Medical Marijuana

  • by Chris Goldstein, Philly NORML June 13, 2019

    Marijuana and MoneyAre you paying too much for medical marijuana?

    Millions of Americans are legally replacing pharmaceuticals with cannabis and the question of affordability has become critical.

    All of the state programs are independent and in various stages of maturity. Prices, even for closely similar products, have a wide range. Confused consumers are often paying $1000 per month at dispensaries, sometimes a lot more.

    Pennsylvania’s closed-loop system of limited marijuana permit holders is not a competitive free market. Under similar structures around the country, like in New Jersey and New York, these licensed cannabis cartels set product costs independently from regulators. There hasn’t been much official critique on the impact.

    Now, a single paragraph buried in Pa.’s medical marijuana law will start bringing some transparency to consumer-level prices. It could also have a profound influence on medical cannabis products nationwide.

    Voila; Section 705 of Pa. Act 16:

    The department [of Health] and the Department of Revenue shall monitor the price of medical marijuana sold by grower/processors and by dispensaries, including a per-dose price. If the department and the Department of Revenue determine that the prices are unreasonable or excessive, the department may implement a cap on the price of medical marijuana being sold for a period of six months. The cap may be amended during the six-month period. If the department and the Department of Revenue determine that the prices become unreasonable or excessive following the expiration of a six-month cap, additional caps may be imposed for periods not to exceed six months.

    These 105 words grant Pennsylvania the first statutory mandate in the country to directly affect the cost of cannabis. No other state gets a place at the table – with the permit holders – for the price fix.

    This regulatory exercise could bring a new wave of relief to consumers. Many are having serious difficulty calculating and covering annual expenses for marijuana therapy.

    The biggest reason price is such an issue is because there are no regular health insurance offsets for cannabis products. That means every sale is cash, directly out of consumers’ pockets.

    Certain conditions require more cannabinoids than others. Thus, the worst impact of high retail pricing at dispensaries falls upon the most seriously ill residents; many of whom also live on a fixed income.

    Operators fiercely defended premium retail prices. The corporate coyotes, howling around their latest stock offering or holding company acquisition, jab fingers towards eager investors seeking a quick return on the pure, liquid capital used for start-ups.

    Price caps that could favor seriously ill patients/consumers will be an entirely new concept to the cannabis industry, but it’s no innovation. Americans enjoy stable costs on everyday essentials like gasoline, electricity, water, food, and basic drugs because of price controls on essentials.

    Many of Pa. permit holders operate in multiple states, including New Jersey. So, this first-of-its-kind provision could also have an impact beyond the Commonwealth’s borders.

    The most devilish detail in the provision is what the Pa. Department of Health considers to be a “dose” of medical marijuana. Labels on products from the. manufacturers have also included suggested doses, especially on the vape pens

    The reality is that cannabinoids have very individualized effects on human beings. Patients need a vast array of possible dosing combinations, sometimes in the same day.

    Epidiolex, the first cannabis-derived drug approved by the FDA, allows doses for children to be increased upwards of 200 times over the original amount during seizure episodes.

    The rule is similar for medical cannabis: Patients working with a doctor determine their individual dose, increasing as needed.

    Hopefully, regulators will focus on the real concern: Monthly and annual costs to consumers. Pa. Department of Revenue spokesperson Jeffrey Johnson confirmed that implementation of Section 705 is underway. Johnson says that Pa.’s operators have 12 months to submit their first price reports – the first started in February 2019 – and then quarterly thereafter.

    State governments in the business of regulating medical marijuana are beginning to recognize a serious responsibility to institute fair prices.

    The tasty underground flower I can buy and smoke today costs $5-$10 per gram. Legal options inside regulated dispensaries should cost less, not more.

  • by Paul Armentano, NORML Deputy Director June 11, 2019

    Patients diagnosed with chronic pain and other debilitating conditions typically reduce, or in some cases, eliminate their use of opioids following their enrollment in state-sanctioned medical cannabis access programs.

    Several peer-reviewed studies now document this trend. In contrast to observational, population-based studies — which only seek to identify whether an association exists between the passage of medical cannabis laws and opioid use trends in the general population — these papers explicitly assess individual patients’ relationship with opioids following their registration in state-sponsored access programs.

    For example, researchers writing in the May edition of the journal Annals of Pharmacotherapy evaluated the use of opioids in 77 intractable pain patients newly enrolled in the Minnesota Medical Cannabis Program. Researchers reported “a statistically significant decrease in MME (milligram morphine equivalents) from baseline to both three and six months.”

    A 2018 study assessing prescription drug use trends among patients enrolled in New York state’s medical cannabis program yielded similar results. On average, subjects’ monthly analgesic prescription costs declined by 32 percent following enrollment, primarily due to a reduction in the use of opioid pills and fentanyl patches. “After three months treatment, medical cannabis improved [subjects’] quality of life, reduced pain and opioid use, and lead to cost savings,” authors concluded.

    These conclusions are hardly unique. A study of 244 state-registered chronic pain patients enrolled in Michigan’s medical cannabis program reported: “[M]edical cannabis use was associated with a 64 percent decrease in opioid use, decreased number and side effects of medications, and an improved quality of life. This study suggests that many CP [chronic pain] patients are essentially substituting medical cannabis for opioids and other medications for CP treatment.”

    A separate review of over 2,000 chronic pain patients in Minnesota reported that 63 percent of those who used opioids at the time of admission into the program “were able to reduce or eliminate their opioid use after six months.”

    Yet another study, this time evaluating the prescription drug use patterns of patients enrolled in Illinois’ medical access program, similarly revealed: “[O]ur results indicate that MC (medical cannabis) may be used intentionally to taper off prescription medications. These findings align with previous research that has reported substitution or alternative use of cannabis for prescription pain medications due to concerns regarding addiction and better side-effect and symptom management, as well as complementary use to help manage side-effects of prescription medication.”

    Perhaps most notably, a 2017 study published in the journal PLoS ONE compared prescription drug use patterns among pain patients enrolled in the New Mexico medical access program versus similarly matched control patents who were not. Compared to non-users, over a 21-month period medical cannabis enrollees “were more likely either to reduce daily opioid prescription dosages between the beginning and end of the sample period (83.8 percent versus 44.8 percent) or to cease filling opioid prescriptions altogether (40.5 percent versus 3.4 percent).” Enrollees were also more likely to report an improved quality of life.

    Authors concluded, “The clinically and statistically significant evidence of an association between MCP (medical cannabis program) enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.”

    Additional information on the relationship between cannabis and opioids is available from the NORML fact-sheet here.

  • by Paul Armentano, NORML Deputy Director June 10, 2019

    Marijuana and OpioidsMilitary veterans who participate in a state’s medical marijuana access program frequently report substituting cannabis for alcohol and other controlled substances, according to data published in The American Journal of Drug and Alcohol Abuse.

    A team of investigators from Palo Alto University in California, Harvard University, and the Perelman School of Medicine in Philadelphia surveyed marijuana use patterns in 93 US military veterans participating in a medical cannabis collective.

    Nearly 80 percent of respondents reported using cannabis “to treat both physical and mental health symptoms.” Respondents were most likely to report using cannabis therapeutically to mitigate symptoms of chronic pain (69 percent), anxiety (66 percent), post-traumatic stress (59 percent), and depression (56 percent).

    Over 60 percent of respondents said that they consumed cannabis as a substitute for other illicit or licit substances, particularly alcohol. Nearly half of all respondents said that they use medical cannabis in place of other prescription medications.

    Authors concluded, “The current study also confirms the findings of previous studies that have documented a trend in substitution behavior, where cannabis is substituted for other drugs, which, if associated with reduced harm, could be beneficial for overall health.”

    Under existing federal regulation, physicians affiliated with the Department of Veterans Affairs may not legally provide the paperwork necessary for veterans to obtain medical cannabis in states that regulate its access.

    The abstract of the study, “A cross-sectional examination of choice and behavior of veterans with access to free medicinal cannabis,” is online here. Additional information is available in the NORML fact-sheet “Marijuana and Veteran Issues.”

  • by Paul Armentano, NORML Deputy Director June 6, 2019

    Marijuana and OpioidsDemocratic Gov. Steve Sisolak has signed legislation, Senate Bill 430, expanding the pool of patients eligible for medical cannabis therapy.

    The measure allows patients diagnosed with anxiety disorders, autism, chronic pain, opioid dependency, and other conditions to obtain a recommendation for medical cannabis.

    The act becomes effective on July 1, 2019.

    An estimated 18,000 Nevadans are registered with the state to access medical cannabis products.

    For more information on pending legislation, visit NORML’s ‘Take Action Center.’

  • by Jamie Kacz, Executive Director of NORML KC June 5, 2019

    With the arrival of summer time in Kansas City, we want to welcome everyone to take part in our Summer Seminar Series. All of these FREE events will focus on rules and regulations of Amendment 2, now Article XIV, for patients and caregivers. These events will have a special topic each month and everyone will have time for Q&A. One of our main objectives for these seminars is to ensure patients have free resources and education around the new medical marijuana program.

    Donate today to support our efforts!

    We will kick off our Summer Seminars with a discussion on how to navigate the finalized rules of Amendment 2/Article XIV from a patient and caregiver perspective, and how to be compliant under the new law. Attendees will also learn how to work with their physicians and clinics to acquire legal MMJ recommendations for qualifying patients, what steps are involved in the process, and what to expect after receiving a recommendation. We will be breaking all of this information down into easy-to-understand steps. Join us at Unity Temple on June 8 from 2pm-5pm! This location is accessible and the general public is welcome to attend.

    Special Guest Speakers:
    Emily Branch, Director of The Green Clinics
    A physician from The Green Clinics
    Jana Lappin, Pharmacist and Co-owner of Missouri Cannabis Clinic
    Pat Talks Law

    Save the Date for our next Summer Seminars on July 20 and August 17!

     We would like to thank everyone that attended the Missouri NORML Spring Conference in April. Our keynote speaker for the event was NORML Executive Director Erik Altieri. The day was filled with several additional speakers including Missouri State Representative Brandon Ellington, Director of Missouri’s Medical Marijuana Program Lyndall Fraker, and Paul E. Callicoat, M.D. Thank you to Chris Smith for documenting our event and sharing the pictures in this newsletter!

    Please support our efforts by making a one-time donation! We’re also looking for volunteers to help move our chapter forward. If you want to help by donating time, your expertise or sponsor an event, please email us at newnormlkc@gmail.com. 

    Marijuana policy should be evidence based. Help dispel the myths with NORML’s Fact Sheets! For more information follow NORML KC on Facebook, and visit our website!

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