Ev­i­dence-based talk about mar­i­juana: dare to dream?

National Post (National Edition) - - NEWS - COLBY COSH Na­tional Post ccosh@na­tion­al­post.com Twit­ter.com/Col­byCosh

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.

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