A new study shows nearly half of marijuana users prefer using cannabis over pharmaceutical drugs to treat health issues, while the pharmaceutical and marijuana industries compete to be at the forefront of capitalizing on the popularity of cannabis use across the country. The study--conducted by Daniel Kruger, of the University of Michigan Institute for Social Research, and Jessica Kruger, a clinical assistant professor at the University of Buffalo--found that 44 percent of medical cannabis users stopped taking a pharmaceutical drug, used less of one, or both, for cannabis. Seventy-eight percent of participants used marijuana to treat a medical or health condition, which included pain, back problems, depression and headaches. These users also reported an increase in trust and use of medical cannabis compared to the mainstream healthcare system. “I imagine these people are representative of millions of people in the United States alone who are already sold on medical cannabis,” Daniel Kruger said. Despite the shifting attitude towards marijuana usage across the country—with medical use of cannabis legalized in 33 states and recreational legalization rapidly expanding—public health curricula and policy have fallen behind the de facto practice of American's cannabis use for medicinal purposes, while the pharmaceutical and marijuana industries chug full steam ahead to capitalize off of the booming market.

Big Pharma and Cannabis: Conflict or Capitalize?

[caption id="attachment_12455" align="aligncenter" width="1254"] pharmaceutical industry, medicine pills are filling in the plastic bottle on production line machine conveyor at the medical factory. selective focus.

pharmaceutical industry, medicine pills are filling in the plastic bottle on production line machine conveyor at the medical factory. selective focus.

iStock / Gumpanat[/caption] The popularity of using marijuana for its medicinal benefits has proven to be a source of both competition and opportunity for the pharmaceutical industry. Soheila Malekzadeh, a 51-year-old California resident, spent nearly twenty years taking 3 mg of Xanax per day to treat her anxiety. But since beginning to self-medicate with marijuana three years ago, she rarely touches her Xanax prescription.

“Xanax made me like a zombie, I didn’t feel anything,” Malekzadeh said. “But when I take marijuana, I’m just so calm and in touch with reality that I don’t need to take Xanax to calm me down. Now I enjoy everything, I’m happy, I dance, I joke and I’m me.”

Medical marijuana users in Kruger’s study reported similar feelings. They rated cannabis better than pharmaceutical drugs in all categories that were questioned, including effectiveness, side effects, safety, addictiveness, availability, and cost. “As we found in our study, cannabis is going to cut into [the pharmaceutical industry’s] market share for their opiates and painkillers and all these other pharmaceuticals they’re making money off of,” Kruger said. Until last year, only synthetic forms of THC, such as Marinol, were available for prescription. But in November, the pharmaceutical industry made a major step towards capitalizing off of growing popularity for medical marijuana usage when Epidiolex, the first cannabis-based prescription approved by the FDA, became available in all 50 states. The drug is used to treat two types of epileptic syndromes and is estimated to cost $32,500 per year, according to its maker, GW Pharmaceuticals. But big pharma also has a history of spending money to push back at the growing cannabis industry. Insys, a pharmaceutical company that manufactures fentanyl--an opiate responsible for driving down the U.S. life expectancy--spent $500,000 to back a successful campaign to squash marijuana legalization in Arizona in 2016. Five months later, the company announced it had been approved by the DEA to manufacture the first liquid form of cannabinoid dronabinol, called Syndros. Pharmaceutical companies are realizing their most profitable future may be to enter the cannabis space. “I do think that as soon as they have the legal green light, they are going to try to capitalize on it because that’s their industry,” Kruger said. On the other hand, the cannabis industry is exploding and expected to be worth $24.1 billion in the U.S. by 2025, according to New Frontier Data. “The cannabis industry itself is way beyond the hippies who are growing in their field or basement, you have the venture capitalists now whose interest in green is money, and that is going drive a lot of the profit motive,” Kruger said.

Public Health Versus De Facto Practices

[caption id="attachment_12456" align="aligncenter" width="1254"] Tweezers hold cannabis bud in a laboratory

Tweezers hold cannabis bud in a laboratory

iStock / boonchai wedmakawand[/caption] The Krugers are public health researchers with a broad range of work in community health and collaboration with people in the community. Before conducting their study, they began noticing a disconnect between the rapid change in the legal status of cannabis and its extensive use, and practices in public health and mainstream medicine. “Basically we see this freight train coming down the tracks, and public health is standing on the tracks, and we’re like, ‘We gotta do something about this’,” Kruger said. The Krugers used data collected from 450 current cannabis users at an event advocating for marijuana law reform in Ann Arbor, Michigan, where medical marijuana was legalized at the time, and now is legalized recreationally. The study sought to advance knowledge in an evidence-based approach to examine harm reduction and benefits of medical cannabis, but Kruger said randomized clinical trials are also needed. Scientific studies and traditional medical practices are stuck in an abstinence-only mindset towards marijuana usage and focus on adverse effects, Kruger said. There are hundreds of known psychoactive compounds in cannabis and thousands of strains with different compositions and effects. The absence of cannabis in mainstream public health research and policy leaves a major gap in the assessment of cannabis dosage levels, benefits, and harm reduction practices. Almost one-third of the study’s participants said their mainstream health provider did not know about their marijuana usage. “Imagine if you went to a physician and they handed you a bag of assorted pills with all different shapes and sizes and colors, and they said, ‘Just keep taking these until you feel better.’ That’s basically the state we’re in with medical cannabis,” Kruger said.

Bridging the Gap

The study argues that the gap between de facto practice and science needs to be bridged in order to reduce harm and increase benefits for patients. Cannabis is categorized as a Schedule I drug on a federal level, which recognizes no medical purpose and a high potential for abuse for the substance. As cannabis products continue to become popularized both by the cannabis and pharmaceutical industries, Kruger said it should at least be rescheduled to acknowledge its medicinal potential so that randomized clinical trials can be performed, in the same methods performed with pharmaceuticals. “When you have unregulated industries with a strong profit motive, that tends to be not so great for consumers, so it’d be great to have objective independent research on these issues,” Kruger said. This could be made possible by treating cannabis like other mainstream medicines where scientists research effective dosage levels for the treatment of various health conditions, conduct standardized testing, systematic assessment, provide informative labeling and consumer education on cannabinoid properties. “People are using it for a very, very broad range of purposes,” Kruger said. “We really need to investigate just how effective it is for each of these and what are the intricacies of the composition of cannabis that maximizes the benefits and minimizes the harm to individuals and society.”