Michigan Pharmacists Association decries medical marijuana

[t-pain]

In april ,the MPA released this document to its members

http://www.michiganpharmacists.org/Portals/0/education/Medical Marijuana.pdf

in it, they whine that marijuana is sold at dispensaries and not pharmacies in a paper titled

"why approving a medical marijuana ordinance may not be the best choice"

where they argue that cities should not license any MMFLA class.

but in 2013 there was a bill to make pharmacies dispense medical marijuana, and the MPA took no position on it.

http://drugtopics.modernmedicine.com/drug-topics/content/tags/medical-marijuana/michigan-bill-calls-pharmacy-medical-marijuana-dispensing

"The Michigan Pharmacists Association did not take a position on the legislation. It issued a statement that partially read: “Unlike other prescription medications that pharmacists provide for patients, marijuana has not gone through the rigorous studies on safety and effectiveness required to be approved by the FDA.”"

you cant have it both ways MPA. either put up or shut up.

[mishigami bear]

Do they expect pharmacists to be "bud-tenders" discussing strains and consumption methods?

[Restorium2]

Pharmacists are supposed to be good little pill pushers. There's no room for anything natural. Natural stuff is so messy and it doesn't fit on the shelves as good as pills. It's just not a good way to go compared to making money off of pills. They have the pill thing all figured out so move along with these crazy ideas. 

[oldirongut]

My wife is a Pharmacist with the St John System, she as many,  has a specialized field, Clinical Anti-Coagulation. She works with patients working on their proper dosing of blood thinning drugs, She is not a simple pill pusher as many are not, some are infectious disease  specialists. She does not share the MAP views as does many of her co-workers do not. She has not pushed a pill in 20 years.

Edited November 8, 2017 by oldirongut

[Restorium2]

56 minutes ago, oldirongut said:

My wife is a Pharmacist with the St John System, she as many,  has a specialized field, Clinical Anti-Coagulation. She works with patients working on their proper dosing of blood thinning drugs, She is not a simple pill pusher as many are not, some are infectious disease  specialists. She does not share the MAP views as does many of her co-workers do not. She has not pushed a pill in 20 years.

The paper from MPA(alleged pill pushers) was definitely telling their members that pills are better than marijuana.

ref; approving a medical marijuana ordinance may not be the best choice

Nice to see some don't march in step with that. 

[ozzrokk]

Quote

Correct stick with Marinol fellas. They are in no way shape or form educated enough for this. They just can't stand anyone cutting into their nice little gig they got going on. One of the reasons this medicine has been held down for so long. That time is coming to an end.

 

[zeebudz]

On 9/7/2017 at 7:36 AM, Restorium2 said:

Pharmacists are supposed to be good little pill pushers. There's no room for anything natural. Natural stuff is so messy and it doesn't fit on the shelves as good as pills. It's just not a good way to go compared to making money off of pills. They have the pill thing all figured out so move along with these crazy ideas. 

Drug stores make a butt load of money on vitamins and herbal supplements, not to mention quack medicine like homeopathy. I'm sure they will be quite capable at figuring out how to add cannabis moolah to their coffers, especially CVS who loses 2 billion a year on not selling tobacco.

[John Dutcher]

Marinol is a synthetic THC, YUCK,Yuck!!

[Restorium2]

8 hours ago, zeebudz said:

Drug stores make a butt load of money on vitamins and herbal supplements, not to mention quack medicine like homeopathy. I'm sure they will be quite capable at figuring out how to add cannabis moolah to their coffers, especially CVS who loses 2 billion a year on not selling tobacco.

Drug stores are losing a butt load(as you say) of money because of cannabis. Along with the drug companies who make opioids, alcohol distributors and manufacturers, cigarette manufacturers, prisons, all the dregs of modern civilization are whining, while cannabis is winning for the human race. 

[zeebudz]

9 hours ago, Restorium2 said:

Drug stores are losing a butt load(as you say) of money because of cannabis. Along with the drug companies who make opioids, alcohol distributors and manufacturers, cigarette manufacturers, prisons, all the dregs of modern civilization are whining, while cannabis is winning for the human race. 

There does seem to be an inverse correlation between opioid deaths and cannabis legalization.

But it's total speculation to suggest that drug stores are losing money because of cannabis. What do you even base this assertion on? 

 

[Restorium2]

14 minutes ago, zeebudz said:

There does seem to be an inverse correlation between opioid deaths and cannabis legalization.

But it's total speculation to suggest that drug stores are losing money because of cannabis. What do you even base this assertion on? 

 

Obviously, the studies that show less opioid use after legalization. Less use means less profit for the chains, who are being sued by the State Of Michigan for pushing pills. I think it's very easy to see. 

[Restorium2]

UNM Study: Medical Marijuana an Alternative for Opioids

The Associated Press

November 28, 2017

 

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(Pureradiancephoto/iStock)

ALBUQUERQUE, N.M. (AP) — University of New Mexico researchers say the legal availability of medical marijuana has the potential to reduce opioid use among chronic pain patients.

 

The work of associate psychology professor Jacob Miguel Vigil and assistant economics professor Sarah See Stith was recently published in the journal PLOS ONE.

The results indicate a strong correlation between enrollment in New Mexico’s medical marijuana program and cessation or reduction of opioid use.

RELATED STORY

The Biology of Cannabis vs. Opioids for Pain Relief

Vigil says informal surveys showed a significant proportion of patients substituted their opioid prescriptions with cannabis.

The study tracked 37 habitual opioid using, chronic pain patients who enrolled in the state medical marijuana program between 2010 and 2015, compared to 29 patients with similar health conditions who didn’t enroll.

As of October, more than 44,000 people were enrolled in the state program.

[Restorium2]

Study outcomes

In our patient-level analysis, Ceased Opioid Prescriptions is a dichotomous {0,1} variable with “0” defined as no Prescription Monitoring Program evidence of an opioid prescription filled during the last three months of observation and “1” defined as any opioid prescription filled during that time period. Reduction in Prescribed Daily Opioid Dosage measures whether the average prescribed daily dosage of IV morphine was lower in the last three months than in the first three months of observation (pre-enrollment for MCP patients). Percentage Point Change in Prescribed Daily Opioid Dosage measures the difference between the average daily dosage in the first and last three months of observation divided by the average daily dosage in the first three months of observation.

In our longitudinal analysis, we converted the prescription-level data from the Prescription Monitoring Program into a patient-month level panel by aggregating dosages and quantities across prescriptions filled each month (for each patient) in order to generate a mean daily dosage per month (mg IV morphine.)

The survey questions (S2 Text) measured existence of side effects, pain levels prior to and following enrollment in the MCP, and effects of cannabis use on quality of life, social life, activity levels, and concentration.

Statistical analysis

We used a logistic regression model to estimate the effect of MCP participation on cessation of prescribed opioids (absence of opioid prescriptions coded “0”, presence of an opioid prescription coded “1”) and on whether or not patients reduced their average daily prescribed dosage between the first three months (pre-enrollment for MCP patients) and the last three months of observation. A least squares approach was used to analyze the effect of MCP participation on the percentage change in opioid prescriptions. In all cases, we control for age and gender. We report odds ratios for the dichotomous outcomes, and for the percentage change in opioid prescriptions, the coefficient is reported. Reported 95% confidence intervals are based on heteroskedasticity-robust standard errors.

A least squares approach also was used for the longitudinal analysis of the monthly change in the daily dosage (mg IV morphine) associated with MCP participation. We regressed the daily dosage on MCP participation, a month-level trend, and the interaction between MCP participation and a month-level trend, controlling for gender and age. Given the disparity in the average starting opioid prescription dosages, we also analyzed the within-patient differences in opioid prescriptions over time, controlling for time-invariant patient-level characteristics through the use of patient-level dummy variables. Because group participation does not vary over time, we include only MCP patients in the within-patient analysis. Standard errors were clustered at the patient-level to control for heteroskedasticity and arbitrary correlation.

Due to the small sample size, limited covariates, and the lack of variation in many of the survey responses, we used simple univariate hypotheses tests and graphical analyses for these outcomes.

Statistical analyses were conducted using Stata/SE 13.1.

Results

Reductions, cessation, and trends in opioid prescription patterns

The descriptive information in Table 1 suggests that MCP patients were more likely either to reduce daily opioid prescription dosages between the beginning and end of the sample period (83.8% versus 44.8%) or to cease filling opioid prescriptions altogether (40.5% versus 3.4%). The percentage point change in daily opioid prescription dosages also differed between the two groups with MCP patients reducing their dosages by 47 percentage points, while the comparison group increased dosages by 10.4 percentage points.

 

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Table 1. Effect of MCP enrollment on opioid prescription patterns (Means comparison).

 

https://doi.org/10.1371/journal.pone.0187795.t001

The odds ratios reported in Panels A and B of Table 2 support the simple means comparison results from Table 1. Not surprisingly, given that only one member of the comparison group ceased their prescriptions of opioids by the end of the sample period, the odds of an MCP patient ceasing opioid prescriptions by the last three months of observation is much larger than that of the comparison group (OR 17.27, CI 1.89 to 157.36, p = 0.012). The odds ratio comparing reduction {0,1} in daily opioid prescription dosages between MCP patients and the comparison group also is statistically and clinically significant at 5.12 (CI 1.56 to 16.88, p = 0.007). The analysis of the percentage point change in daily opioid prescription dosages in Panel C almost matches the results of the means comparisons in Table 1 with MCP patients reducing their daily dosages by 47.13 percentage points relative (p = 0.034) to the comparison group (mean = 10.4% increase), suggesting that the effect of the MCP on opioid prescription patterns did not vary significantly by gender or age in our sample.

 

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Table 2. Effect of MCP enrollment on opioid prescription patterns (Regression analysis).

 

https://doi.org/10.1371/journal.pone.0187795.t002

In order to capture the variation over time in the Prescription Monitoring Program records for each patient, we also created a patient-month level dataset. Fig 1 shows the relationship in the raw data between time (measured in months) and average daily opioid prescription dosage of IV morphine (mg) using a scatter plot. Linear time trends were overlaid for each group. According to Fig 1, the MCP patients appear to have started at higher dosages than the comparison group, but while the MCP patients’ opioid prescription dosages declined over time, the comparison group’s stayed flat or may even have increased slightly. The regression results in Panel D and E of Table 2 further explore this longitudinal relationship. Panel D replicates Fig 1, adjusting for age and gender. MCP patients started at higher prescribed dosages than the comparison group (12.47mg IV morphine higher, CI 2.48 to 22.46, p = 0.015) and although the overall effect of the linear trend is positive (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.08), albeit statistically insignificant, the coefficient on the linear time trend-MCP interaction shows a 0.64mg reduction in the daily opioid prescription dosage of IV morphine per month (CI -1.10 to -0.18, p = 0.008) among MCP patients. Combining the trend coefficients implies that on average, MCP patients were prescribed a lower average daily dosage of IV morphine than the comparison group after about 15.2 months of enrollment ([12.47/(0.64+0.18)] = 15.21 months.)

Panel B showed that MCP patients had higher odds of reducing daily opioid prescription dosages during our observation period. The results in Panel E indicate how the reduction in opioid prescriptions among MCP patients occurred over time by comparing across three month groups, controlling for time-invariant patient characteristics. The coefficient for the first three months post-enrollment is negative, but statistically insignificant; for the fourth through sixth month post-enrollment, the coefficient is larger but still statistically insignificant at conventional levels. For the following three month periods, from month 7 through month 18 post-enrollment, all coefficients are large, negative, and statistically significant. The coefficients also increase in size and show that by the last three month group (months 19 through 21), the average MCP patient was prescribed 11.43 fewer milligrams of IV morphine per day than she or he was in the pre-enrollment period.

 

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Fig 1. Mean prescribed daily opioid dosage by month.

Notes: Month “1” represents the first month post-enrollment for the MCP patients (n = 37) and the fourth month of observation for the comparison group (n = 29). The time trends add a linear representation of the relative change in prescribed daily opioid dosage starting with the time of treatment (enrollment in the MCP).

 

https://doi.org/10.1371/journal.pone.0187795.g001

We conducted robustness checks adjusting our inclusion criteria to ensure a closer match between our MCP patients with our Comparison patients. Although any restriction reduces the already small sample size, we found that restricting the sample to only back pain patients (8 MCP patients excluded), to only patients between the ages of 30 and 70 (2 MCP patients and 6 Comparison patients excluded), or using a stricter criteria for outliers (mean daily dosage in the first three months of greater than 48mg, which gives a similar mean daily dosage across the MCP and Comparison groups and excludes six MCP patients) does not materially affect the results in terms of magnitude and statistical significance.

In all our regressions, the 95% confidence intervals for our coefficients are large, i.e., while the sign of our coefficients is reliable, we cannot make precise predictions regarding the size of the effect. This could be an artifact of our small sample size or an indication that the magnitude of the effect of MCPs on opioid prescription patterns may vary substantially across individuals even among our relatively homogeneous patients.

Pain, quality of life, and side effects of using cannabis

Table 3 shows that respondents reported pain reduction from self-administered cannabis use (33 of 34 patients) and a statistically significant change in pain levels from pre- to post-enrollment (mean change = -3.4 on a scale of 0 to 10, p<0.001). No respondents reported any serious side effects from cannabis use. Fig 2 shows that no patient reported “negative” or “extremely negative” effects on Quality of Life (n = 23) or Social Life (n = 23), all but three patients reported a “good” or “great benefit” in their Activity Level (n = 23), and the majority reported an improvement in Concentration (n = 22) relative to prior to enrollment in the MCP.

 

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Fig 2. Effects of medical cannabis on quality of life, social interactions, activity levels and concentration.

Notes: These survey questions were administered as a follow-up survey to 23 of the 37 MCP patients with frequent use of prescription opioids. No “extremely negative” impacts were reported by any patient, and a “negative impact” was reported by one patient for Activity levels and by two patients for Concentration.

 

https://doi.org/10.1371/journal.pone.0187795.g002

 

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Table 3. Survey responses at one year Post-MCP enrollment.

 

https://doi.org/10.1371/journal.pone.0187795.t003

Discussion

The current preliminary findings build upon recent studies suggesting that medical cannabis laws result in clinically and statistically significant (up to 33%) reductions in opioid-related causes of death [12,13] and opioid usage.[14,18] We showed that MCP enrollment, and thus having the legal ability to self-manage cannabis therapy, reduced opioid prescriptions filled by a small sample of habitual opioid-using, non-cancer chronic pain patients. Our observational study circumvented some of the limitations to external validity found in the existing literature, e.g., a lack of comparison group, accurate baseline dosage, and/or potencies much lower than those found in products typically used by NM MCP patients.[20,21] Consistent with previous work suggesting that patients may substitute cannabis for prescription opioids,[14–17] over 80% of the MCP enrollees in our sample reduced their daily opioid prescription dosages, and over 40% ceased filling opioid prescriptions altogether by 1.5 years after enrollment. In addition, MCP patients consistently reported reduced pain and improved quality of life, social interactions, and activity levels as a result of their participation in the MCP.

The relative safety and efficacy of cannabis in comparison to that of opioid prescriptions filled by the patients in our sample is beyond the scope of this study. However, one potential interpretation of our results is that cannabis enables opioid-using patients to engage in their own method of harm reduction. Several meta-analyses have shown that opioids provide only modest immediate pain relief in people with lower back pain,[22–24] and no documented evidence exists of long-term benefits for treating chronic pain.[25,26] Moreover, due to an intense public safety campaign against the dangers of opioid prescriptions in the U.S., patients might be increasingly aware of the associated risks including lethal overdose, abuse, behavioral accidents, myocardial infarction, and other side effects (e.g., gastrointestinal and sexual dysfunctions).[25,27] In contrast, some recent studies have suggested that smoked Cannabis sativa flower may be relatively safer for long-term use in adults,[28,29] generally well-tolerated by patients,[7,30] and is not associated with an increased risk of mortality in people with or without comorbid opioid, alcohol, or cocaine use disorders.[31–33] While numerous short-term adverse events can result from cannabis use (e.g., dizziness, confusion, disorientation, loss of balance, somnolence, hallucinations), the majority of patient-reported side effects appear to be non-serious.[11,34] It remains unstudied how cannabis-based products (e.g., edibles, concentrates) and the extraction methods and solvents used to make such products affect patient health.

Our study does have limitations, including the small sample size (underpowered statistical analyses) and observational nature (unmeasured confounding) of the study, likely affecting the extent of its generalizability to other patient groups. Under federal law, we could not randomly assign patients to the MCP; rather patients self-selected into the program and then into renewal, introducing possible selection bias if our comparison group differs fundamentally from our MCP patients in ways that affect opioid consumption over our sample period. The comparison group patients had previously declined referral for medical cannabis, though the reasons are unknown but could include previous ineffective use of cannabinoids, as well as social or financial constraints. Publicly available data from the MCP indicates that 88% of patients who enrolled in the MCP in 2014 reenrolled in 2015, and reasons to not reenroll could include not only a failure to experience therapeutic benefits, but also such significant benefits that cannabis is no longer necessary or external factors such as social pressures or employment concerns. Yet another possible source of selection bias is the statistically significant difference in baseline opioid prescriptions between the two groups, with the MCP patients starting off with higher average daily opioid dosages than the non-MCP patients during the first three months of observation. It may be that the average patient must be prescribed a relatively high average daily dose before she or he is willing to consider enrolling in an MCP. Clearly we cannot rule out selection bias in our between-patient analyses. However, the within-patient (fixed-effects) analyses support that, even after controlling for time-invariant patient characteristics, at least those patients inclined to join an MCP show a statistically and clinically significant reduction in opioid consumption, as measured by their prescribed average daily dose.

Another limitation was that the inclusion of only patients who renewed their MCP licenses likely oversampled patients with an incentive to convince their medical referee that cannabis had been an effective treatment. Although reported attrition in the MCP was low, we were unable to measure it directly. We also were only able to measure MCP enrollment and opioid prescriptions filled, not actual cannabis and opioid consumption, and diversion or hoarding may have existed for both medications. Urine drug screening was also not used to verify cannabis or opioid use in the MCP group due to the nature of the study design (i.e., patient-generated claims that resulted in the construction of a historical cohort study). Without a longer pre-enrollment observation period, we were not able to establish pre-existing trends in opioid usage, and it is possible that some MCP patients were already reducing their consumption in conjunction with seeking alternative treatments or as a result of regression towards the mean, although mean reversion would not explain the group differences in cessation rates. Our pain assessment method was also limited by its non-standardized, informal, and retrospective nature, and was only completed by the MCP patients. Finally, the generalizability of our study is likely limited in part due to the small number of patients in our sample; a single state MCP and clinic; and demographic characteristics specific to our sample. Caution should therefore be taken in extending the results of our study to populations thought to be at greater risk of negative side effects.[35] Future, larger investigations should attempt to target causation and variant patterns (e.g., rates of change) of medication usage, while controlling of relevant individual-level factors (e.g., life-histories, current social environments, setting of substance usage), and incorporate more comprehensive bio- and psychometric outcomes/effects assessments through the implementation of creative research designs that can operate around the current federal barriers for conducting medical cannabis research in the U.S.[20]

Despite the current study’s limitations, the results from this preliminary study showed a strong correlation between enrollment in an MCP and cessation or reduction of opioid use. From a harm reduction standpoint, our results highlight the necessity of more extensive research into the possible use of cannabis as a substitute for opioid painkillers, especially in the form of placebo-based, randomized controlled trials and larger sample pragmatic studies.[36] The economic impact of cannabis treatment may also be considered given the current burden of opioid prescriptions on healthcare systems, which have been forced to implement costly modifications to general patient care practices, including prescription monitoring programs, drug screening, more frequent doctor-patient interactions, treatment of drug abuse and dependence, and legal products and services associated with limiting opioid-related liability.[37] In summary, if cannabis can serve as an alternative to prescription opioids for at least some patients, legislators and the medical community may want to consider medical cannabis programs as a potential tool for combating the current opioid epidemic.[14,38]

Supporting information

 

Showing 1/3: S1 Text.docx

[zeebudz]

22 hours ago, Restorium2 said:

Obviously, the studies that show less opioid use after legalization. Less use means less profit for the chains, who are being sued by the State Of Michigan for pushing pills. I think it's very easy to see. 

On February 1, 2018 CVS will limit opioid prescriptions to seven days for certain conditions for new patients. They will also put a limit on pain pills they dispense based on their strength. Loss of profits from patients using cannabis instead of opioids is probably a tiny fraction of a percent (and only in a few states) compared to those new restrictions.

And when cannabis is fully legal - as I said originally - "they will be quite capable at figuring out how to add cannabis moolah to their coffers", whether as a dispensed product with known component strengths (critical for a prescribed substance) or as an OTC herbal preparation. The only question is whether they will sell packaged herb - if they look at it more like tobacco because it is smoked then I doubt it (regardless of the differences between smoked cannabis & tobacco), but if they look at it more like an intoxicant like alcohol then certainly.

[Phil69]

Is it the pharmacist's decision which medicine you decide to take?  Why is this even a discussion (Not why are WE discussing it, why are THEY discussing it)? Aspirin is available otc and is FAR more dangerous than cannabis- maybe they need to shift their attentions to how they may be able to dispense (Not that I would ever like to see that happen- government is concerned with $, not quality or improvement of the flower).

I work in healthcare and see many pts coming in with narcotic-induced lack of peristalsis, addiction and seeking of these narcotics, and a myriad of other narcotic issues.

It's sad what our pharmacists and their uncle Sam will push out their doors in a plastic bottle and call "good medicine."  However, the one and only benign (relatively speaking) plant that can treat more conditions than any other single medication in their formulary, gives them justification to look down on us and treat us like criminals?

Eff that

They're legalized pushers giving medications out willy nilly that then require more medications to treat their side effects.  It's a domino effect until they're on 30 medications (I have seen higher med counts than that, even), over half unnecessary and causing more damage than good! Explain how that is ethical and legal!

 

Sorry, I will stop my rage engine, but only after noting that I have lost 100lbs in the last year using only cannabis in a purposeful and directed manner (wasn't a side effect, I used it as a tool).  Spurs in many joints, including back and ankles (makes a 12 hour shift a biotch)- the pain and inflammation gone within minutes of vaping flower.  I feel like a hunch back wobbling around the house sometimes- I go out and vape a bit.  I'll come back in and realize I'm standing straight with ABSO-F@$#*ING-LUTELY NO pain!  That football in my spine that ached, stabbed, burned yet cold at the same time, the numbness in the front of my legs- all GONE.

I was on effexor for 10 years (anxiety misdiagnosed as depression for as far back as I can remember).  I could not sit or stand still for more than a few minutes without my eyes feeling like they were being pulled shut.  That med is a mainstay in their Arsenal! I wasted 10 years of my life on that bunny muffin!  I've been off it a couple months.  I have more energy and "get up and get it done" than I remember being possible, now!  My gosh! All I missed out on or didn't take part in, because I had ZERO drive to do anything!

 

Thank you pharmacists, but I could not give a F.All to your concerns about this plant that I honestly and truly believe is here as a perfect medicine, given by God (or whomever your higher power is) himself.  I wouldn't go back on the poison they're pushing, if it were the only option available.

Effexor took forever to ween off, and the accelerated course I took was a living hell of withdrawl!  If you've never experienced a serotonin storm, every time you turn your head or even move your eyes too quickly, it feels like your knees were locked and someone just snuck up behind you and kicked your knees forward.  Every part of your body goes numb and tingly (the storm is due to your central nervous system being over simulated).  I was dizzy for several months (thank goodness for cannabis!)(hmmmm, my medicine reversed all conditions of the withdrawal of their medicine- not the first I've heard of cannabis being used to treat withdrawal).  But wait! Cannabis is a gateway drug!  Funny, because I've only ever had pharmacist's medicines, cannabis, and I grew some shrooms, once or twice.

I must be doing it all wrong!  I'm way behind!  I should at least be on meth or H by now! (Sarcasm very thick here)

 

My source of flower is a flake and I'm tired of begging for a response to a text; i'm done with him, just waiting for card to be delivered.  I've been dry for several days now (after years of daily use) and guess what my side effects are?? ABSOLUTELY F.-ALL!  my only withdrawl symptoms are the pain and aching that are not being treated without it!

So, long story short- I started to read the original post, but couldn't get past the pharmacists' opinions.  I feel they're full of bunny muffin and are in it for the money, like uncle Sam.

Funny all the politicians that are for legalizing now that they see all the money being made in Colorado, Cali, Oregon, etc.

 

Okay- rage switch turned off now🤣

Edited December 29, 2017 by Phil69