Prohibition or Prescription? The Status of Medical Marijuana and Health Insurance

You’ve got to love America. We have a long history of love/hate relationships with mood-altering substances, which we have often described as having “medicinal value” until science stops us cold. Of course, these scientific studies in medicine often never catch up to folklore, which exists everywhere in our culture in the form of things we “know” but cannot prove.

For example, if I said, “Red wine is good for you, you should drink a few glasses every day,” you’d probably nod your head and agree with me. But, the science behind that folklore is rather complex. Red wine contains a compound (resveratrol) that has a variety of positive impacts on your health, if consumed in the right quantities. But red wine is far from the best source of resveratrol, which is much more present in grapes and berries before they are fermented.

Experts who study wine say you shouldn’t drink more than one or two glasses per day, and there are a whole class of people who should never drink alcohol (like pregnant women, people younger than 21, drivers, people on certain medicines, etc.). On top of this, regular alcohol consumption increases your risk for a host of diseases, including cancer. As you can see, the folklore on the medicinal value of substances is complex.

So, what’s a health insurance company like Blue Cross and Blue Shield of Louisiana to do when members ask us to cover something called “medical marijuana?” We get similar results to red wine when we look at the science for that, too. Here’s the Straight Talk on some of the complexities with legalizing medical marijuana.

What Does the FDA Say?
Our national standards organization for drug effectiveness and safe use is the U.S. Food and Drug Administration (FDA). The FDA has several ongoing lines of research around medical marijuana, and their latest conclusions are:

The FDA has not approved marijuana as a safe and effective drug for any indication!

Doesn’t get much Straighter than that! At this point, the FDA can’t find any physical application for botanical marijuana where it is safer or more effective than other existing treatments. Throw in the legal complexities of the marijuana trade from state to state, and we’ve got a real mess on our hands.

Why Can’t We Just Legalize It?
For starters, marijuana, medical or otherwise, is still considered a Schedule 1 drug by the federal Drug Enforcement Authority (DEA), which means it is in the category of drugs with the highest potential for abuse and the creation of a psychological and/or physical dependence. To put it in perspective, opioids are considered Schedule 2 drugs; and marijuana shares the Schedule 1 category with drugs like heroin.

It’s also illegal under federal law to possess or grow marijuana, whether for medical purposes or recreational use. Although many people disagree with these classifications and think there should be stated differences for medical marijuana, Congress has not taken action to change the laws.

Confusing the issue even more, over the past few years, with the tacit (though temporary) approval of the U.S. Attorney General, 29 states have already written laws that approve of marijuana’s use for “medicinal purposes,” and eight of those 29 have legalized recreational use, too. This was facilitated because the previous administration instructed the U.S. Department of Justice not to prosecute or interfere with states’ marijuana use laws, which was the case until very recently.

The current administration’s Attorney General has yanked back this implied permission from the federal government and turned enforcement authority back to the local prosecutors, who now have permission to prosecute in all 50 states if they want to. Remember, the federal law against possession, use or sale of marijuana as a Schedule 1 Drug has never been removed; it’s still there. Legally speaking, under federal law using marijuana for medical purposes is no different from using it to get high.

And as if that wasn’t complex enough, more than 60 percent of the American public believes the recreational use of marijuana should be legal. That includes a ton of state and local legislators who want to regulate and tax marijuana (another sin tax!) and use that money for local needs like roads and schools. This puts upward pressure on the federal government to act, but that does not seem likely at this point.

With the federal laws in place, even in the states where marijuana use is legal, the businesses and growers who produce and sell marijuana cannot deposit their proceeds into any bank that uses the FDIC (only about 400 banks were willing to open accounts for marijuana businesses prior to the Attorney General’s memo). That forces most medical marijuana business to a cash-only enterprise, with billions of dollars moving back and forth in armored trucks!

What Do We Know About Using Marijuana?
In my studies, I’ve noticed some disturbing trends in the states that have legalized marijuana for recreational use. The emergence of something called Cannabinoid Hyperemesis Syndrome in regular users is particularly scary. This causes constant nausea, vomiting and abdominal pain, which are the kind of drug-use side effects that would normally come out in research done through proper channels under FDA rules. I’m sure we’ve all seen the warning lists on pharmaceutical commercials. The problem with medical marijuana is that because it’s not an FDA-approved treatment, we don’t even know what should go in the warning label. That’s scary!

On top of that, the unregulated inclusion of the active ingredient in marijuana (cannabis) in food items like candy and baked goods has also led to a rash of child poisonings. Children don’t always know the gummy bears they just ate were really medicine. When FDA-regulated pills that have potentially dangerous side effects for children go to market, they get put in hard-to-open, childproof bottles.  We still have a long way to go in that direction on medical marijuana.

A mess? You bet. But that’s not all.

Why Don’t Health Plans Cover Marijuana?
As your health insurance company, we exist in a very heavily regulated world. We are effectively a federal contractor, a state contractor and subject to regulations that come from the U.S. Department of Labor, the Internal Revenue Service, federal health agencies, the state Insurance Commissioner and state and local law enforcement.

It is our job to responsibly manage around $6 billion of our members’ and employers’ money to pay for the healthcare needs of around 1.6 million people. We manage very sensitive data that is federally protected, and we even take the precaution of regularly drug/alcohol testing our own workforce. We believe our members deserve our best work and judgment in how we spend their money and secure their futures.

How on earth could we involve them in this chaos by covering marijuana, medical or otherwise, at this point?

Today, it would be inappropriate for us to use the funds those 1.6 million people trust us with to pay for a substance whose legality and effectiveness is questionable at best. So, we are not paying for any marijuana for any health benefit at this point. I think it’s pretty clear why we don’t. And, we’re not alone – the majority of major health payers around the country have taken the same stance, for the same reasons I’ve outlined here.

Of course, I personally am constantly monitoring this situation, because it is very fluid and the pressures to legalize marijuana are great and growing. The FDA and other drug companies have begun growing new strains and testing marijuana for new treatments and uses. The current science to me appears mostly anecdotal, but that doesn’t mean there isn’t some breakthrough on the horizon. If there is, and the FDA approves it, we’ll be right on top of that.

So, we will watch. And wait. And continue to evaluate marijuana.

And I was Totally Straight when I wrote this!