disclosure statement with the Securities and Exchange Commission, it acknowledged to shareholders that it was making the donation because it feared a decline in the sales of its powerful opioid product and that of a second drug it is developing: Dranabinol, a synthetic cannabinoid. Synthetic cannibinoid is a blanket term for an artificial version of tetrahydrocannabinol, or THC — the active compound in the marijuana plant — intended to alleviate chemotherapy-caused nausea and vomiting. The company concedes that the scientific literature has confirmed the benefits of natural marijuana over synthetic THC:
“Legalization of marijuana or non-synthetic cannabinoids in the United States could significantly limit the commercial success of any dronabinol product candidate. … If marijuana or non-synthetic cannabinoids were legalized in the United States, the market for dronabinol product sales would likely be significantly reduced, and our ability to generate revenue and our business prospects would be materially adversely affected.”
The Arizona Republic reported that the company, while publicly claiming to have kids’ best interests in mind, is clearly more concerned with ways to “protect its own bottom line.”
And the company has good reason for that fear. Recently published studies have found that states that provide for the legal use of medical marijuana had a 25 percent decline in opioid prescriptions. Another recent study from Columbia University found the implementation of medical marijuana programs is associated with a decrease in the prevalence of opioids detected among fatally injured drivers, based on a review of 69,000 fatalities in 18 states, according to data published in the American Journal of Public Health. Where legal marijuana is available, people use far fewer opioid drugs.
So we now have direct evidence that this pharmaceutical company in Arizona is spending large amounts of money to avoid having to compete with legal marijuana, in order to protect its market share for an addictive and dangerous synthetic opioid and a synthetic form of THC, at the expense of public health.
This is not the first instance of pharmaceutical companies pouring money into the “war on drugs.” In 2014, The Nation published an article revealing that the makers of Oxycontin and Vicodin were two of the largest contributors to The Partnership for Drug Free Kids and the Community Anti-Drug Coalition of America, two groups that oppose marijuana legalization and support continued prohibition.
Insys will certainly not be the last pharmaceutical company caught putting company profits ahead of concern for public health, but it is the first instance we have seen where a company was caught with its hands in the cookie jar, opposing a marijuana legalization initiative purely for reasons of corporate greed.
Tobacco and alcohol companies have long opposed legal marijuana.
It is understandable that recreational and pharmaceutical industries would not wish to compete with legal marijuana. By any measure, their products are far more dangerous and far more addictive.
For comparison purposes, according to the National Institute on Alcohol Abuse and Alcoholism, excessive alcohol use results in approximately 88,000 deaths per year in this country. And, according to the Centers for Disease Control and Prevention, tobacco smoking results in more than 480,000 deaths each year in this country, about 1,300 people each day.
A 2014 study by Johns Hopkins University found that states that legalized medical marijuana saw a 25 percent decline in overdose deaths from prescription drugs.
Marijuana has never caused an overdose death in the history of mankind. According to a recent report from the World Health Organization, one would have to smoke “between 238 and 1,113 joints a day – or at least 10 joints an hour, for 24 hours straight – before overdose would become a realistic concern” for marijuana.
While one can develop a dependence on marijuana smoking, the threat of dependence with marijuana is far less than with either alcohol or tobacco. Here is what the National Academy of Sciences Institute of Medicine concluded in regard to cannabis’ potential dependence liability, in the context of other controlled substances:
“In summary, although few marijuana users develop dependence, some do. But they appear to be less likely to do so than users of other drugs (including alcohol and nicotine), and marijuana drug dependence appears to be less severe than dependence on other drugs.”
Here are their dependence ratings:
Tobacco: 32 percent (proportion of users who ever become dependent)
Heroin: 23 percent
Cocaine: 17 percent
Alcohol: 15 percent
Anxiolytics/sedatives: 9 percent
Marijuana/hashish: 9 percent
So if one is electing to use a recreational drug, marijuana is clearly the safest alternative. And if one is using an opioid drug for pain, they should experiment with marijuana as a substitute for the more dangerous and addictive opioids. For many, it is an effective and far less dangerous alternative.
Keith Stroup is a Washington, D.C. public-interest attorney who founded NORML in 1970.
This column was first published in ATTN.com.
The implementation of medical marijuana programs is associated with a decrease in the prevalence of opioids detected among fatally injured drivers, according to data published in the American Journal of Public Health.
Researchers at Columbia University in New York and the University of California at Davis performed a between-state comparison of opioid positivity rates in fatal car accidents in 18 states. Authors reported that drivers between the ages of 21 and 40 who resided in states that permitted medical marijuana use were approximately half as likely to test positive for opioids as were similar drivers in jurisdictions that did not such programs in place.
They concluded, “Operational MMLs (medical marijuana laws) are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose.”
Prior comparisons have determined that medical cannabis access is associated with lower rates of opioid use, abuse, and mortality. Most recently, a 2016 study published in the journal Health Affairs reported a significant decrease in the use of prescription medications following the implementation of medical marijuana programs.
An abstract of the study, “State medical marijuana laws and the prevalence of opioids detected among fatally injured drivers,” appears online here.
Fewer young people are reporting that marijuana is ‘easy’ to obtain, according to an analysis released this week by the US Centers for Disease Control.
Investigators from the Substance Abuse and Mental Health Services Administration and the CDC evaluated annual data compiled by the National Survey on Drug Use and Health for the years 2002 to 2014. Researchers reported that the percentage of respondents aged 12 to 17 years who perceived marijuana to be “fairly easy or very easy to obtain” fell by 13 percent during this time period. Among those ages 18 to 25, marijuana’s perceived availability decreased by three percent.
Researchers further reported that “since 2002, the prevalence of marijuana use and initiation among U.S. youth has declined” – a finding that is consistent with numerous prior studies.
By contrast, authors reported an uptick in use among adults. However, they acknowledged that this increase in adult marijuana consumption has not been associated with a parallel increase in problematic use. There has been “steady decreases in the prevalence of marijuana dependence and abuse among adult marijuana users since 2002,” the study found. Those adults experiencing the greatest percentage increase in marijuana use during the study period were respondents over the age of 55.
A separate analysis of the data published in the journal Lancet Psychiatry similarly acknowledged no observed increase in marijuana use disorders. A previous assessment of marijuana use patterns since 2002, published earlier this year in JAMA Psychiatry, also reported a decline in the percentage of adults reporting problems related to their marijuana use.
Full text of the CDC study, “National estimates of marijuana use and related indicators – National Survey on Drug Use and Health, 2002-2014,” appears online here.
The United States Drug Enforcement Administration has rejected a pair of administrative petitions that sought to initiate rulemaking proceedings to reschedule marijuana under federal law.
Although the DEA’s ruling continues to classify marijuana in the same category as heroin, the agency also announced in a separate decision that it is adopting policy changes designed to expand the production of research-grade cannabis for FDA-approved clinical studies.
Presently, any clinical trial involving cannabis must access source material cultivated at the University of Mississippi — a prohibition that is not in place for other controlled substances. Today, the agency announced for the first time that it will be seeking applications from multiple parties, including potentially from private entities, to produce marijuana for FDA-approved research protocols as well as for “commercial product development.” This change was initially recommended by the DEA’s own administrative law judge in 2007, but her decision was ultimately rejected by the agency in 2011.
Below is a statement from NORML Deputy Director Paul Armentano regarding the DEA’s decisions:
For far too long, federal regulations have made clinical investigations involving cannabis needlessly onerous and have placed unnecessary and arbitrary restrictions on marijuana that do not exist for other controlled substances, including some other schedule I controlled substances.
While this announcement is a significant step toward better facilitating and expanding clinical investigations into cannabis’ therapeutic efficacy, ample scientific evidence already exists to remove cannabis from its schedule I classification and to acknowledge its relative safety compared to other scheduled substances, like opioids, and unscheduled substances, such as alcohol. Ultimately, the federal government ought to remove cannabis from the Controlled Substances Act altogether in a manner similar to alcohol and tobacco, thus providing states the power to establish their own marijuana regulatory policies free from federal intrusion.
Since the DEA has failed to take such action, then it is incumbent that members of Congress act swiftly to amend cannabis’ criminal status in a way that comports with both public and scientific opinion. Failure to do so continues the federal government’s ‘Flat Earth’ position; it willfully ignores the well-established therapeutic properties associated with the plant and it ignores the laws in 26 states recognizing marijuana’s therapeutic efficacy.
Under the U.S. Controlled Substances Act of 1970, the cannabis plant and its organic cannabinoids are classified as Schedule I prohibited substances — the most restrictive category available under the law. By definition, substances in this category must meet three specific inclusion criteria:
The substance must possess “a high potential for abuse”; it must have “no currently accepted medical use” in the United States; and, the substance must lack “accepted safety for use … under medical supervision.”
Substances that do not meet these criteria must, by law, be categorized in less restrictive federal schedules (Schedules II through V) and are legally regulated accordingly. Alcohol and tobacco, two substances widely acknowledged to possess far greater dangers to health than does cannabis, are not classified under the Controlled Substances Act.
A recent review of FDA-approved clinical studies evaluating the safety and efficacy of herbal cannabis concluded: “Based on evidence currently available the Schedule I classification is not tenable; it is not accurate that cannabis has no medical value, or that Information on safety is lacking.”
Added Armentano: “The DEA’s decision is strictly a political one. There is nothing scientific about willful ignorance.”
The DEA has previously rejected several other rescheduling petitions, including a 2002 petition filed by a coalition of marijuana law reform and health advocacy organizations, and a 1972 petition filed by NORML. The petitions that triggered this latest DEA action were filed in 2009 by a nurse practitioner and in 2011 by then-Govs. Christine Gregoire of Washington and Lincoln Chafee of Rhode Island.
Marijuana consumers do not access health care services at rates that are higher than non-users, according to data published online ahead of print in the European Journal of Internal Medicine.
Researchers at the Medical College of Wisconsin assessed the relationship between marijuana use and health care utilization in a nationally representative sample of 174,159,864 US adults aged 18 to 59 years old.
Authors reported “no significant increase in outpatient health care visits and overnight hospital admissions in marijuana users compared to non-users.” They also reported that those who consumed cannabis multiple times per day were no more likely to seek health care patient services as compared to those who used the substance less frequently.
They concluded, “[C]ontrary to popular belief, … marijuana use is not associated with increased healthcare utilization, [and] there [is] also no association between health care utilization and frequency of marijuana use.”
A previous assessment, published in 2014 in the Journal of General Internal Medicine, similarly reported that the use of marijuana within the past three months was not associated with adverse effects on health, comorbidity, ER visits, or hospitalization.
An abstract of the study, “Marijuana users do not have increased healthcare utilization: A National Health and Nutrition Examination Survey (NHANES) study,” appears here.