Healthcare to Improve for Cannabis Patients – part 3
The lack of a therapeutic infrastructure for medical cannabis slowed the development of second-‐decade MCPs. Like the states that followed California in the first decade, second-‐decade MCP states have grown slowly, particularly in years 1-‐2 post-‐MCP legislation. The programs established during the second decade are summarized below:
By every measure except the number of approving states, the growth of MCPs has fallen far short of projections. The number of registered cannabis patients has plateaued at between 1-‐2% of all state residents with a qualifying condition. The “therapeutic gap” is in part a function of shortcomings in different aspects of a state’s program, including too few dispensaries (DC, DE, MA), limited number of qualifying conditions (NJ, DC), and skeptical medical communities.
Until the CARERS Act or similar legislation passes at the federal level, medical cannabis will continue to be delivered through a patchwork of state programs, each a unique, “n=1” entity. Each state MCP has its own set of qualifying conditions and therefore patients, HCPs, drug supply and distribution, and (most importantly) program rules. Furthermore, since 1996 state MCPs have not only been separated from one another, but they have also been established in direct opposition to federal prohibition of cannabis. Though cannabis has a stunningly broad range of therapeutic applications – it is unlike any other drug in the US pharmacopeia – and cannabis patients are more diverse in terms of their medical conditions than the patients on any other pharmaceutical regimen, it is also the least studied medicine in broad use in the world.
420 InSight believes this characteristic of medical cannabis – the relative lack of trusted research and practical clinical information – is a structural feature of medical cannabis in the US. Eliminating this lack of information will require much more than growing more cannabis in Mississippi or streamlining the process for obtaining federal approval for clinical trials. The common thread connecting disparate state MCPs is patients and their HCPs, and only when cannabis patients are organized, their treatment approaches are cataloged and analyzed, and their HCPs are educated about the endocannabinoid system, will there be a national therapeutic infrastructure for medical cannabis.
Once such an infrastructure is in place, medical cannabis will become the least risky and yet most dynamic cannabusiness sectors:
- Established state MCPs (all cannabis and CBD-‐only) are here to stay – The national mood and federal policy have swung sharply in favor of the medical benefits of cannabis, though legalization for recreational use is still uncertain. Montana’s experience with Operation Smoke Jumper in 2011 will not be repeated again, and law enforcement activities will be aimed at illegal distribution of cannabis for recreational use.
- A legitimate therapeutic infrastructure will distinguish and insulate medical cannabis from recreational pot – The requirements of cannabis patients are very different than those of recreational users. As legalization for recreational use advances, the value of a therapeutic infrastructure will be more important than ever.
- Cannabis is used in 1-‐2% of cases involving qualifying conditions; it could be used in 3-‐7% of cases -‐ In chronic pain (the most commonly cited qualifying condition), cannabis is recommended in far less than 1% of cases, though chronic pain is by far the most common qualifying condition (cited in 70-‐90% of recommendations). The ceiling on medical cannabis is quite high.
- Most important, cannabis health information does not face the same obstacles and regulation as cannabis products – The complexity and broad therapeutic spectrum of cannabis mean all players in the medical cannabis market will need trusted health information before users are able to maximize the effectiveness and minimize the costs of cannabis for their intended application, whether medical or recreational.