Pubdate: Thu, 28 Jul 2016
Source: LA Weekly (CA)
Copyright: 2016 Village Voice Media
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Website: http://www.laweekly.com/
Details: http://www.mapinc.org/media/228
Author: Sophia Kercher

LEGAL POT STATES SAVE MILLIONS IN MEDICARE

Prescription Drug Rates Drop As More Patients Turn to Cannabis

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.

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."
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MAP posted-by: Jay Bergstrom