Doctors prescribe opioids, which are covered by patient insurance. Sometimes patients become addicted to it.
Doctors prescribe another drug, also covered by insurance, to remove them from opioids. Many patients get just as much pain relief from cannabinoids. And cannabis doesn’t cause the same destruction as opioids. However, it is not covered by health insurance.
In fact, opioids can destroy lives. Usually cannabis does not.
These are the lifetime dependency rates of several substances, some of which are prescribed and some of which are not:
Cannabis: 7% (varies by age)
Whether these substances are covered by insurance or not, the drugs and programs associated with the treatment of their addiction are.
The rate of cannabis dependence is highly dependent on the age of the user: the lifetime rate of cannabis dependency is around 3% in people over 25 years of age. The majority of patients seeking medical cannabis treatment are well over 25 years old. Teens tend to abuse cannabis, and their addiction rate is 18% – similar to alcohol and lower than nicotine – both of which are readily available.
Here are some recently shared clinical statements:
“Cannabis is the only thing that helps my (disabled) daughter’s spasticity, but we can’t always afford it and it’s not covered by insurance.”
“I still feel the pain from where my legs were. I have tried all kinds of prescription drugs and none of them have helped. Cannabis works! But, I am on a fixed income and cannabis is expensive.
“Oxycodone gives me terrible headaches, but when they move me from my wheelchair to the shower the pain is terrible so I have to take it. Cannabis takes the pain away and doesn’t make me sick, but insurance doesn’t cover it.
“I had terrible anxiety. But, now that I use a small edible in the evening, I only have to use benzodiazepines twice a month!
How is it possible that we have allowed the creation of an insurance system that will cover drugs to help people get rid of the same drugs that were covered by insurance and on which they have become dependent? Yet these same insurance companies do not cover a low dependency drug, which is better tolerated and safer for most patients.
There are few options available for pain management, and most of them have terrible side effects, including addiction, respiratory depression, and death. Even taking enough aspirin or acetaminophen can lead to death, one by gastrointestinal bleeding and the other by destroying the liver. What about cannabis? If overdosed, it can cause paranoia and anxiety, but it does not lead to death.
Cannabis, as a medicine, is not yet recognized at the federal level. Hospitals cannot prescribe cannabis to relieve a patient’s pain without risking losing federal funding. Imagine being one of the many patients who suffer from chronic pain often secondary to cancer, arthritis, etc. and you cannot get your drugs state approved because they are not recognized by the federal government.
And, for those who don’t know, federal funding is essential for research, residency programs, and hospital scholarships. Hospitals that are the world’s leaders in medical care and research are unable to prescribe a safer drug due to the risk of losing federal funds. They are not even allowed to do research to prove or disprove that these drugs are safer to use, for example, with postoperative patients.
What about states that allow medical cannabis? If these states are really attached to the idea that cannabis is a good, useful medicine, why isn’t it covered by insurance? To go further, why is it not prescribed and dispensed in pharmacies rather than in dispensaries? And, while there are opportunities for physicians to be educated on the evidence-based use of cannabinoid medicine, most practitioners do not avail themselves of such training. Often, obtaining a medical cannabis card equates to a 20% discount (taxes) rather than getting real medical care with concomitant treatments.
It’s time for a change. There is a place for the adult recreational use of cannabis. But, this system should not be one that dispenses medical cannabis and medical advice. Instead, real patients deserve real care. They deserve doctors, treatment plans, risk / benefit analyzes, a prescription system and mutual funds that pay for their care.
Jill Becker, MD is a medical cannabis specialist based in Framingham.