Things aren’t going so hot in the public-health war against the opioid epidemic that is sweeping America right now. Deaths from opioid overdoses hit an all-time high in 2014, the latest year for which there’s official data, and there isn’t much reason to believe the epidemic will be over any time soon.
New legislation provides for a range of policy options for addressing the epidemic, but all will likely be woefully underfunded. States hit the hardest by the crisis are passing their own legislation to combat it, but the different elements of health-care regulation, criminal law, and public-health law that are involved make the scope of the problem difficult to deal with. All the while, groups like elderly Americans are becoming increasingly vulnerable to opioid addiction.
At the same time, seniors already beset by the fears of the opioid crisis are faced with another major issue: Health care—especially prescription drugs—is getting more and more expensive. The twin issues of prescription drug costs and opioids have been among the country’s most pressing concerns for months, and have defied easy policy solutions. But these problems might have at least one cheap and unmistakably pungent partial solution: medical marijuana. A growing body of research indicates legalization of medical marijuana is associated with lower health-care costs and fewer prescriptions for seniors, and also associated with reduced deaths from opioids.
A new study by researchers Ashley Bradford and W. David Bradford at the University of Georgia indicates that legalizing medical marijuana prescriptions for seniors reduces “use of prescription drugs for which marijuana could serve” and also “has a significant effect on prescribing patterns and spending in Medicare Part D,” the Medicare component that pays for prescription drugs for enrollees. The researchers identified nine conditions for which medical marijuana has evidence of efficacy in treatment—including anxiety, depression, sleep disorders, and pain—and compared overall prescriptions for other existing drugs in states where medical marijuana is legal versus states where it is not legal. They also analyzed Medicare Part D spending in states that have legalized medical marijuana.
The spending results showed a modest decrease in Part D spending in 2013 of about $165 million in states that had approved medical marijuana, from a reduction of costlier prescriptions. Bradford and Bradford estimated that the country could save over $400 million annually in Part D costs if every state legalized medical marijuana. That number seems minuscule compared to the $66 billion spent annually on Medicare Part D drugs alone and the almost $400 billion spent on drugs in the country, and it is. But as drug costs have risen even faster than inflation or other medical costs, policies that can slow that rise have been sought by politicians. Legalizing medical marijuana might be the rare policy that can not only halt the yearly rise in some spending categories, but actually reverse it.
But the money that medical marijuana saves in prescription costs is perhaps only a fraction of the money that it really saves in total. Of the conditions and drug categories for which marijuana could serve as a substitute, pain was easily the most common, with around 30,000 Part D prescriptions per physician. That number is astounding, especially considering the next highest category is anxiety, with around 11,000 prescriptions per physician. Bradford and Bradford’s data indicates that states with medical marijuana had pain prescription rates that were 3,600 lower per physician—or 12 percent less—than states without it. That reduction should show up in a reduction of opioid addiction, which itself should lower treatment costs in other Medicare spending categories and reduce deaths.
Seniors represent a very vulnerable risk group for opioid addiction and overdose deaths, and that risk is probably underreported because they are less likely to enter treatment than younger people and also are more likely to die from other causes while suffering opioid addictions. But the nature of care for seniors and the nature of their problems—many deal with chronic, increasing pain as a normal course of other conditions and also are prescribed painkillers after surgery—make exposure to addiction an almost routine part of life. The true costs of opioids may be hidden in or contributing to the jumbled, ballooning mess of elderly and end-of-life care, and Bradford and Bradford’s data suggests that medical marijuana may play a part in diminishing it.
Of course all of these data are just for Medicare patients, but they match other research that shows that medical marijuana has been particularly effective in reducing deaths from opioid addiction. That research has been corroborated and updated with a new working paper that indicates that states with medical marijuana dispensaries not only see reduced opioid deaths, but also an accelerating decrease in opioid substance-abuse treatment admissions. These data might be applicable for seniors, and the data on seniors might be generalizable across the country. Medical marijuana could be reducing deaths—especially for the most vulnerable populations—making health care cheaper for the most expensive groups, and fighting a public-health nightmare.
Just under half the country now allows medical marijuana, and states like Florida and Missouri are considering it. Support for the drug seem to be expanding among both medical professionals and the public at large. In Florida—which already allows for medical marijuana usage for patients facing mortal illness— medical marijuana could help its large population of seniors and help it combat a serious opioid problem at once. That logic holds for the country writ large, fighting a two-front war against health-care costs and the opioid crisis that is driving up those costs, with seniors in the middle of both fights. Medical marijuana increasingly looks like a useful tool in that fight—and the rare health policy that makes health care both cheaper and more effective.
By Vann R. Newkirk II - The Atlantic/July 18, 2016
Photo: David McNew, Reuters
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