After Medical Marijuana Legalized, Medicare Prescriptions Drop For Many Drugs

In states that made medical marijuana legal, prescriptions for a range of drugs covered by Medicare dropped.

from NPR

Prescription drug prices continue to climb, putting the pinch on consumers. Some older Americans appear to be seeking an alternative to mainstream medicines that has become easier to get legally in many parts of the country. Just ask Cheech and Chong.

Research published Wednesday found that states that legalized medical marijuana — which is sometimes recommended for symptoms like chronic pain, anxiety or depression — saw declines in the number of Medicare prescriptions for drugs used to treat those conditions and a dip in spending by Medicare Part D, which covers the cost on prescription medications.

Because the prescriptions for drugs like opioid painkillers and antidepressants — and associated Medicare spending on those drugs — fell in states where marijuana could feasibly be used as a replacement, the researchers said it appears likely legalization led to a drop in prescriptions. That point, they said, is strengthened because prescriptions didn’t drop for medicines such as blood-thinners, for which marijuana isn’t an alternative.

The study, which appears in Health Affairs, examined data from Medicare Part D from 2010 to 2013. It is the first study to examine whether legalization of marijuana changes doctors’ clinical practice and whether it could curb public health costs.

The findings add context to the debate as more lawmakers express interest in medical marijuana. This year, Ohio and Pennsylvania passed laws allowing the drug for therapeutic purposes, making it legal in 25 states, plus Washington, D.C. The approach could also come to a vote in Florida and Missouri this November. A federal agency is considering reclassifying medical marijuana under national drug policy to make it more readily available.

Medical marijuana saved Medicare about $165 million in 2013, the researchers concluded. They estimated that, if medical marijuana were available nationwide, Medicare Part D spending would have declined in the same year by about $470 million. That’s about half a percent of the program’s total expenditures.

That is an admittedly small proportion of the multibillion dollar program. But the figure is nothing to sneeze at, said W. David Bradford, a professor of public policy at the University of Georgia and one of the study’s authors.

“We wouldn’t say that saving money is the reason to adopt this. But it should be part of the discussion,” he added. “We think it’s pretty good indirect evidence that people are using this as medication.”

The researchers found that in states with medical marijuana laws on the books, the number of prescriptions dropped for drugs to treat anxiety, depression, nausea, pain, psychosis, seizures, sleep disorders and spasticity. Those are all conditions for which marijuana is sometimes recommended.

The study’s authors are separately investigating the effect medical marijuana could have on prescriptions covered by Medicaid, the federal-state health insurance program for low-income people. Though this research is still being finalized, they found a greater drop in prescription drug payments there, Bradford said.

If the trend bears out, it could have other public health ramifications. In states that legalized medical uses of marijuana, painkiller prescriptions dropped — on average, the study found, by about 1,800 daily doses filled each year per doctor. That tracks with other research on the subject.

Marijuana is unlike other drugs, such as opioids, in which overdoses are fatal, said Deepak D’Souza, a professor of psychiatry at Yale School of Medicine, who has researched marijuana. “That doesn’t happen with marijuana,” he added. “But there are whole other side effects and safety issues we need to be aware of.”

Study author Bradford agreed: “Just because it’s not as dangerous as some other dangerous things, it doesn’t mean you want to necessarily promote it. There’s a lot of unanswered questions.”

Because the federal government classifies marijuana as a Schedule I drug, doctors can’t technically prescribe it. In states that have legalized medical marijuana, they can only write patients a note sending them to a dispensary.

Insurance plans don’t cover it, so patients using marijuana pay out of pocket. Prices vary based on location, but a patient’s recommended regimen can be as much as $400 per month. The Drug Enforcement Agency is considering changing that classification — a decision is expected sometime this summer. If the DEA made marijuana a Schedule II drug, the move would put it in the company of drugs such as morphine and oxycodone, making it easier for doctors to prescribe and more likely that insurance would cover it.

To some, the idea that medical marijuana triggers costs savings is hollow. Instead, they say it is cost shifting. “Even if Medicare may be saving money, medical marijuana doesn’t come for free,” D’Souza said. “I have some trouble with the idea that this is a source of savings.”

Still, Bradford maintains that if medical marijuana became a regular part of patient care nationally, the cost curve would bend because marijuana is cheaper than other drugs.

Lester Grinspoon, an associate professor emeritus of psychiatry at Harvard Medical School, who has written two books on the subject, echoed that possibility. Unlike with many drugs, he argued, “There’s a limit to how high a price cannabis can be sold at as a medicine.” He isn’t associated with the study.

And, in the midst of the debate about its economics, medical marijuana still sometimes triggers questions within the practice of medicine.

“As physicians, we are used to prescribing a dose. We don’t have good information about what is a good dose for the treatment for, say pain,” D’Souza said. “Do you say, ‘Take two hits and call me in the morning?’ I have no idea.”


3 thoughts on “After Medical Marijuana Legalized, Medicare Prescriptions Drop For Many Drugs

  1. Oh doctors, Cannabis is purest medicine, so start and have your very own experiences with it, and finally drop the dogma and the bullshit about it, it does not harm anybody.

    Cannabis is the least toxic therapeutically active substance known to man. Its Therapeutic Ratio (TR) is so high as to be virtually impossible to calculate but is believed to be between 1:20000 and 1:40000. Thus if 100mg of cannabis would produce an medicinal effect, between two to four kilos (taken at once) would be lethal. This amount is, of course, impossible to consume.

    Therapeutic Ratio (TR) is the ratio of effective dose for 50% of users (ED50) to lethal dose for 50% of users (LD50). The TR of alcohol is 1:20. TR of heroin is 1:5.

    Also, cannabis works on our body because it modulates the human endocannabinoid system which consists of a network of CB1 and CB2 receptors throughout the body and endocannabinoids which are the body’s natural chemicals equivalent to the phytocannabinoides in the cannabis plant. The CB1 receptor is now believed to be the most prevalent receptor in the brain but does not exist in the brain stem which controls the cardiovascular and pulmonary systems. This is why, unlike opiates, alcohol or other drugs, cannabis cannot depress basic life functions to the point of death.

    Many doctors are unaware of the human endcocannabinoid system because it was only discovered in 1988 and so has only recently been documented in medical education. It is now believed to be the most important physiological system in our body, regulating the central nervous system, immune, cardiovascular, gastrointestinal and reproductive systems.

    This is why mankind has found cannabis such a safe and effective medicine for at least 5,000 years for such a wide variety of conditions.

    And, if you as a doctor are interested in real help, then read my recipe and use it to treat the sick people.


  2. Yes, well, I can tell you why MY opiate use dropped… primarily because I’m a medical marijuana patient.
    That’s right, most ‘pain management’ personnel will refuse to give opiates to a medical marijuana user, using urine tests as a way to ‘weed out’ the users from their practice.
    With stuttering tongues they make claims that the DEA can ‘bust’ them for allowing me to use cannabis, which is a lie. Congress told the DEA to back off of medical marijuana, and rightly so.
    Haven’t seen anyone else chime in on this on either this site, or the Norml site which also ran a version of this story. However the fact remains, cannabis users generally have no access to opiates.


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