In the Journals

Medical marijuana laws reduce prescription drug use, could save Medicaid $1 billion

Prescription drug use in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws, according to research recently published in Health Affairs.

The researchers estimated that if all states had had a medical marijuana law in 2014, the estimated total savings for fee-for-service Medicaid could have topped $1 billion.

“There is a rapidly growing literature about the clinical effects of medical marijuana on specific diseases and symptoms and an expanding economic literature on the effects of marijuana legalization on traffic accidents, illicit drug use among youth, and recreational marijuana legalization policies,” Ashley C. Bradford, a master of public administration student at the University of Georgia, Athens, and W. David Bradford, PhD, of the department of public administration and policy, University of Georgia, wrote. “However, almost nothing is known about how state medical marijuana policies affect traditional clinical care in the community or spending in the health care sector.”

To fill in this gap, researchers collected the dates that states passed and enacted medical marijuana laws, quarterly State Drug Utilization Data on FDA-approved prescription drugs and analyzed the effect of medical marijuana laws on prescribing behavior for nine clinical conditions for which marijuana might be a potential alternative treatment: spasticity, sleep and seizure disorders, psychosis, pain, nausea, glaucoma, depression and anxiety.

The researchers found that in each of those clinical areas, observations without a medical marijuana law in effect had fewer annual prescription units dispensed, compared with observations with a law in place. However, state quarterly data with medical marijuana laws in effect were otherwise similar to state quarters without such a law. Simple bivariate comparisons for each medication studied fewer units were dispensed in those states with medical marijuana laws than in those that did not have such laws. Further, having a medical marijuana law was associated with reductions in the average number of doses aggregated to the state, quarter, and drug class level for FDA-approved drugs to treat nausea, depression, psychosis, seizure disorders and pain. Evidence of a clinical benefit from marijuana use was weakest among those who used it for anxiety, depression, psychosis and sleep disorders.

“Our findings that actual prescription drug use in Medicaid varies in ways consistent with marijuana’s being a substitute product provides additional, albeit indirect, evidence of medical use, similar to recently published evidence of a response in Medicare prescribing,” the authors wrote. “The reduced spending in Medicaid that we estimated does not represent a pure change in social welfare — as economists would define it — since some of the estimated savings represented a transfer of costs from the program to its enrollees who chose to pay for marijuana out of pocket. But in times of significant budget pressure, the possible savings of $1.01 billion nationally in spending on prescriptions in fee-for-service Medicaid is significant.”

Previously published research has suggested that medical marijuana laws may also reduce opioid use in those aged 21 to 40 years.

The AAFP states on its website that it requests that the FDA change marijuana’s classification for the purpose of facilitating clinical research, and to ensure funding for this type of research. Although the AAFP acknowledges that some states have passed laws approving the medical use of marijuana, it does not endorse them. - by Janel Miller

Disclosure: Healio Family Medicine was unable to determine the researchers’ relevant disclosures prior to publication.

Further reading: http://www.aafp.org/about/policies/all/marijuana.html (accessed 04-25-17)

Prescription drug use in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws, according to research recently published in Health Affairs.

The researchers estimated that if all states had had a medical marijuana law in 2014, the estimated total savings for fee-for-service Medicaid could have topped $1 billion.

“There is a rapidly growing literature about the clinical effects of medical marijuana on specific diseases and symptoms and an expanding economic literature on the effects of marijuana legalization on traffic accidents, illicit drug use among youth, and recreational marijuana legalization policies,” Ashley C. Bradford, a master of public administration student at the University of Georgia, Athens, and W. David Bradford, PhD, of the department of public administration and policy, University of Georgia, wrote. “However, almost nothing is known about how state medical marijuana policies affect traditional clinical care in the community or spending in the health care sector.”

To fill in this gap, researchers collected the dates that states passed and enacted medical marijuana laws, quarterly State Drug Utilization Data on FDA-approved prescription drugs and analyzed the effect of medical marijuana laws on prescribing behavior for nine clinical conditions for which marijuana might be a potential alternative treatment: spasticity, sleep and seizure disorders, psychosis, pain, nausea, glaucoma, depression and anxiety.

The researchers found that in each of those clinical areas, observations without a medical marijuana law in effect had fewer annual prescription units dispensed, compared with observations with a law in place. However, state quarterly data with medical marijuana laws in effect were otherwise similar to state quarters without such a law. Simple bivariate comparisons for each medication studied fewer units were dispensed in those states with medical marijuana laws than in those that did not have such laws. Further, having a medical marijuana law was associated with reductions in the average number of doses aggregated to the state, quarter, and drug class level for FDA-approved drugs to treat nausea, depression, psychosis, seizure disorders and pain. Evidence of a clinical benefit from marijuana use was weakest among those who used it for anxiety, depression, psychosis and sleep disorders.

“Our findings that actual prescription drug use in Medicaid varies in ways consistent with marijuana’s being a substitute product provides additional, albeit indirect, evidence of medical use, similar to recently published evidence of a response in Medicare prescribing,” the authors wrote. “The reduced spending in Medicaid that we estimated does not represent a pure change in social welfare — as economists would define it — since some of the estimated savings represented a transfer of costs from the program to its enrollees who chose to pay for marijuana out of pocket. But in times of significant budget pressure, the possible savings of $1.01 billion nationally in spending on prescriptions in fee-for-service Medicaid is significant.”

Previously published research has suggested that medical marijuana laws may also reduce opioid use in those aged 21 to 40 years.

The AAFP states on its website that it requests that the FDA change marijuana’s classification for the purpose of facilitating clinical research, and to ensure funding for this type of research. Although the AAFP acknowledges that some states have passed laws approving the medical use of marijuana, it does not endorse them. - by Janel Miller

Disclosure: Healio Family Medicine was unable to determine the researchers’ relevant disclosures prior to publication.

Further reading: http://www.aafp.org/about/policies/all/marijuana.html (accessed 04-25-17)