Pubdate: Thu, 07 Jul 2016
Source: Herald, The (Everett, WA)
Copyright: 2016 The Daily Herald Co.
Note: The Philadelphia Inquirer


Patients fill significantly fewer prescriptions for conditions like 
nausea and pain in states where medical marijuana is available, 
researchers reported Wednesday in one of the first studies to examine 
how medical cannabis might be affecting approved treatments.

Prescriptions for all drugs that treat pain combined, from cortisone 
to OxyContin, were nearly 6 percent lower in states with medical 
marijuana programs. Anxiety medication was 5 percent lower.

The result was a drop of more than $165 million in health care 
spending in states that had medical marijuana programs running in 
2013, according to the analysis of national Medicare data. The 
savings would equal 0.5 percent of the entire Medicare program's drug 
budget if medicinal cannabis was available in every state, the 
authors projected.

For years, lawmakers in state after state have approved medical 
marijuana programs after pleas from desperate patients. The debates 
centered largely on the limited evidence of benefit and concerns 
about harm and abuse. There was little discussion of how medicinal 
cannabis would change treatments that patients were already receiving.

The new study, published Wednesday in the journal Health Affairs, is 
one of the first to hint at that effect.

"When states turned on a medical marijuana law," use of treatments 
approved by the Food and Drug Administration went down, said senior 
author David Bradford, a health economist at the University of 
Georgia, "suggesting that they were substituting something else - and 
the plausible thing that they would be substituting was marijuana."

Although the relationship may seem obvious, he and others made clear 
that the associated trends do not prove cause and effect. Nor can 
they suggest whether substitution would be a good thing or a bad thing overall.

"Let's say a patient comes to my office saying, 'I'm using marijuana 
to sleep because your drugs didn't work for me.' He tells me he is 
using marijuana because it really helps him sleep and his 
antidepressant isn't working - 'and by the way, I've flunked out of 
school,' " said Michael Bostwick, a psychiatrist at the Mayo Clinic 
in Rochester, Minnesota.

While there is some evidence that medical marijuana can be helpful 
for certain conditions, Bostwick said, "you may need to decide 
whether you want your degree or your drug, and that's not addressed" 
by the new study, which he nevertheless called "ingenious."

To measure the effect of medical marijuana programs, the researchers 
examined prescriptions filled in the Medicare Part D program in the 
17 states plus the District of Columbia that had legalized medicinal 
cannibis through 2013, compared with those that had not. They 
analyzed prescriptions for hundreds of drugs that can be used to 
treat nine conditions for which there is some evidence of benefit 
from marijuana. More than one condition may be present in some 
diseases, like HIV.

For glaucoma and spasticity, the average number of daily doses 
prescribed by each physician was too small to determine a difference. 
But all the others were significantly lower in the states with 
medicinal cannabis: anxiety, depression, nausea, pain, psychosis, 
seizures, and sleep disorders.

By contrast, there was no difference for four classes of drugs that 
have no impact on conditions that may be treated by medical 
marijuana, such as blood-thinners and antibiotics.
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