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    State medical marijuana laws continue to expand


    State updates

    Despite federal prohibitions, 24 states and the District of Columbia have passed statutes that permit the prescription of cannabis for the treatment of conditions ranging from anxiety and depression to glaucoma, nausea, seizures, and sleep disorders. Several states also allow medical marijuana as a pain treatment.

    Seventeen have legalized cannabidiol (CBD), “an extract from the marijuana plant that has no THC content,” Miller added.

    The state laws are a result of public demand and the allure of tax revenue, the speakers said. But the federal government might have incentives for tolerating medical marijuana, as well: Medicare Part D prescription medication spending appears to decline in states that legalize medical marijuana.

    “For all conditions except glaucoma, fewer prescriptions were written [for pharmaceuticals] when a medical marijuana law was in effect,” Edgar noted. The estimated savings to Medicare have grown as more states have legalized medical marijuana, from $104.5 million in 2010 to more than $515 million in 2014, she said.

    “The number of prescription drugs prescribed dropped for indications such as anxiety, depression, nausea, pain, psychosis, seizures, sleep disorder, and spasticity,” Edgar said.

    Estimated savings from reduced criminal justice spending following legalization of marijuana exceed $7.7 billion, she said. Nationwide, predicted tax revenues exceed $2.4 billion annually if marijuana is taxed like most other goods, up to as much as $6.2 billion annually if marijuana were taxed at rates similar to those for tobacco.

    Federal update

    Support is growing in Congress for federal laws that would harmonize national and state laws on medical marijuana. Proposed, bipartisan federal Compassionate Access, Research Expansion, and Respect States (CARERS) legislation was introduced in the Senate in March 2015 and represents “the most aggressive” proposed federal legalization effort to date, Miller said.

    Because marijuana is a Schedule I drug, research on its potential clinical or therapeutic benefits remains nascent. There is no consensus, for example, regarding its effects on psychosis or schizophrenia, Edgar said.

    Opponents to marijuana legalization point to increased use for nonmedicinal purposes. Youth are more likely to try marijuana for the first time following legalization, Edgar said.

    An important goal of the bill was to try to ensure that states were not in conflict with federal law by removing marijuana from Schedule I drug status. The bill would also have allowed Veterans Affairs clinicians to offer opinions to veterans about medical marijuana.

    There are also concerns about public safety related to drugged driving and acute cognitive impairment at workplaces, attention deficits, and impulse control and crime. Learning and educational attainment concerns are also frequently voiced, as are concerns about long-term decision making and cognitive performance associated with chronic use.

    Next: Implications for pharmacists, providers



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