New data published this summer studies medical marijuana trends in the United States. Specifically, one article published in Health Affairs and written by Ashley and David Bradford of the University of Georgia reviews how medical marijuana availability has impacted other prescriptions filled by Medicare Part D enrollees1. The study, also noted in the BMJ, found there were several categories where prescriptions where reduced2. On average, states with medical marijuana saw a 20% decrease in prescription medications for spasticity, and an 8-13% decrease in medications for anxiety, depression, nausea, psychosis, and sleep disorders. The decrease in prescription drug use saved an estimated $165.2 million in Medicare funds in 2013 alone. If medical marijuana was available nationwide, the authors estimated that Medicare could see a 0.5% reduction of the program’s nation-wide spending.
Overall, this decrease in prescription drug utilization saved approximately $165.2 million in Medicare funds in 2013 alone.
While the Bradford study shows that marijuana appears to be replacing several other medications, the question is whether marijuana actually as effective as other drugs? The answer is that several randomized clinical trials data support the effectiveness of marijuana , some researchers question the standards used to evaluate how well it really works. For example, research has examined how marijuana helps gastrointestinal conditions, such as Crohn’s disease3. Yet, most of this research evaluates subjective responses to marijuana, and do not focus on objective disease markers such as intestinal inflammation or C-reactive protein levels. Therefore, even if patients using marijuana note pleasurable side-effects of the drug as effective treatment, it may not directly impact the disease process itself. Dartmouth Drs. Koliani-Pace and Siegel co-authored an article calling for increasing the quality control of marijuana research. They wrote: “If marijuana can meet all of the FDA requirements, including efficacy data, evidence of safety, and a meticulous quality control program, then the medicinal use of marijuana could be supported”3. Besides objective outcome data, other major concerns still left unanswered include the untoward respiratory side effects of marijuana smoke, as well as the co-use of marijuana and tobacco, with some research showing that marijuana use can increase tobacco use and dependence4.
Currently, 39 states now allow medical marijuana despire still being listed as a Schedule 1 drug by the Federal government. Although individual state regulations vary, every program requires a physician to prescribe the use of marijuana or marijuana-derived substances. As the policies and regulations regarding marijuana continue to change, it will be essential to continue researching both the efficacy of marijuana treatment and the impact on healthcare utilization. As providers, it is important to understand the impact these policies on our patients. The research and experience of providers is an important part of creating safe and viable policies to protect and treat our patients.
1. Bradford AC, Bradford WD. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D. Health Aff (Millwood) 2016;35:1230-6.
2. Dyer O. US states that allow medical marijuana see drop in prescriptions for other drugs, study finds. BMJ 2016;354:i3942.
3. Koliani-Pace J, Siegel CA. Is the Hype of Medical Marijuana All Smoke and Mirrors? Am J Gastroenterol 2016;111:161-2.
4. Wang JB, Ramo DE, Lisha NE, Cataldo JK. Medical marijuana legalization and cigarette and marijuana co-use in adolescents and adults. Drug Alcohol Depend 2016;166:32-8.
Evan Kuhl, MD is an Emergency Medicine Resident at The George Washington University Hospital
