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Old 01-22-2020, 12:36 PM
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medical marijuana as medicine


now that medical marijuana is accepted in multiple states, will it--has it been--accepted as prescribed medicine by health insurance plans?
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Old 01-22-2020, 12:42 PM
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I suspect lack of FDA approval will give insurance companies an excuse not to.
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Old 01-22-2020, 01:32 PM
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We are getting close to being able to purchase it with MSA funds, at least for CBD and CBG products. I work at a place that provides these types of things for the Cancer Treatment Centers of America.
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Old 01-22-2020, 01:58 PM
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Unfortunately the nature of the Federal scheduling of it has made it very hard to produce the sort of trials and research you would need for FDA approval. Something that hopefully will eventually change. The actual real, peer reviewed, trial-studied and long duration and large scope tests that have been done to really understand the various different pharmacological implications of marijuana used for treatment purposes just hasn't been done yet. A lot of people self report they feel better in a variety of situations when they use it therapeutically, and it's an area that needs studied.

I think if it was unscheduled Federal it'd basically be seen as an herbal supplement from a regulatory viewpoint, which most health insurance plans don't cover (I believe you can use FSA/HSA dollars on them though.)
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Old 01-22-2020, 02:15 PM
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Originally Posted by Martin Hyde
Unfortunately the nature of the Federal scheduling of it has made it very hard to produce the sort of trials and research you would need for FDA approval.
I think this problem has been exaggerated, seeing that considerable research has been done both in the U.S. and abroad and more is ongoing. For instance, a recently published meta-analysis/review of research on cannabis use in chronic pain found that adding cannabis to opioids did not reduce chronic pain of cancer patients. It looked at five randomized controlled clinical trials.
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A lot of people self report they feel better in a variety of situations when they use it therapeutically
That's probably the biggest roadblock to getting quality research done, one that's also found with "alternative" remedies of various kinds. As long as selective positive anecdotes can be used to generate sales, there's little incentive for companies to fund bona fide clinical trials which carry the risk of negative findings.

It'd be nice if those wanting marijuana legalization because they enjoy the drug would stop hiding behind dubious medical justifications*, but that's the situation we have now.

*not referring to anyone in this thread.
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Old 01-22-2020, 07:38 PM
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Do any states that allow medical marijuana do it by "prescription"? In NY, you don't get a prescription for medical marijuana, you get a "certification" - and I suspect the reason is that prescription drugs are regulated by the FDA. If you don't get it by prescription, I wouldn't expect prescription drug coverage to cover it anymore than it covers OTC medications.
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Old 01-22-2020, 11:21 PM
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Dronabinol/Marinol is basically THC, and it is prescribed by doctors, and covered by health insurance. Same with Epidiolex, which is derived from CBD.

Last edited by pjacks; 01-22-2020 at 11:21 PM.
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Old 01-25-2020, 10:37 PM
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If you went for a drug screen, would it show as positive?

could that lead to problem with an employer even if you showed a prescription?

And lets say a person is say taking prescription cannibas for something plus smoking weed on their own. How would a test know one from another?
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Old 01-25-2020, 10:50 PM
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Originally Posted by Urbanredneck View Post
If you went for a drug screen, would it show as positive?



could that lead to problem with an employer even if you showed a prescription?



And lets say a person is say taking prescription cannibas for something plus smoking weed on their own. How would a test know one from another?


Yes, you would test positive. No, there’s no way to distinguish medical marijuana from whatever you smoke on your own by testing. Problems with the employer will depend on state law - medical marijuana use is not covered by the ADA because marijuana remains illegal under Federal law. Regardless of state law, Federal law prohibits a person from using marijuana and possessing a firearm , so anyone whose job involves possessing a firearm can run into trouble with their employer.


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Old 01-26-2020, 04:32 AM
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Problems with the employer will depend on state law - medical marijuana use is not covered by the ADA because marijuana remains illegal under Federal law.
Federal employees, of course, will have problems regardless of the laws of the state in which they either live or work because, as you note, it is illegal in the eyes of the Feds.
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Old 01-26-2020, 05:12 AM
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Dronabinol/Marinol is basically THC, and it is prescribed by doctors, and covered by health insurance. Same with Epidiolex, which is derived from CBD.
Yeah, a friend of mine was on marinol for nausea for a chronic condition* and it was covered by insurance.

*For her, at least, it worked like a charm.
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Old 01-26-2020, 09:03 AM
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A lot of people self report they feel better in a variety of situations when they use it therapeutically
And? Why isn't that enough justification?

I'm a medical marijuana patient, using cannabis in a manner Pennsylvania finds acceptable after 46 years of using it illegally. I no longer have to arrange to meet with a dealer to buy product of unknown provenance. I'm happy and the state is getting tax money to boot.

A licensed physician, recognized by my state to be knowledgeable in the recognition of problems the state accepts as responding to cannabis use has certified me with "PTSD". Sure, I'd rather just purchase (or ideally grow) cannabis without all the paperwork and expense, but one adapts to the conditions put upon them.
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Old 01-26-2020, 01:21 PM
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And? Why isn't that enough justification?
Here's my answer: If "lot of people self report they feel better in a variety of situations when they use [something] therapeutically," (A) that could be entirely due to the placebo effect, and (B) that tells you nothing about the possible dangers or side effects, and (C) insurance may not want to cover even an effective treatment if there are other alternatives that are safer, cheaper, and/or more effective.
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Old 01-26-2020, 01:35 PM
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Do any states that allow medical marijuana do it by "prescription"? In NY, you don't get a prescription for medical marijuana, you get a "certification" - and I suspect the reason is that prescription drugs are regulated by the FDA. If you don't get it by prescription, I wouldn't expect prescription drug coverage to cover it anymore than it covers OTC medications.
In California it’s a “recommendation”. It remains illegal Federally which still can cause problems. I work for a tech company and they stopped testing for mj for new hires many years ago. Even back when they screened for it, they gave people a second chance when it was a fail for mj only.
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Old 01-26-2020, 03:04 PM
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Originally Posted by Martin Hyde View Post
Unfortunately the nature of the Federal scheduling of it has made it very hard to produce the sort of trials and research you would need for FDA approval. Something that hopefully will eventually change. The actual real, peer reviewed, trial-studied and long duration and large scope tests that have been done to really understand the various different pharmacological implications of marijuana used for treatment purposes just hasn't been done yet. A lot of people self report they feel better in a variety of situations when they use it therapeutically, and it's an area that needs studied......
Regarding approval of cannabis per se: there’s a fundamental problem when it comes to the FDA approving cannabis as a medicine: over 100 active compounds* have been isolated from cannabis, and I believe the pharmacology of the vast majority of them is not well understood. It would be politically extremely difficult (I would say impossible in the case of cannabis) for the FDA to approve a medicine containing potent actives whose pharmacology was poorly understood. Note also that these actives will typically interact with each other in ways that are not well understood.

(To back up a bit, and keeping it simple, cannabinoids work at several different types of receptors distributed throughout the body. These receptors serve different functions, and affect eg nausea, pain etc. The actives in cannabis can be either agonists (lock onto the receptor and make it trigger); antagonists (block the receptor and prevent other cannabinoids, including endogenous ones [ie, the ones your body makes and uses], from making the receptor trigger; or partial agonists (somewhere in between). So there are a horde of different actives (agoinsts, antagonists and partial agonists) competing at different types of receptors in different parts of the body – that’s why they are (directly) interacting with each other in an extremely complex way. I’m using “trigger” here as a shorthand for “make a cell do something”).

Of course, there have been cannabis derived medicines which have been licensed, but these have been single-active medicines. There is a case for combining cannabinoids to create medicines – you may want both to be acting at the same or different receptor (cf THC + CBD) – but the point remains that you have to have a reasonable understanding of what you are doing (and usually how you are doing it) before you can get a medicine licenced. In the case of these two-active combinations, you also have to elucidate the functioning of the combination, justify the ratio in which the actives are present, etc etc.

Even if your strain of cannabis is predominantly CBD plus THC, the presence of (many) other extraneous cannabinoids presents a problem (and I would say, an insurmountable one).

So: I don’t see the FDA (or any other reputable regulatory bodies) licensing cannabis per se, ever.

j

* - Last I saw, 113 and counting. Anyone seen higher?
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Old 01-26-2020, 06:29 PM
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I think this problem has been exaggerated, seeing that considerable research has been done both in the U.S. and abroad and more is ongoing. For instance, a recently published meta-analysis/review of research on cannabis use in chronic pain found that adding cannabis to opioids did not reduce chronic pain of cancer patients.
You're using a UK metastudy to counter a point about US law that affects experimental studies. Impressive.

Last edited by Ruken; 01-26-2020 at 06:30 PM.
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Old 01-26-2020, 11:49 PM
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You're using a UK metastudy to counter a point about US law that affects experimental studies. Impressive.
A previous poster had said "the nature of the Federal scheduling of it has made it very hard to produce the sort of trials and research you would need for FDA approval." My post (which you evidently scanned superficially) noted that "considerable research (on medical cannabis) has been done both in the U.S. and abroad and more is ongoing." As an illustration of that research (not submitted as a complete compendium), I referred to a meta-analysis that looked at 5, um, experimental studies (randomized controlled clinical trials) and concluded that cannabis added nothing to chronic pain control in cancer patients.

Too often we hear the gripe that "alternative medicine" is not studied in the U.S. because "it can't be patented" (false) and also in the case of cannabis, that bad ol' Uncle Sam forbids such studies (also false, as a cursory search of the Pub Med database would tell you).

Would you agree that if cannabis was shown in legitimate non-U.S. research to be a highly useful drug in any clinical application (especially if it were to be shown that no good substitute exists), that 1) American researchers/drug developers would clamor for studies aimed at gaining U.S. approval, and that 2) the evil F.D.A. could be convinced to allow them?

Somehow Epidiolex was approved for use in the U.S. to treat rare forms of epilepsy. Research into other cannabis derivatives not likely to be diverted to pleasure-seeking applications, if they showed real promise for various conditions, could certainly be studied in the U.S. and if shown to be effective, approved for prescription use.
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Old 01-27-2020, 09:39 AM
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A previous poster had said "the nature of the Federal scheduling of it has made it very hard to produce the sort of trials and research you would need for FDA approval." My post (which you evidently scanned superficially) noted that "considerable research (on medical cannabis) has been done both in the U.S. and abroad and more is ongoing." As an illustration of that research (not submitted as a complete compendium), I referred to a meta-analysis that looked at 5, um, experimental studies (randomized controlled clinical trials) and concluded that cannabis added nothing to chronic pain control in cancer patients.

Too often we hear the gripe that "alternative medicine" is not studied in the U.S. because "it can't be patented" (false) and also in the case of cannabis, that bad ol' Uncle Sam forbids such studies (also false, as a cursory search of the Pub Med database would tell you).

Would you agree that if cannabis was shown in legitimate non-U.S. research to be a highly useful drug in any clinical application (especially if it were to be shown that no good substitute exists), that 1) American researchers/drug developers would clamor for studies aimed at gaining U.S. approval, and that 2) the evil F.D.A. could be convinced to allow them?

Somehow Epidiolex was approved for use in the U.S. to treat rare forms of epilepsy. Research into other cannabis derivatives not likely to be diverted to pleasure-seeking applications, if they showed real promise for various conditions, could certainly be studied in the U.S. and if shown to be effective, approved for prescription use.
FDA will consider foreign, non-IND studies for IND applications if they comply with 21 CFR 312.120, which is neither here nor there. The point is that a tiny UK metastudy of cannabis-derived compounds for a narrow condition says little about how US scheduling affects research on cannabis, cannabis-derived compounds, and cannabis-related compounds. It does negatively affect research. DEA approval of your lab is a pain in the ass. Until ~2018, the only cannabis you could legally (federally) buy was the NIDA Ole Miss ditch weed (which until 2019 wasn't representative of what people actually grow and use today), when low-THC strains (now legally just "hemp") were descheduled. Nonetheless, there have been literally hundreds of US clinical trials on the above three categories in the last two decades. Never mind the pre-clinical studies. That's a reason against blaming US scheduling.

I'm not saying Martin Hyde is correct, just that your argument is poor.
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Old 01-27-2020, 10:22 AM
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Oh, I see. You're acknowledging that my point about there being abundant U.S. and foreign research into medical cannabis was correct, but just having a snit over the sample study I referenced.*

Carry on.

*chronic pain is not a "narrow condition". It's commonly cited by pot boosters as a reason for legalization, despite a lack of good evidence that it's effective for pain control.
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Old 02-09-2020, 11:57 AM
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Medical marijuana laws as they now stand put us further away from actual marijuana-based medicine, not closer. They remove the incentive to put in the long and difficult work needed to turn a plant into a medicine, by instead pretending that the plant by itself is already a medicine.
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Old 02-09-2020, 12:27 PM
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Medical marijuana laws as they now stand put us further away from actual marijuana-based medicine, not closer. They remove the incentive to put in the long and difficult work needed to turn a plant into a medicine, by instead pretending that the plant by itself is already a medicine.
That’s probably true but it was unfortunately a necessary step before full legalization. I had a med card before it was legal here and the process for getting one was a silly formality.
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