Patients use fewer prescription drugs in states where access to medical cannabis is legally regulated, according to data published in the journal Health Affairs.
Investigators at the University of Georgia assessed the association between medical cannabis regulations and the average number of prescriptions filled by Medicaid beneficiaries between the years 2007 and 2014.
Researchers reported, “[T]he use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied.” They added, “If all states had had a medical marijuana law in 2014, we estimated that total savings for fee-for-service Medicaid could have been $1.01 billion.”
The findings are similar to those previously published by the team which reported that medical cannabis access was associated with significantly reduced spending by patients on Medicare Part D approved prescription drugs.
Separate studies have reported that patients with legal access to medical marijuana reduce their intake of opioids, benzodiazepines, anti-depressants, migraine-related medications, and sleep aids, among other substances.
An abstract of the study, “Medical marijuana laws may be associated with a decline in the number of prescriptions for medicaid enrollees,” appears here.
The National Academy of Sciences, Engineering, and Medicine released a comprehensive report today acknowledging that “conclusive or substantial evidence” exists for cannabis’ efficacy in patients suffering from chronic pain, and sharply criticized longstanding federal regulatory barriers to marijuana research – in particular “the classification of cannabis as a Schedule I substance” under federal law.
Authors of the report also addressed various aspects of marijuana’s effect on health and safety, acknowledging that the substance may pose certain potential risks for adolescents, pregnant women, and for those who may be driving shortly after ingesting cannabis. In each of these cases, these risks may be mitigated via marijuana regulation and the imposition of age restrictions in the marketplace.
Commenting on the report, NORML Deputy Director Paul Armentano said:
“The National Academy of Science’s conclusions that marijuana possesses established therapeutic utility for certain patients and that it possesses an acceptable safety profile when compared to those of other medications or recreational intoxicants are not surprising. This evidence has been available for some time, yet for decades marijuana policy in this country has largely been driven by rhetoric and emotion, not science and evidence.
“A search on PubMed, the repository for all peer-reviewed scientific papers, using the term ‘marijuana’ yields over 24,000 scientific papers referencing the plant or its biologically active constituents — a far greater body of literature than exists for commonly consumed conventional drugs like Tylenol, ibuprofen, or hydrocodone. Further, unlike modern pharmaceuticals, cannabis possesses an extensive history of human use dating back thousands of years, thus providing society with ample empirical evidence as to its relative safety and efficacy.
“Today, 29 states and Washington, DC permit physicians to recommend marijuana therapy. Some of these state-sanctioned programs have now been in place for nearly two decades. Eight states also permit the regulated use and sale of cannabis by adults. At a minimum, we know enough about cannabis, as well as the failures of cannabis prohibition, to regulate its consumption by adults, end its longstanding criminalization, and to remove it from its Schedule I prohibitive under federal law.”
The report marks the first time since 1999 that the National Academy of Sciences has addressed issues surrounding marijuana and health. Authors reviewed over 10,000 scientific abstracts in their preparation of the new report.
You can read the full report here.
Medical cannabis administration is associated with improved cognitive performance and lower levels of prescription drug use, according to longitudinal data published online in the journal Frontiers in Pharmacology.
Investigators from Harvard Medical School, Tufts University, and McLean Hospital evaluated the use of medicinal cannabis on patients’ cognitive performance over a three-month period. Participants in the study were either naïve to cannabis or had abstained from the substance over the previous decade. Baseline evaluations of patients’ cognitive performance were taken prior to their cannabis use and then again following treatment.
Researchers reported “no significant decrements in performance” following medical marijuana use. Rather, they determined, “[P]atients experienced some improvement on measures of executive functioning, including the Stroop Color Word Test and Trail Making Test, mostly reflected as increased speed in completing tasks without a loss of accuracy.”
Participants in the study were less likely to experience feelings of depression during treatment, and many significantly reduced their use of prescription drugs. “[D]ata revealed a notable decrease in weekly use across all medication classes, including reductions in use of opiates (-42.88 percent), antidepressants (-17.64 percent), mood stabilizers (-33.33 percent), and benzodiazepines (-38.89 percent),” authors reported – a finding that is consistent with prior studies.
Patients in the study will continue to be assessed over the course of one-year of treatment to assess whether these preliminary trends persist long-term.
Full text of the study, “Splendor in the grass? A pilot study assessing the impact of marijuana on executive function,” appears online here.
Investigators at Tel Aviv University and the Rabin Medical Center in Israel assessed the impact of cannabis exposure on motor symptoms and pain parameters in patients with Parkinson’s disease.
Researchers reported that cannabis inhalation was associated with improved symptoms 30-minutes following exposure. “Cannabis improved motor scores and pain symptoms in PD patients,” authors concluded.
A prior Israeli trial evaluating the impact of cannabis on PD patients reported “significant improvement after treatment in tremor, rigidity, and bradykinsea (slowness of movement) … [as well as] significant improvement of sleep and pain scores.”
Over 20,000 Israeli patients receive cannabis under a federally regulated program. Over 90 percent of those participants report significant improvements in pain and function as a result of their medicinal cannabis use.
An abstract of the study, “Effect of medical cannabis on thermal quantitative measurements of pain in patients with Parkinson’s disease,” is available online here.
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.