Think back ten or twenty years ago. Marijuana was a polarizing issue. Those who were caught with it, especially those dealing, were handcuffed, dragged to jail, and then saw their mugshots paraded on the local news.
Today, marijuana is almost better tolerated by society than alcohol. A Pew poll from 2019 found that 91% of Americans support legalization of some type, and of those, 59% said marijuana should be legal for both medical and recreational purposes. The number is striking; it’s hard to get 9 out of 10 people to agree on anything, much less the legalization of a Schedule I drug.
Despite this overwhelming support for marijuana, the federal government still keeps marijuana on its hit list. While the merits of recreational use are up for debate, its role in supporting patients with severe medical conditions is undeniable. Because it’s a controlled substance, however, its status gets in the way of efforts to make sure patients of all backgrounds benefit.
What’s happening with medical marijuana, and could legalization be the boom it needs to reach more patients?
Paying for Controlled Substances is Illegal
Even as states assert their right to legalize marijuana, the federal government continues to list it on the Controlled Substances Act. Although states have the option to safeguard the “health, welfare, safety, and morals” of their residents, federal law says that any state law that conflicts with rules, like the Controlled Substances Act, is preempted by federal law. Whether or not a state has the right to control the distribution of controlled substances is still an open question.
Think back to Colorado’s decision to legalize marijuana in 2013. The demand was huge, and Colorado became the home of a booming marijuana industry. They had one equally enormous problem, however. Banks wouldn’t take dispensary money because it was a violation of federal law. Even today, in 2020, the state is still trying to pioneer ways for the cannabis industry to get access to normal banking.
The same problem is happening in the healthcare industry. Marijuana empowers patients struggling with severe and chronic pain and allows them to improve their quality of life. States have the right to make marijuana legal for medicinal use, but even when it’s not illegal to buy, medical cannabis is not cheap. The Medical Marijuana Association says that legal, non-organic marijuana averages $15 per gram, and high-grade products can run up to $60 per gram. Each patient has a unique dose, and it’s not uncommon for patients to need multiple grams per day. Geography impacts prices, but there’s even a bigger problem: health insurance won’t cover it. Why? Because marijuana is illegal under federal law.
Let’s say the fed removed it from the list of controlled substances. What then? Would the money flow more easily? Unfortunately, things don’t look any cheerier.
Physicians Can’t Prescribe Marijuana in Legal States
State legalization is supposed to unlock the power of medical marijuana and give the power to the people to control their own lives. However, without the federal government on board, it’s very difficult to deliver medical marijuana, at least from a physician’s perspective. Making changes in healthcare requires more than persuasion and strong leadership. It’s incredibly complicated because of the sheer number of players involved.
Even though some states have licensed dispensaries and procedures for medical marijuana, physicians can’t actually write a script for it. Because it’s a Schedule I drug, prescriptions aren’t allowed. Physicians can recommend medical marijuana, but that’s it, and that’s only half the battle.
A drug on the controlled substance list isn’t on the short-list for FDA approval. Without FDA approval, it won’t end up on health insurance companies’ formulary list, which is the list of prescription drugs your insurance provider will pay for. Even if it was reclassified as an herbal remedy, you’d still have to pay for it yourself. Herbal remedies aren’t FDA approved either.
It all sounds a bit crazy when you consider that insurance companies are happily paying for prescription opioids, knowing full well that the opioid epidemic is costing many Americans their lives. It’s a shame because new opioid use has decreased in states that have legalized medical marijuana. But even legalized marijuana is unlikely to fix the opioid epidemic on its own.
Integration into Healthcare Could Make Marijuana Inaccessible
It’s clear that marijuana’s status as a Schedule I drug makes it incredibly difficult to work around, even with legalization, but, at the same time, full legalization and an embrace by the FDA and insurers could be even more damaging. Just look at insulin. Insulin was first tested in 1922 and its inventor opted not to patent it, citing its life-saving properties. Fast forward to the U.S. today. The average price of insulin rose to $450 by 2016 as insurers and drug manufacturers allowed the price to explode.
It’s very likely that the same issue would occur with marijuana without an act from the federal government to set fair prices. Unfortunately, legislation like this seems unlikely at present. The Affordable Drug Manufacturing Act of 2018 aimed to create transparency in drug pricing, and it is effectively dead in the water. FDA approval could be a death-knell for legal marijuana, even though it’s what’s required to help pay for it.
The Future of Medical Marijuana is Still Up in the Air
In summary, those who embrace the benefits of medical marijuana — and there are more now than ever before — are stuck between a rock and a hard place. The current system isn’t optimal; it prevents people from accessing a treatment that could transform their quality of life. But the state of U.S. healthcare also suggests that institutional recognition of marijuana could make the problem worse.
Those whose lives are wrapped up in the stakes of this issue may not have long to wait. The DEA’s announcement that it will loosen the restrictions on cannabis research suggests that answers may be coming soon.
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