Recent findings show that medical marijuana not only saves state and federal governments millions of dollars on Medicare but it may help curb prescription drug use too. A new study reports that in states where medical marijuana is available, prescriptions for painkillers have dipped drastically.
There’s been a spate of studies on how overdose and painkiller abuse — particularly among chronic pain patients — are lower in medical marijuana states, but the researchers have largely hypothesized that these patients are picking pot over prescription drugs. Now, a recent report in the journal Health Affairs suggests that the link between prescriptions and marijuana is no longer just a hypothesis.
Authored by a University of Georgia research team, the study found that in the 17 states with a medical marijuana law in place by 2013, prescriptions for painkillers and other drugs dropped significantly compared with states that did not legalize medical marijuana. Medical marijuana’s availability in these states, whether it was available to be cultivated at home or at dispensaries, also had a significant effect on Medicare spending. According to the study, Medicare saved approximately $165.2 million in 2013 because of lower prescription drug use.
The declines the study discovered in prescription-use were significant. The study says in medical marijuana–approved states, the average doctor prescribed fewer doses of antidepressants, seizure and anti-nausea medication. They also found that doctors prescribed fewer doses of anti-anxiety medication — and a particularly notable reduction of painkiller prescriptions too.
W. David Bradford, a health economist and co-author of the study, as well as a public policy professor at the University of Georgia, says that about $52 million of the $165.2 million in Medicare savings came from California in 2013. “California is a big state as far as spending goes,” he says. The study’s results suggest that if all states followed California’s lead in legalizing medical marijuana, the overall savings to Medicare would be roughly $468 million.
The research’s findings, according to Bradford, started with a simple question: How is marijuana affecting prescription drug use? He and his co-author — and daughter — Ashley Bradford decided to rake through the public database of all prescription drugs paid for under Medicare Part D — also known as the Medicare prescription benefit — from 2010 to 2013 to find answers. Medicare Part D is funded federally by the government to subsidize prescription drug costs for Medicare participants.
“Four years of Medicare Part D prescriptions gave us a variation across the states,” Bradford says. “We were able to run some statistical models that helped us to identify what the causal effect of what the medical marijuana effects were.” He adds that they ruled out accidental occurrences — or when they spotted outside trends that led to lower prescription or marijuana rates — to isolate marijuana’s impact, rather than simply associate it with prescription use.
The Bradfords also narrowed down their research to include only medical situations where marijuana might serve as an alternative treatment. They chose the following nine categories for their results, selecting at least one medication that the FDA approved: "pain, anxiety, nausea, depression, sleep disorders, psychosis, seizures, spasticity and glaucoma." It’s worth noting that these conditions are often approved under state laws for medical marijuana treatment. To check their data, the researchers did a similar analysis on prescription drug categories such as antiviral drugs, antibiotics and blood thinners, which treat conditions that are not characteristically treated with marijuana. Among these drugs, they did not discover any changes in prescription patterns. Their original nine categories they selected revealed a different story.
“We found that in seven of the nine disease groups that we looked at, there were large reductions in Medicare prescribing once states turned on medical marijuana laws,” Bradford said. “And by ‘turning them on,’ we mean that they were active in the sense that a patient could get access to medical marijuana. So either it was a home cultivation state where the law was in effect, or it was a dispensary state where a dispensary was open.”
The study did not single out opioid prescription rates among the pain medication; that's currently a critical issue because of the rise of opioid abuse in the United States, including here in Los Angeles (according to Medicare Part D data, claims for opioid drugs are up more than 30 percent locally). However, in examining pain medication, Bradford noted that many, if not most, of the pain medications the research team included in the study were opioids. Medicare declined to comment on the study, but said it is making efforts to reduce the number of people with Medicare who are using opioids excessively.
This comes as no surprise to Bradford. “Given the nature that it is a Schedule 1 drug, I can’t imagine that [Medicare] want to get involved. Even if they are in favor of it,” Bradford says.
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Pot is classified federally as a Schedule 1 drug, in the same category as heroin and meth, which means that the government sees it as having no medical use, and a high potential for abuse.
“If it were moved to Schedule 2, it would be legal to be administered as supervised by a physician, and that’s what is necessary before you can get any kind of third-party reimbursement, either Medicare or anybody else,” Bradford said.
The researchers are currently at work analyzing medical marijuana’s impact on Medicaid patients’ prescriptions. Funded federally and by states, Medicaid offers low-cost healthcare to low-income individuals as well as people with disabilities and the elderly. “The results at this point look very similar to Medicare as far as the reduction in these categories. I think the results are going to be even larger,” Bradford said. He explains that because medical marijuana is such an issue currently for policymakers, he hopes the research findings for both of his studies can serve as a tool for determining the pros and cons that come with legalizing medical marijuana.
“We do think that one of the most important take-home messages from this study is that physicians and patients are reacting to the availability of medical marijuana as if it’s medicine. And that’s just another piece of evidence that we think argues against the Schedule 1 status for marijuana.”