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Monday, February 6, 2023

Medical cannabis must be covered by health insurance

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Doctors prescribe opioids that are covered by patient insurance. Sometimes patients become addicted to it.

Doctors prescribe another medication, which is also covered by insurance, to get rid of opioids. Many patients get the same amount of pain relief from cannabis. And cannabis does not cause nearly as much damage as opioids. However, it is not covered by health insurance.

In fact, opiates can destroy lives. In general, cannabis does not.

These are the lifetime dependency rates on several substances, some described and some not:

Nicotine: 32%
Opiates: 24%
Benzodiazepines: 18%
Cocaine: 18%
Alcohol: 15%
Cannabis: 7% (varies by age)

Whether or not these substances are covered by insurance, the drugs and programs associated with treating their addiction are.

The rate of cannabis dependence depends, in large part, on the age of the user: the rate of cannabis dependence for life is around 3% in those over 25 years of age. Most patients who seek medical care for cannabis are much older than 25 years. Teens tend to overuse cannabis and have an addiction rate of 18% – similar to that of alcohol and less nicotine – both of which are readily available.

Here are some of the statements recently shared at the clinic:

“Cannabis is the only thing that helps my (disabled) daughter with spasticity but we can’t always afford it and it’s not covered by insurance.”

“I still feel pain from where my legs were. I have tried all kinds of prescribed medications and none of them have helped. Cannabis works! But I get a steady income and cannabis is expensive.”

“Oxycodone gives me a terrible headache but when they move me from a wheelchair to the bathroom the pain is terrible so I have to take it. Cannabis takes away the pain and doesn’t make me sick but the insurance doesn’t cover it.”

“I had terrible anxiety. But, now that I use a small amount of food at night, I only have to use benzodiazepines twice a month!”

How could we have allowed the creation of an insurance system that covers medications to help people get rid of addiction to the same insurance drugs they have become addicted to? However, the insurance companies themselves do not cover drugs with a low addiction rate, which are better tolerated and safer for most patients.

There are a 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 cause death, one by gastrointestinal bleeding and the other by destroying the liver. What about hemp? In cases of overdose it can certainly cause paranoia and anxiety, but it does not lead to death.

Cannabis, as a drug, is not yet federally recognized. Hospitals cannot prescribe cannabis for a patient’s pain without risking losing federal funding. Imagine that you are one of many patients with chronic pain often secondary to cancer, arthritis, etc., and you cannot get the state approved drug because it is not federally recognized.

And for those who aren’t in the know, federal funding is essential for hospital research, residency programs, and fellowships. Hospitals that lead the world 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 refute that these drugs are safer to use, for example, in postoperative patients.

What about countries that allow medical cannabis? If those countries are really dedicated to the idea that cannabis is a good and useful drug, why isn’t it covered by insurance? Going forward, why not prescribe and distribute it in drugstores instead of dispensaries? And while there are opportunities to educate clinicians about the evidence-based use of cannabis medicine, most practitioners do not benefit from such training. Often times, getting a medical cannabis card is a 20% discount (taxes) rather than getting real medical care with accompanying treatments.

It’s time for a change. There is a place for adults’ recreational use of cannabis. But, this system should not be the only one dispensing medical cannabis and medical advice. Instead, real patients deserve real care. They deserve the doctors, treatment plans, risk/benefit analyses, the prescription system, and health insurance companies that support their care.

Jill Baker is a medical cannabis doctor based in Framingham.

Grow guide for marijuana beginners.
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