States that legalized marijuana as a medical alternative saw a drop in prescription drug use, according to a new study published in July in Health Affairs — suggesting that medical marijuana may be one way to combat the United States’ deadly opioid epidemic.
The researchers, a father-daughter team at the University of Georgia, combed through three years of prescription data filled under Medicare Part D between 2010 to 2013. Then they looked specifically at nine conditions for which marijuana can be used as an alternative treatment: anxiety, depression, glaucoma, nausea, pain, psychosis, seizures, sleep disorders, and spasticity.
In the 17 states plus Washington, D.C. that had legalized medical marijuana as of 2013, prescriptions for eight of the nine conditions went down — for example, prescriptions written for pain dropped by 1,826 daily doses.
For glaucoma, however, written prescriptions actually went up. While marijuana is an effective treatment for glaucoma, which causes severe eye pain and can lead to blindness, it’s only effective for an hour. Because taking marijuana every hour isn’t realistic, the researchers expected patients who used marijuana to treat glaucoma to then turn to their doctors for longer-lasting prescription drugs.
“It turns out that glaucoma is one of the most Googled searches linked to marijuana, right after pain,” David Bradford, one of the study’s authors and a professor of Public Policy at UGA, said in a university press release. “The patient then goes into the doctor, the doctor diagnoses the patient with glaucoma, and no doctor is going to let the patient walk out without being treated.”
Taken together, the increase in glaucoma prescriptions and the decrease in prescriptions for the other conditions suggest that people in states that allow it are truly using marijuana as a medical treatment, rather than using it for recreational purposes, the researchers concluded.
“One of the questions about about marijuana legalization is whether it’s actually medicine, or whether its just a backdoor way to approve recreational marijuana. What our evidence is suggesting is that the response that patients are having, and that clinicians are having, is that there is a significant amount of actually clinical use,” Bradford said in a video interview. “That helps answer one of the questions: Is it just a backdoor recreational approval? We believe no.”
As a bonus, they also found that the lower prescription use saved Medicare $165.2 million in 2013. If all states had implemented medical marijuana, then they estimate that savings to Medicare would have been around $468 million. However, those savings, while benefiting Medicare’s bottom line, likely reflect a greater cost to the patients. Medicare and other forms of insurance do not cover medical marijuana, meaning that patients turning to marijuana for medical relief were paying out of pocket instead.
Decreasing America’s reliance on prescription painkillers, however, is about more than just lowering Medicare costs. Drug overdoses in the United States are at an all-time high, driven by an opioid epidemic supplied by prescription painkillers. Four out of five new heroin users start out by misusing prescription opioids.
Since 1999, prescription opioid sales — which include painkillers like oxycodone, hydrocodone, codeine, morphine, and fentanyl — have nearly quadrupled in the United States. At the same time, deaths from prescription opioid abuses have also nearly quadrupled. Still, the very quick-release opioids fueling the epidemic make up 90 percent of painkiller products available on the market.
Marijuana, by contrast, has never caused a fatal overdose. Study after study has found that marijuana can relieve pain, ease nausea and promote appetite — greatly improving quality of life for patients struggling with chronic pain and diseases such as cancer. According to a 2013 New England Journal of Medicine Survey, an overwhelming majority of doctors said they would prescribe it as treatment.
As of June, over half of the United States has legalized medical marijuana. At a federal level, however, cannabis is still classified as a Schedule I substance, the most restrictive possible designation under the Controlled Substances Act and a higher designation than highly addictive substances like cocaine and many opioids, such as morphine, oxycodone, and hydrocodone.
Officially, this classification means that cannabis is held to have “no accepted medical use” — a designation that makes less and less sense as contradicting scientific evidence accumulates and as states move towards medical marijuana legalization. However, the federal standard makes it very difficult to expand research on the effects of marijuana, including further research into how marijuana might be able to help alleviate the prescription painkiller epidemic.
Nonetheless, some researchers are breaking through. This new research comes on the heels of a 2014 study published in JAMA Internal Medicine finding the states that legalized medical marijuana from 1999 to 2010 had significantly fewer deaths from painkiller overdoses than predicted.
“What we found was that in states where patients have access to medical marijuana, they experienced a better quality of life when they cut their use of hard prescription drugs, which have a very high potential for addiction and fatal overdose. Even for the nine percent of regular users that become addicted to marijuana, the harms associated with marijuana addiction are far less dangerous and never fatal,” Megan Fox, the communications manager at the D.C.-based Marijuana Policy project, told us..