Evidence-based talk about marijuana: dare to dream?
When the federal Liberals set a Canada Day 2018 deadline for marijuana legalization last weekend, they erected a new landmark in our country’s history. I do not refer to the proposed changes to the law; you would, after all, have to be crazy to take a Liberal promise of this kind to the bank. But whether or not the Liberals make their Cannabis Day target, its mere creation is bound to change the way we talk about pot.
Legalization is a reality now, something that has a birthday. Old canards, theories, and dreads are destined to get a last airing before we become preoccupied with concrete policy specifics — and then, when the unthinkable actually happens, we shall start having arguments based on actual data. fatality rates in those states have not gone up significantly, and they remain low compared to the rest of the U.S., although in Washington they have found, for whatever it’s worth, that more fatally injured drivers had traces of THC in their bloodstream when the coroner got to them.
Motz also observed, correctly, that primitive attempts at creating instant roadside tests for marijuana impairment have been abominable. He thinks that without a pot breathalyzer, legalizing the drug is “putting the cart before the horse.” That seems like a proverb one might use to describe worrying about a roadside marijuana test before we know whether there is any social or public-health need for police to have one.
What leapt out at me in Motz’s stream of consciousness was a claim that “healthcare costs are starting to rise” in the recreational-marijuana states. What could this mean? The U.S. doesn’t have singlepayer universal public health care, and its programs for the poor, the aged, and veterans are all administered federally. But if Motz wants to bring up health-care costs, we can certainly go there.
One of the most remarkable economic findings of any kind on piecemeal marijuana acceptance in the U.S. appeared in the journal Health Affairs last July. It became famous almost immediately as the “Medicare Part D study”: two policy specialists at the University of Georgia in Athens looked at data on 87 million pharmaceutical prescriptions paid for by the federal government from 2010 to 2013. They found that when individual states legalized medical marijuana (as 28 now have), doctors in those states began to fill fewer prescriptions addressing medical conditions for which there is some evidence that marijuana might help — anxiety, nausea, seizures, and the like.
By “fewer” I mean “a lot fewer.” The study estimated, for example, that medical marijuana reduced prescriptions for pain medication by about 1,800 per physician per year. That estimate could be off by an order of magnitude and still be pretty impressive. It is only one study, but when the researchers doublechecked their results by looking at conditions that nobody thinks marijuana is indicated for, they found no declines in prescribing.
Marijuana is still an outlawed Schedule I drug under U.S. federal law, doctors even in medical-marijuana states “recommend” the stuff rather than formally prescribing it, and patients have to pay for it. Moreover, pot may be relatively unpopular with the (mostly pension-age) Medicare-eligible population. The Medicare Part D study shows, if nothing else, that American medicine is already making heavy professional use of marijuana. The authors think it might have saved Medicare half a billion dollars over the four-year study period. Perhaps there are concomitant harms that this study does not account for. It is hard for me to imagine what they might be, but I am not a politician.