Addiction Treatment In The Era Of Marijuana Legalization

By Monica E. Oss

What a difference a few decades make. When I was in college and joined the National Organization for the Reform of Marijuana Laws, I thought that we wouldn’t see decriminalization of marijuana use in my lifetime. But, in 1996, California became the first state to legalize marijuana for medical purposes. Since then medical marijuana has been legalized in a total of 30 states. Recreational marijuana is now legal in nine states and Washington D.C. (see Here’s Where You Can Legally Consume Marijuana In The US In 2018).

There are a few key trends that executives in the health and human service field should be aware of.

The first is that the changes in legislation have decreased marijuana-related traffic in the criminal justice system for some states. My police officer friends in states where decriminalization is in place tell me they have quit processing all but the most egregious uses of recreational marijuana. The state of Colorado, for example, has seen dramatic drops in arrests. According to the report Marijuana Legalization in Colorado: Early Findings, the total number of marijuana arrests decreased by 46% (from 12,894 to 7,004) between 2012 and 2014; possession arrests dropped 47%; sales arrests decreased by 24%; and arrests with unspecified reasons went down by 42%.

This trend hold true across all states that have legalized the use of marijuana—the state of Washington saw the number of low-level marijuana court filings decrease by 98% between 2011 and 2015; Washington, D.C. saw marijuana arrests decrease by 76% between 2013 and 2016; Oregon saw arrests drop 96% between 2013 and 2016; and Alaska saw arrests drop by 93% between 2013 and 2015 (see From Prohibition to Progress: A Status Report on Marijuana Legalization).

The legalization of medical marijuana is also estimated to have reduced the violent crime rate in states that border Mexico (California, Arizona, and New Mexico) by between 5.6% and 12.5% (see Is Legal Pot Crippling Mexican Drug Trafficking Organizations? The Effect of Medical Marijuana Laws on US Crime).

The second trend is the declining stigma of using marijuana, as large numbers of health care professionals and consumers seem to be in favor of marijuana for medical purposes. In 2017, 61% of Americans said that marijuana should be legalized, up from 31% in 2000 (see About Six-In-Ten Americans Support Marijuana Legalization). Over 90% of consumers who have used marijuana medicinally claim that it was effective (see 92% Of Patients Say Medical Marijuana Works).

The New England Journal Of Medicine found that 76% of physicians were in favor of the use of medical marijuana in 2013 (see Medicinal Use of Marijuana – Polling Results). And I’ve heard anecdotal discussion among mental health professionals of veterans moving to states with legal recreational marijuana in order to “self medicate” their PTSD.

For health plans and provider organizations that are looking into marijuana-related treatment options, the conversations are usually focused on “cannabinoid derivatives.” Cannabinoid derivatives are drugs that use active ingredients derived from the cannabis plant, better known as marijuana.

Currently for treatment of the central nervous system (applicable to neurodisorders like epilepsy), there is only one approved (although not yet on the market). Earlier this year, the U.S. Food & Drug Administration (FDA) approved Epidiolex oral solution for the treatment of seizures associated with Lennox-Gastaut syndrome and Dravet syndrome, two rare and severe forms of epilepsy (see FDA Approves First Drug Comprised Of An Active Ingredient Derived From Marijuana To Treat Rare, Severe Forms Of Epilepsy). The approval marks the first-ever drug comprised of an active ingredient derived from marijuana to be approved by the FDA. The other uses of cannabinoid derivatives are indicated mainly for CINV (chemotherapy induced nausea and vomiting), and for appetite stimulation in people with AIDS (CINV and AIDS fall under different therapeutic spaces).

But in the states that have approved the use of medical marijuana, the list of approved uses is long and continuing to grow—including conditions such as:

• Arthritis
• Autism
• Cancer
• Crohn’s disease
• Damage to the nervous tissue of the central nervous system (brain-spinal cord) with objective neurological indication of intractable spasticity, and other associated neuropathies
• Dyskinetic and spastic movement disorders
• Epilepsy
• Glaucoma
• HIV / AIDS
• Huntington’s disease
• Intractable seizures
• Multiple sclerosis
• Neurodegenerative diseases
• Opioid use disorder, when conventional therapeutic interventions are contraindicated or ineffective
• Parkinson’s disease
• Post-traumatic stress disorder (PTSD)
• Sickle cell anemia
• Terminal illness

But decriminalization and legalization is not without its problems. First, like any other psychoactive substance, there is the potential for abuse. Despite the common belief in the general public that marijuana isn’t addictive, statistics from the National Institute on Drug Abuse say otherwise—an estimated 9% of all users (17% who start smoking in their teens) become addicted (see Is Marijuana Addictive?). In addition, 80.6% of illicit drug consumers combine marijuana with other drugs (see Is Marijuana Addictive?). And my friends in law enforcement keep discussing an alternative to blood-alcohol testing for impaired drivers. How can they determine if someone has consumed enough marijuana (or opioids) to impair their driving?

For more on this issues, I reached out to OPEN MINDS Senior Associate, Annie Medina, who noted:

Annie Medina

The up-tick of information on medicinal marijuana, cannabidiol oil (CBD oil), and cannabanoid derivative drugs showcase the importance of the consumer voice in driving industry trends. Long-standing stigmatization of marijuana use prevented wide-spread consideration of it as a therapeutic. 

However, increased awareness of medicinal benefits, coupled with the ability to select out psychotropic effects, have helped to reduce the stigma associated with marijuana, and pave the way for increased therapeutic offerings both inside and outside of the pharmaceutical industry. High-profile stories, such as that of Charlotte Figi, a young girl with Dravet’s Syndrome and the inspiration behind the low-THC, high-CBD strain named “Charlotte’s Web” (see Marijuana Treatment Reduces Severe Epileptic Seizures) have further helped to cement the importance of the consumer voice in legitimizing a therapy with a formerly-negative reputation. We can anticipate that this type of consumer involvement in shaping therapeutics will persist, especially with regard to medicinal marijuana.