Who Are America’s Medical Marijuana Patients

Analysis by California NORML coordinator Dale Gieringer, Ph.D

An interesting new study of the California medical cannabis user population by Prof. Craig Reinarman et al. appears in the Journal of Psychoactive Drugs 43(2) Apr-Jun, 2011: “Who Are Medical Marijuana Patients? Population Characteristics from Nine California Assessment Clinics”.

Noteworthy findings:

*Medical cannabis use is higher than average among Blacks and Native Americans, lower among Latinos and Asians.

*73% of patients are male.

*Use is heaviest in the 25-44 year age group.

*Leading indications:

82.6% for pain

70.7% to improve sleep

55% for “relaxation”

41% for muscle spasms

41% for headaches

38% for anxiety

28% for nausea

26% for depression

51% use as a substitute for prescription medication (showing that medical cannabis may offer significant health cost savings)

Medical cannabis users report significantly lower alcohol & cocaine use than the average population,  supporting the substitution theory that more cannabis use may lead to less abuse of other drugs.

Abstract - Marijuana is a currently illegal psychoactive drug that many physicians believe has substantial therapeutic uses. The medical literature contains a growing number of studies on cannabinoids as well as case studies and anecdotal reports suggesting therapeutic potential. Fifteen states have passed medical marijuana laws, but little is known about the growing population of patients who use marijuana medicinally. This article reports on a sample of 1,746 patients from a network of nine medical marijuana evaluation clinics in California. Patients completed a standardized medical history form; evaluating physicians completed standardized evaluation forms. From this data we describe patient characteristics, self-reported presenting symptoms, physician evaluations, other treatments tried, other drug use, and medical marijuana use practices. Pain, insomnia, and anxiety were the most common conditions for which evaluating physicians recommended medical marijuana. Shifts in the medical marijuana patient population over time, the need for further research, and the issue of diversion are discussed.

America’s One Million Legalized Marijuana Users

At Least 1 – 1.5 Million Americans are Legal Medical Marijuana Patients

Market for these patients in sixteen states and D.C. estimated at between $2 – $6 billion annually

MAY 31, 2011 - We don’t know his or her name, but somewhere in one of sixteen states and the District of Columbia is America’s 1,000,000th legal medical marijuana patient. We estimate the United States reached the million-patients mark sometime between the beginning of the year to when Arizona began issuing patient registry identification cards online in April 2011.

16 states, the Capitol, and ONE MILLION legal marijuana users.

Between one to one-and-a-half million people are legally authorized by their state to use marijuana in the United States, according to data compiled by NORML from state medical marijuana registries and patient estimates.  Assuming usage of one-half to one gram of cannabis medicine per day per patient and an average retail price of $320 per ounce, these legal consumers represent a $2.3 to $6.2 billion dollar market annually.

Based on state medical marijuana laws, the amounts of cannabis these legal marijuana users are entitled to possess means there is between 566 – 803 thousand pounds of legal usable cannabis allowed under state law in America.  These patients are allowed to cultivate between 17 – 24 million legal cannabis plants.  There may possibly be more, as California and New Mexico “limits” may be exceeded with doctor’s permission and some California counties explicitly allow greater amounts, so there may be as much as 1 million pounds of state-legal cannabis allowed under state law in America.

Yet after fifteen years, one million patients, and a million pounds of legal marijuana, few if any of the dire predictions by opponents of medical marijuana have come to fruition.  Medical marijuana states like Oregon are experiencing their lowest-ever rates of workplace fatalities, injuries, and accidents.  States like Colorado are experiencing their lowest rates in three decades of fatal crashes per million miles driven.  In medical marijuana states for which we have data (through Michigan in 2008), use by minor teenagers is down in all but Maine and down by at least 10% in states with the greatest proportion of their population using medical cannabis. (more…)

Proposition 19 Is No Threat To Workplace Safety

Redding Record Searchlight

September 12, 2010

by Dale Gieringer (Dale Gieringer is director of California NORML)

Opponents of marijuana legalization complain that Proposition 19 could endanger workplace safety. Employers, such as Ed Rullman of the Best Western Hilltop Inn in his Aug. 15 Op-Ed, object that Proposition 19 has a clause protecting employees against discrimination for private, adult use of marijuana. However, this is qualified by an important provision protecting employers’ right “to address consumption that actually impairs job performance.”

Why then should Proposition 19 be a problem for employers? Because they want to test employees for behavior that doesn’t affect job performance by using the inherently flawed and inaccurate technology of urine testing.

Contrary to popular misconception, urine tests don’t measure the active presence of marijuana in the system, but rather non-active chemical by-products that linger for days or weeks after any impairing effects have faded. Urine testing routinely flags the most harmless, weekend use of marijuana, while completely ignoring the No. 1 cause of drug abuse, alcohol.

Urine testing is therefore a highly unreliable indicator of impairment or job fitness. In fact, it is perfectly possible to be high as a kite and still pass a urine test with flying colors because marijuana doesn’t show up in the urine until hours after smoking. Such problems can be avoided by other, more accurate screening methods, such as blood tests, which detect the active presence of drugs in the system, or the field sobriety checks used by law enforcement in DUI stops.

But aren’t urine tests still helpful in protecting workplace safety? Scientific evidence for this is conspicuously lacking. Urine testing has never undergone the kind of rigorous FDA “safety and efficacy” studies that are required for other medical devices and drugs.

Numerous studies have found that subjects who test positive for marijuana are no more accident-prone, and in some instances even safer, than those who don’t.

A recent expert review by the Canadian Center for Addictions Research recommended against use of drug urinalysis, concluding that “urinalysis has not been shown to have a meaningful impact on job injury/accident rates.”

A study of high-tech companies found that drug testing was associated with reduced productivity, apparently because it undermines worker morale and trust. Drug urinalysis may thus be an indicator of sloppy management by large corporations who exercise poor oversight over workers.

Until recent years, it would have been laughable to suppose that American workers should be forced to submit urine samples to prove their job worthiness. The U.S. is alone among developed countries in regarding urine testing as a routine practice. In the Netherlands, where marijuana is legally available to all adults, drug testing is hardly used, yet workplace safety is substantially better than in the U.S.

The bottom line is that marijuana residues in urine pose no risk to workplace safety. In many cases, it is even preferable to let employees use marijuana for medical purposes at home so as to help avoid pain and other problems that can impair their performance.

Of course, there may exist situations where some kind of drug testing is useful in protecting workplace safety. If so, Proposition 19 specifically permits it. In no case would Proposition 19 override existing federal drug testing rules, anymore than did Proposition 215.

In general, however, Proposition 19 would benefit countless workers — pot users and non-users alike — by sparing them the degrading indignity of submitting to intrusive, misleading urine tests that have no bearing on job fitness.

Risk of stoned drivers minimal with Prop. 19

Our California NORML Coordinator, Dale Gieringer, has penned an informative viewpoint for the Sacramento Bee, addressing the one of the only two arguments against legalization of marijuana that still have any traction with the people: “Marijuana Mayhem on the Freeways!” (the other being: “My God! What About the Children!?!”)

As usual, the prohibitionists’ stark warnings about the peril of stoned drivers after legalization only makes sense if you believe nobody is smoking pot now.

Studies on marijuana and driving safety are remarkably consistent, though greatly under-publicized because they fail to support the government’s anti-pot line. Eleven different studies of more than 50,000 fatal accidents have found that drivers with marijuana-only in their system are on average no more likely to cause accidents than those with low, legal levels of alcohol below the threshold for DUI.

The major exception is when marijuana is combined with alcohol, which tends to be highly dangerous.

Several studies have failed to detect any increased accident risk from marijuana at all. The reason for pot’s relative safety appears to be that it tends to make users drive more slowly, while alcohol makes them speed up.

Thus legalization could actually reduce accidents if more drivers used marijuana instead of alcohol, but it could also increase them if there were more combined use of the two.

Nobody is saying “toke up and get behind the wheel”; our Principles of Responsible Use firmly states “The responsible cannabis consumer does not operate a motor vehicle or other dangerous machinery while impaired by cannabis”. However, it would be naive to think every cannabis consumer uses responsibly.

Geiringer addresses this by pointing out that California, the state with the easiest access to medical marijuana, has only the 14th-highest rating of states with marijuana-related accidents, while states like Indiana and South Carolina, some of the most hostile states with respect to marijuana, have far more marijuana-related accidents.  Within California, two of the most liberal cities for pot access, San Francisco and Santa Cruz, had zero marijuana-related accidents in the past year of record.

US accident rates in general have been declining steadily since the 1960s, even as marijuana use reached its greatest rates in the late 1970s.  Even in the 1980s when marijuana legalization was at its lowest levels of support and throughout the 1990s and 2000s as medical marijuana spread from state to state, the highway accident rates have continued their steady decline.  It seems that whether marijuana is popular and legal or not, it makes no difference in roadway safety.

Besides, driving under the influence of marijuana is illegal in California now and Prop 19 does nothing to undo that.  Californians can and have been arrested for drugged driving over the past fourteen years, even with legal medical marijuana.  Whatever cops are doing now to arrest pot-smoking drivers for DUID will still be done after Prop 19 passes.

Labs Testing For Marijuana Use By Marinol Patients

By Dale Gieringer, Ph.D, Director, California NORML

California NORML has recently heard increasing reports that Marinol patients are being drug tested and denied employment for use of marijuana. In particular, we have heard from legal Prop. 215 patients who were denied jobs despite presenting Marinol prescriptions after being re-tested specifically for marijuana. Until recently, Marinol and marijuana were indistinguishable on the standard drug tests, so that patients with a Marinol prescription had a valid medical excuse under federal law for testing positive for marijuana.

However, special testing techniques have been developed that make it possible to distinguish the two by testing for non-standard cannabinoids that appear in marijuana but not Marinol. Until recently, these tests were expensive and rarely used except in high-profile criminal cases. However, it appears that they are now being routinely used by certain laboratories in cases where Marinol use is claimed. In particular, we have heard reports of such testing being used to disqualify Marinol-using Prop 215 patients by the transportation industry and by Walmart.

California NORML has accordingly altered its drug testing information to warn against relying on Marinol RXs as a screen for marijuana use: http://www.canorml.org/healthfacts/testing.tips.html

There is of course no valid scientific or health justification for allowing patients to use Marinol but not marijuana. The only purpose is to enforce compliance with the law. It is a tribute to the power and influence of the drug testing industry that they have prevailed in foisting the costs of this unnecessary and obnoxious procedure on employers.

California NORML, 2215-R Market St. #278, San Francisco CA 94114

(415) 563-5858 / www.canorml.org