Monday, February 8, 2016

Medical Marijuana Programs — Why Might They Matter for Public Health & Why Should We Better Understand Their Impacts?

Although cannabis is an illegal drug, ‘medical marijuana programs’ (MMPs) have proliferated (e.g., in Canada and several US states), allowing for legal cannabis use for therapeutic purposes. While both health risks and potential therapeutic benefits for cannabis use have been documented, potential public health impacts of MMPs — also vis-à-vis other psychoactive substance use — remain under-explored.

We briefly reviewed the emerging evidence on MMP participants' health status, and specifically other psychoactive substance use behaviors and outcomes.

While data are limited in amount and quality, MMP participants report improvements in overall health status, and specifically reductions in levels of risky alcohol, prescription drug and — to some extent — tobacco or other illicit drug use; at the same time, increases in cannabis use and risk/problem patterns may occur.

MMP participation may positively impact — for example, by way of possible ‘substitution effects’ from cannabis use — other psychoactive substance use and risk patterns at a scale relevant for public health, also influenced by the increasing population coverage of MMPs. Yet, net overall MMP-related population health effects need to be more rigorously and comprehensively assessed, including potential increases in cannabis use related risks and harms.

...Beyond the effects of MMP participation for an individual, an emerging body of evidence suggests that MMPs may have discernable — both positive and negative — impacts relevant on a population health level. Most MMP participants are individuals with severe/chronic, and often multiple — physical or mental — health problems (e.g., pain, psychiatric, sleep, gastro-intestinal, MS, arthritis, HIV/AIDS, neurological problems), many of whom report improved health status/outcomes which may result in reduced health care needs or utilization. For example, among n = 100 California MMP participants, 59% reported MMU for > 1 chronic condition; they reported significantly higher (average global rating 81 vs. 52; p < .01) effectiveness of MMU over other medication (). Among n = 348 Michigan MMP participants, 87% reported multiple conditions (mostly pain); improved pain scores, and physical and mental health function scores, were reported by returning (n = 153) compared to first-time (n = 195) MMP patients (). A Hawaii sample of returning MMP patients with mainly pain as the principal condition reported a 64% overall reduction in pain scores following MMP initiation; about half reported relief from anxiety/stress and insomnia problems (). Among n = 130 San Francisco MMP patients with multiple conditions, 55% reported “better symptom management” from MMU compared to other prescription drugs (); similar data from UK-based MMP patients reported superior effects from MMU on their symptoms (, ). Among n = 628 Canadian MMP participants largely reporting multiple chronic conditions, 72% reported that MMU was “always helpful” and 24% reported that it was “often helpful” towards “effective symptom relief” ()...

Full article at:

By:  Benedikt Fischer,a,b,c, Yoko Murphy,a,b Paul Kurdyak,c,d Elliot Goldner,a and Jürgen Rehmb,c,e
aCentre for Applied Research in Mental Health and Addictions (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia V6B 5K3, Canada
bSocial & Epidemiological Research, Centre for Addiction & Mental Health (CAMH), Toronto, Ontario M5S 1S1, Canada
cDepartment of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
dMental Health & Addiction Research Program, Institute of Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5, Canada
eDalla Lana School of Public Health, University of Toronto, Ontario M5T 3M7, Canada
Benedikt Fischer: ac.ufs@rehcsifb
Corresponding author at: Centre for Applied Research in Mental Health and Addictions (CARMHA), Faculty of Health Sciences, Simon Fraser University, 2400 — 515 W Hastings St., Vancouver V6B 5K3, Canada. Fax: + 1 778 782 7768. Email: ac.ufs@rehcsifb

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