Legalizing marijuana: What happens if Medicaid starts paying for it?

Dr. Sanjay Gutpa has come out on the side of medical marijuana.   To him, that is a big deal.  Here is a snippet of what he said:

I apologize because I didn’t look hard enough, until now. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.

Instead, I lumped them with the high-visibility malingerers, just looking to get high.

I am all for weed in those legitimate cases, as Dr. Gupta would say.  In Maine, where medical marijuana is legal, I never started prescribing it because of who was coming out of the woodwork.

I did have a great example of a patient, however, with chronic pain and scarring from severe hidradenitis supportiva who was seeing a pain doctor and was on narcs for years.   He negotiated a deal with me to see the “weed doctor” and he started a trial, knowing that I would now test him for narcs.

Long story short, he did great on weed and never took painkillers again.  Great story, right?  Well, I am here to tell you and Dr. Gupta that this is a rarity.  I cannot tell you how many suspect patients who started begging me to get a script.  The law allows them two ounces a week which, as Bill Murray from Caddyshack would say, will allow them enough to “smoke the bejesus out of it” and then share or sell a ton more.

In my opinion, over 90% of the people who asked me for it were people/patients whose intentions I did not trust.  Was I wrong?  That depends:

A recent study by Quest Diagnostics suggests that medical marijuana users are no more likely to misuse prescription drugs such as oxycodone than other patient populations. However, recreational marijuana users are more likely to misuse those drugs. The study, “Prescription Medication Misuse in America,” based on an analysis of 227,402 de-identified urine lab-test results of patients on commonly abused prescription medications, shows that 37 percent of medical marijuana users (those taking prescribed cannabinoids as pharmaceutical preparations) misused other non-prescribed drugs, while nearly half of patients who used marijuana recreationally misused prescription medications.

First of all, it is crazy to me that 37% of medical marijuana users are misusing other non-prescribed drugs and this is felt to be equal to the normal population.  But let’s take this study at face value.   My first patient who I described above truly needed weed and was someone I could trust and the study supports that.

The other patients, who I thought were just looking to get a legal excuse to smoke weed, I could not.   They were already recreational users and probably abusing other drugs as well.  I guess the study proves my point.   It is about trust just like when we prescribe narcotics.

So, to summarize, I support medical marijuana but I am not pollyanna about it.  Just because Dr. Gupta had some epiphany about cannibis doesn’t mean there aren’t those out there ready to abuse the hell out of it.  I will stick to my 90% statement.

Now before people get on my case about being a hardass or why not just let them have it or weed never kills anyone and on and on, let me remind you of the next debacle that will occur once you open these flood gates.  Right now, Medicaid isn’t paying for it (and for some funny reason these patients now have cash for it) but there will be a movement to change this.

Lawyers will eventually get this overturned and that is when the fun begins. Then the 90% will turn to 99% because it will be a great new source of income for a ton of people as they sell what they supposedly medically need.  Not only will our taxes be paying for suspect people to use the drug but it will pay for their supply to sell it on the streets.  And this will not change it if is legalized for non-medical use either, by the way, because these same patients will want it for free via a prescription (think about the times they ask for Tylenol scripts).

You may think, so what, we do this already for narcotics.  And I would say, exactly.

Doug Farrago is a family physician who blogs at Authentic Medicine.

View 17 Comments >