After Medical ********* Legalized, Medicare Prescriptions Drop For Many *****
************ **** prices continue to climb, putting the pinch on consumers. Some older Americans appear to be seeking an alternative to mainstream medicines that has become easier to get legally in many parts of the country.
Research published Wednesday found that states that legalized medical ********* — which is sometimes recommended for symptoms like chronic pain, anxiety or depression — saw declines in the number of Medicare prescriptions for ***** used to treat those conditions and a dip in spending by Medicare Part D, which covers the cost on ************ medications.
Because the prescriptions for ***** like opioid painkillers and antidepressants — and associated Medicare spending on those ***** — fell in states where ********* could feasibly be used as a replacement, the researchers said it appears likely legalization led to a drop in prescriptions. That point, they said, is strengthened because prescriptions didn't drop for medicines such as *****-thinners, for which ********* isn't an alternative.
The study, which appears in Health Affairs, examined data from Medicare Part D from 2010 to 2013. It is the first study to examine whether legalization of ********* changes doctors' clinical practice and whether it could curb public health costs.
The findings add context to the debate as more lawmakers express interest in medical *********. This year, Ohio and Pennsylvania ****** laws allowing the **** for therapeutic purposes, making it legal in 25 states, plus Washington, D.C. The approach could also come to a vote in Florida and Missouri this November. A federal agency is considering reclassifying medical ********* under national **** policy to make it more readily available.
Medical ********* saved Medicare about $165 million in 2013, the researchers concluded. They estimated that, if medical ********* were available nationwide, Medicare Part D spending would have declined in the same year by about $470 million. That's about half a percent of the program's total expenditures.
That is an admittedly small proportion of the multibillion-dollar program. But the figure is nothing to sneeze at, said W. David Bradford, a professor of public policy at the University of Georgia and one of the study's authors.
"We wouldn't say that saving money is the reason to adopt this. But it should be part of the discussion," he added. "We think it's pretty good indirect evidence that people are using this as medication."
The researchers found that in states with medical ********* laws on the books, the number of prescriptions dropped for ***** to treat anxiety, depression, nausea, pain, psychosis, seizures, ***** disorders and spasticity. Those are all conditions for which ********* is sometimes recommended.
The study's authors are separately investigating the effect medical ********* could have on prescriptions covered by Medicaid, the federal-state health insurance program for low-income people. Though this research is still being finalized, they found a greater drop in ************ **** payments there, Bradford said.
If the trend bears out, it could have other public health ramifications. In states that legalized medical uses of *********, painkiller prescriptions dropped — on average, the study found, by about 1,800 daily doses filled each year per doctor. That tracks with other research on the subject.
********* is unlike other *****, such as opioids, overdoses of which can be fatal, said Deepak D'Souza, a professor of psychiatry at Yale School of Medicine, who has researched *********. "That doesn't happen with *********," he added. "But there are whole other side effects and safety issues we need to be aware of."
Study author Bradford agreed: "Just because it's not as dangerous as some other dangerous things, it doesn't mean you want to necessarily promote it. There's a lot of unanswered questions."
Because the federal government classifies ********* as a Schedule I ****, doctors can't technically prescribe it. In states that have legalized medical *********, they can only write patients a note sending them to a dispensary.
Insurance plans don't cover it, so patients using ********* pay out of pocket. Prices vary based on location, but a patient's recommended regimen can cost as much as $400 per month. The **** Enforcement Agency is considering changing that classification — a decision is expected sometime this summer. If the DEA made ********* a Schedule II ****, the move would put it in the company of ***** such as morphine and oxycodone, making it easier for doctors to prescribe and more likely that insurance would cover it.
To some, the idea that medical ********* triggers cost savings is hollow. Instead, they say it is cost shifting. "Even if Medicare may be saving money, medical ********* doesn't come for free," D'Souza said. "I have some trouble with the idea that this is a source of savings."
Still, Bradford maintains that if medical ********* became a regular part of patient care nationally, the cost curve would bend because ********* is cheaper than other *****.
Lester Grinspoon, an associate professor emeritus of psychiatry at Harvard Medical School, who has written two books on the subject, echoed that possibility. Unlike with many *****, he argued, "There's a limit to how high a price cannabis can be sold at as a medicine." He isn't associated with the study.
And, in the midst of the debate about its economics, medical ********* still sometimes triggers questions within the practice of medicine.
"As physicians, we are used to prescribing a dose. We don't have good information about what is a good dose for the treatment for, say, pain," D'Souza said. "Do you say, 'Take two hits and call me in the morning?' I have no idea."
