What If Medical Marijuana Was Free?

By Pat Anson

Chronic pain patients in the U.S. who are curious about trying medical marijuana are often turned off by the cost. Depending on where they live and how much legal marijuana is taxed, an ounce of medium-quality cannabis costs about $250; a one-ounce tincture bottle can cost up to $80; and a package of edibles might range from $20 to as high as $60.

Consulting with a doctor and getting a prescription for medical marijuana costs $40 to $150, and getting a medical marijuana card from your state could be another $100.  

All of these are out-of-pocket expenses, since health insurers don’t cover cannabis, although that could be changing now that the DEA has reclassified medical marijuana as a Schedule 3 controlled substance, which allows for some medical use. That opens the door to insurance coverage, although private insurers, Medicare and Medicaid have yet to take that step. 

In short, medical marijuana is currently out of reach financially for many patients.

But imagine if it was free. Would pain sufferers benefit if the cost of cannabis was no longer an issue?

The short answer is yes, according to a small new study in the Cureus Journal of Medical Science.

Researchers at the University of Pennsylvania’s Perelman School of Medicine found 29 patients with long-term chronic pain who wanted to reduce their opioid use and try medical marijuana, but considered cost a “major barrier.” With advice from a medical cannabis pharmacist, patients selected from a variety of no-cost cannabis products and started on a personalized opioid tapering plan.

“To our knowledge, this is the first prospective study evaluating whether medical cannabis can be used as an alternative to opioids in patients with chronic pain for whom cost has been a primary barrier to access,” wrote lead author Franklin Caldera, DO, who specializes in Physical Medicine and Rehabilitation at Hospital of the University of Pennsylvania.

At the start of the study, the average daily dose of opioids for participants was 46.8 morphine milligram equivalents (MMEs). Most had been taking opioids for over a decade to treat chronic back pain caused by degenerative disc disease or lumbar radiculopathy.

After five weeks of daily medical marijuana use, the average pain score for patients fell from 7 (on the zero to 10 pain scale), to a little less than 6 – a 16% reduction. Participants also reported improvements in their physical functioning, fatigue, general health, social functioning, and emotional well-being.

Even more impressively, patients reduced their average daily opioid dose to 16.2 MME – a 65% reduction. Seven participants were able to completely discontinue opioid therapy. Researchers say the reductions were sustained after a five month follow-up period.

“The findings of this study add to the growing body of literature supporting the safety profile and potential therapeutic role of cannabis. These data may help inform future considerations regarding reclassification, which could reduce financial barriers to access and help destigmatize its use for pain management and other medical indications,” said Caldera. 

“When used under appropriate medical supervision, medical cannabis may represent an effective adjunctive strategy for reducing opioid use among patients receiving long-term opioid therapy.” 

An obvious weakness of the study is its small size. Participants also wanted to reduce or stop their opioid use, which may have influenced the results.

We know nothing about the dose or type of medical marijuana they consumed, since patients selected their own cannabis products, the dose, and frequency of use. Without a standardized dose and method of delivery, we don’t know whether vaping or smoking were more effective, or if tinctures provided better pain relief than edibles. That’s unfortunate.

Previous studies have found that medical cannabis can help reduce the use of opioids and other medications. A recent survey of over 3,500 cannabis users in Germany found that most were able to reduce their use of painkillers, sleep medications, anti-depressants and other prescription drugs once they started using medical cannabis.

A similar survey of medical cannabis users in Florida found that many who have chronic pain were able to reduce or stop their use of opioids. Patients also reported less pain, and better physical and social functioning.