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.

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.

Fourteen of the seventeen medical marijuana jurisdictions have mandatory registries while two (California and Colorado) offer optional registries and one (Washington) has no registry system.  Estimating California’s patient numbers is hampered by its registry system being on a county-by-county basis.  California NORML’s Dale Gieringer estimates between 2% – 3% of the state’s population are holding medical marijuana recommendations – meaning possibly over one million medical marijuana patients in California alone.

California’s patient population can be estimated from data from other medical marijuana states where patients are required to register, shown in the table below. The top two of these are Colorado and Montana, which, like California, have a well developed network of cannabis clinics and dispensaries, and which report usage rates of 2.5% and 3.0%, respectively. Other states, where medical marijuana is less developed, report lower rates of 1% and less. However, California is likely to be on the high side because it has the oldest and most liberal law in the nation. Significantly, California is the only state that permits marijuana to be used for any condition for which it provides relief – in particular, psychiatric disorders, such as PTSD, bipolar disorder, ADD, anxiety and depression, which account for some 20%-25% of the total patient population. Adjusting for this, usage in California could be as much as 25% to 33% higher than in Colorado and Montana, which would put it well over 3% of the population (1,125,000).

A 2%+ patient population estimate is supported by data from the Oakland Patient ID Center, which has been issuing patient identification cards to its members since 1996. The OPIDC serves patients from all over the state, but especially the greater Oakland-East Bay area of Northern California, where its cards are honored by law enforcement. As of 2010, the OPIDC had issued ID’s to 19,805 members from five East Bay cities (Oakland, Berkeley, Alameda, Hayward and Richmond), amounting to 2.4% of the local population.Because the cards were issued over a period of 14 years, they include numerous patients who have lapsed, moved, or deceased. On the other hand, they do not include many other local patients who have current recommendations but never registered with the OPIDC.

We have made a similar estimate for Washington State’s patients, who are the only ones in the nation with no registry system in place (Gov. Gregoire recently signed a bill that initiates a voluntary registry).  With a law very similar to Oregon’s concerning qualifying conditions, applying Oregon’s 1.04% patient population figure gives us about 69,000 patients in Washington. However, Washington State’s larger urban centers (Seattle and Spokane), combined with a more liberal law than Oregon’s regarding who can sign recommendations (osteopaths, naturopaths, and nurse practitioners can recommend in Washington) and the lack of a state registry’s burden to patient compliance with the program suggests a higher estimate of 1.5% – 2% may be appropriate.  Numbers like Colorado’s 2.5% and Montana’s 3% are improbable as Washington lacks the greater patient access to dispensaries seen in those states.

Delaware, New Jersey, and D.C.’s programs are not operational yet, so they are not shown in our data table.  Most of the other state’s programs produce reports of patient registry numbers.  With Arizona signing up over 3,600 patients since mid-April, when it’s online-only registration went into effect, Arizona is on track to register over 30,000 patients this year.

Quick Facts about Medical Marijuana States:

• The 1.1 – 1.5 million estimated and registered medical marijuana patients in America are legally entitled to cultivate 17 – 24 million cannabis plants and possess 283 –  402 tons of harvested buds.
• The seventeen jurisdictions with medical marijuana encompass over 90 million Americans and 162 votes in the 2012 Electoral College.
• Patients make up over 3% of the population of Montana, almost 2.5% of Colorado, over 2% of California. and over 1% of Oregon, and Washington.
• After Michigan at 0.76% of population, every other medical marijuana state has less than 3 in 1,000 (0.3%) patients in its population.
• California, Colorado, Washington, Michigan, Oregon, and Montana comprise over 98% of the legal medical marijuana patients in America.
• More than 3 out of four (77% – 83%) of all medical marijuana patients live on the West Coast.
• Rhode Island and Vermont, two states where over 10% of the adult population uses marijuana monthly, have patient populations of 0.29% and 0.05%, respectively.
• Monthly teen use of marijuana is down in every medical marijuana state except Maine.
• Annual highway fatalities are down in every medical marijuana state except Rhode Island.
• Incidents of workplace injuries and illnesses are down in every medical marijuana state.

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.

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.

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

Rhode Island: The Rhode Island Senate approved Senate Bill 2693 on May 15 in a 29-6 vote. A companion bill to this important measure, which seeks to create a dispensary system for Rhode Island’s state-qualified medical cannabis patients, awaits action by the Rhode Island House of Representatives. According to a new poll, nearly 70 percent of state voters support enacting a medical cannabis distribution system. Rhode Islanders are encouraged to write their state Representatives in support of this effort via NORML’s online advocacy system. To hear an interview with RIPAC‘s Jesse Stout about this measure, check out NORML’s Daily Audio Stash here.

California: In an important victory for medical marijuana patients, the Assembly Committee on Labor and Employment has approved Assembly Bill 2279 in a 6-2 vote. The measure will now go to the Assembly floor. If passed, AB 2279 would protect patients from employment discrimination on the basis of their state-licensed medical cannabis use in off-work hours. Californians are strongly encouraged to contact their Assemblymembers via NORML’s online advocacy system.

California: Voters in Northern California’s Mendocino County will decide next month whether or not to repeal an eight-year old county law (The Personal Use of Marijuana Initiative, also known as Measure G) which legalized the possession and use of up to 25 marijuana plants. Measure B, a Mendocino County-wide ballot initiative, seeks to overturn the measure. To learn more about efforts opposing Measure B, please visit CANORML or No on B. You can also listen to California NORML Coordinator Dale Gieringer discuss this and other statewide campaigns on NORML’s Daily Audio Stash by clicking here.

Illinois: Senate Bill 2865, which seeks to allow for the therapeutic use of cannabis for qualified patients, continues to await action by the full Senate. This bill was recently amended to address concerns voiced by some of the Illinois law enforcement community. Illinois NORML supporters are urged to contact their state Senators in support of SB 2865 through NORML’s online advocacy system. To listen to Illinois NORML’s Daniel Linn discuss this effort, please click here.

Minnesota: Medical cannabis legislation is anticipated to go before the full House for a floor vote imminently. Passage of this legislation would ensure that medical marijuana patients in Minnesota would no longer have to fear arrest or prosecution from state law enforcement. However, Governor Pawlenty has indicated that he intends to veto this bill if it gets to his desk. You can view an ad urging Governor Pawlenty to rethink his position here. Minnesotans are strongly encouraged to urge their Representatives and the Governor to support these bills via NORML’s online advocacy system. You can also listen to IDFI Executive Director Charles Thomas discuss this effort on NORML’s Daily Audio Stash here.