(Reuters) – Pfizer Inc said on Tuesday it would take a 25 percent stake in Allogene Therapeutics to accelerate the development of CAR T cell therapies sourced from donors instead of patients.
A company logo is seen at a Pfizer office in Dublin, Ireland November 24, 2015. REUTERS/Cathal McNaughton
CAR T drugs are seen as the future of cancer treatments, with a number of drugmakers looking to boost their pipeline with such drugs.
San Francisco-based Allogene specializes in allogeneic therapies that are engineered from cells of healthy donors, allowing them to be stored for “off-the-shelf” use and reducing the time patients must wait for treatment.
Allogene is co-founded and led by former Kite Pharma executives, including its former chief executive, Arie Belldegrun, who sold Kite to Gilead Sciences Inc for $12 billion last year.
“The agreement marks a shift in Pfizer’s strategy from an active role to a passive role in the CAR-T space,” Guggenheim analyst Tony Butler said in a client note.
Creating therapies for blood cancers and solid tumors from allogeneic CAR T cells could be “disruptive” in the immuno-oncology space, Butler said.
Allogene will receive from Pfizer rights to 16 pre-clinical CAR T assets, which are licensed from French cell therapy specialist Cellectis SA and French drugmaker Servier.
Cellectis, in which Pfizer has an 8 percent stake, is eligible to receive $2.8 billion on net sales of any products that are sold by Allogene.
San Francisco-based Allogene will also get rights to one clinical asset from Servier, which is called UCART19, an “off-the-shelf” cell therapy currently in early-stage study.
Pfizer will get a representation on Allogene’s board, but financial details of the deal were not disclosed.
Servier and Allogene aim to start mid-stage studies in 2019, with Allogene having the exclusive rights to develop and commercialize UCART19 in the United States. Servier will have the exclusive rights to all other countries, Pfizer said.
Allogene is a Two River portfolio company, which was formed with $300 million from an investment consortium that includes TPG Capital, Vida Ventures, BellCo Capital, the University of California Office of the Chief Investment Officer and Pfizer.
U.S.-listed shares of Cellectis rose 16.2 percent to $35.72.
Reporting by Kanishka Singh and Tamara Mathias in Bengaluru; Editing by Gopakumar Warrier and Anil D’Silva
STAMFORD, Connecticut (Reuters) – In record time, Loxo Oncology (LOXO.O) developed a novel drug for a wide variety of tumors that share a rare mutation. It recently struck a partnership with Germany’s Bayer (BAYGn.DE). Its stock tripled in the past year.
FILE PHOTO – An orchid stands on a table at the entrance to Loxo Oncology headquarters in Stamford, Connecticut, U.S., February 20, 2018. Picture taken February 20, 2018. REUTERS/Bill Berkrot
But in an unusual move for biotech – where hype is often the norm – its founders are tempering expectations.
They are quick to point out that their task ahead is no small one: Getting doctors and insurers to agree to testing several hundred thousand cancer patients to find the one percent, or less, whose tumor has the mutation its drug targets.
“We’re very cautious about this because we understand that for all of these patients to be identified, broad testing across the spectrum of human cancer has to happen,” Jacob Van Naarden, Loxo’s chief business officer, told Reuters. “It’s an exquisitely rare patient population.”
Because of its small size and narrow focus, Loxo is among the most dependent on adoption of widespread genomic testing. But they aren’t alone. Bigger drugmakers, such as Roche Holding (ROG.S), are also working on treatments that depend on finding a mutation driving many different cancers.
Loxo, founded in 2013, leapt from obscurity last year. The turning point came at a major cancer conference in June, when it released data showing its pill, larotrectinib, shrank tumors significantly in 75 percent of patients with cancer in the lung, pancreas, colon or more than a dozen other locations.
Its stock skyrocketed and the company now has a market valuation more than $3 billion. (For a graphic, see tmsnrt.rs/2Id3kCD)
Loxo’s trial tested 55 advanced cancer patients, all of whose tumors had the mutation, TRK fusion. Many had run out of treatment options, while some were children facing limb amputations.
Wall Street analysts expect U.S. approval this year and forecast annual larotrectinib sales reaching $500 million to $1 billion. Bayer, which expects to file for European approval this year, will help bring larotrectinib and a potential successor drug to market in a partnership worth up to $1.6 billion.
With Bayer in charge of pricing, the drug could cost $15,000 a month, said Bernstein analyst Wimal Kapadia.
FILE PHOTO – Loxo Oncology CEO Joshua Bilenker (L) and Chief Business Officer Jacob Van Naarden stand for a portrait in Stamford, Connecticut, U.S., February 20, 2018. The drawing on the left is a depiction of the TRK genetic mutation their lead cancer drug, Larotrectinib, targets. Picture taken February 20, 2018. REUTERS/Bill Berkrot
In interviews at company headquarters in Stamford, Connecticut, Loxo executives addressed the hurdles ahead. For starters, “we don’t actually know how many patients there are,” Van Naarden said. An estimated 1,500 to 5,000 people may be candidates out of 500,000 U.S. cancer patients diagnosed each year.
To find them, new genomic tests will need to include the TRK fusion defect.
“These drugs will do well as people adopt this testing,” said Dr. David Hyman of Memorial Sloan Kettering Cancer Center in New York, who led larotrectinib clinical trials.
But getting doctors and pathologists across the country to order that testing is a significant hurdle.
The U.S. government last month said the Medicare program for the elderly will cover so-called next generation sequencing (NGS) which looks for hundreds of mutations across all solid tumors for advanced cancer patients. Loxo will need TRK fusion to be included in those tests once its drug is approved.
For the moment, private insurers such as Anthem Inc (ANTM.N) and Humana Inc (HUM.N) typically only pay for narrow diagnostic tests for a particular type of cancer.
Given uncertainties around finding the right patients, “we don’t think it’s a billion-dollar drug,” said Loxo Chief Executive Joshua Bilenker. Bayer said it was too soon to predict eventual sales.
GETTING TESTED Until now, cancer drugs that target mutations have been primarily limited to the tumor type against which it was tested. Pfizer Inc’s (PFE.N) Xalkori works against ALK and ROS1 mutations in lung cancer. Roche’s (ROG.S) Zelboraf treats melanoma with an abnormal BRAF gene.
Merck & Co’s (MRK.N) Keytruda was the first cancer drug approved for many tumor types based on a single mutation and will benefit from large scale testing, though that remains a relatively small market for its treatment.
Newer players, such as Loxo, Blueprint Medicines Co (BPMC.O) and Ignyta, recently bought by Roche, target tumor mutations regardless of their organ of origin. This requires far more people to be tested, since such a small number of patients will have the mutations in any one tumor type.
These advanced tests, provided by Foundation Medicine (FMI.O), Thermo Fisher Scientific (TMO.N), Caris Life Sciences, and others, can detect hundreds of mutations from a tiny tissue sample. Testing positive for one of about of dozen of these mutations could directly influence treatment.
While the cost has dropped dramatically, to about $1,000-$1,500 per patient, private insurers argue such comprehensive testing amounts to funding research, not medical care.
Foundation and Thermo said they are talking to private insurers about coverage. Humana and Anthem said they are evaluating their policies following the Medicare decision.
“Reimbursement is a continuous and ongoing battle,” said Foundation Chief Medical Officer Vince Miller.
Major cancer centers, which conduct extensive research, use tests that detect hundreds of mutations. But to justify such testing, community hospitals will need know it will identify the patients likely to benefit.
Bayer will reach out to cancer doctors about larotrectinib once it is approved, while Loxo will educate pathology laboratories on the need to test for TRK, Loxo said.
The companies say the cost is worth it since doctors could prescribe a highly effective drug if their patient has the TRK defect instead of more toxic chemotherapy or expensive immunotherapy with a lower probability of working.
“That’s an amazing return on investment for the healthcare system,” Bilenker said.
Medicare has started sending new cards with new Medicare Numbers to people with Medicare. Your new Medicare card will include a new number unique to you, instead of your current Social Security-based number. This will help to protect you against fraud.
Starting this month, people who are enrolling in Medicare for the first time will be among the first in the country to get the new cards. If you have Medicare already, you’ll get your new card over the coming months. Medicare will mail cards on a rolling basis, sending a new card with a new number at no cost to everyone with Medicare over the next year. To update your official mailing address, visit your MySocialSecurity account, or call 1-800-772-1213.
If you want to know when new cards start mailing to your area, visit Medicare.gov/NewCard, and sign up to get email alerts from Medicare. We’ll send you an email when cards start mailing in your state, and we’ll also email you about other important Medicare topics. While the cards have a new look, your Medicare coverage and benefits will stay the same.
GALLUP, N.M. — On a crisp sunny day, Tyson Toledo, a precocious 5-year-old boy, hobbled into a private health clinic to have his infected foot examined.
Pediatrician Gayle Harrison told his mother to continue to apply antibiotic ointment and reminded them to come back if the swelling and redness worsened.
The appointment at Rehoboth McKinley Christian Health Care Services’ outpatient center comes at no charge for the Toledo family, who live 30 miles away on the Navajo Nation Reservation. That’s because Tyson is covered by Medicaid, the state-federal health insurance program for the poor.
New Mexico leads all other states in Medicaid enrollment, with 43 percent of its residents on the program. That’s partly because the state has a large Native American population, living in communities historically riven with poverty. The numbers offer an eye-popping snapshot of the promotion of Medicaid expansion since 2013: Nearly a third of the 900,000 New Mexico beneficiaries joined as part of the Affordable Care Act’s option to expand Medicaid.
Kaiser Health News is examining Medicaid’s role in the U.S. as the health care program comes under renewed fire from Republicans who generally want to put the brakes on the program, even as many Democrats credit the expansion with reducing the number of uninsured Americans to historic lows. Conservatives view the costs as prohibitive for state and federal budgets.
Nina Owcharenko, a senior research fellow in health policy with the conservative Heritage Foundation, said the enrollment boost is “not a positive story.” While the high enrollment underscores the pervasive poverty in New Mexico, it also signals surging costs for taxpayers, she said.
“I am growing more concerned about the cost of shifting Medicaid dollars to the federal government and without a budget cap on the program. … That is a dangerous fiscal course for the country,” she said.
“This is a problem that needs to be fixed. … We need to find a way that is more rational and more fiscally sustainable,” said Owcharenko, who was a top Health and Human Services official in 2016.
Tyson Toledo and his mother, Stephanie Ranger, sit outside Rehoboth McKinley Christian Health Care Services’ outpatient center in Gallup, N.M., in October 2017. (Heidi de Marco/KHN)
In Gallup, a city of about 23,000 people, Medicaid is as much a part of the fabric as Native American-crafted jewelry and green chile sauce. Recipients include the waitress at the downtown bar, the clerk at a loan store and the maid at the hotel.
And multigenerational families are common in Gallup and surrounding McKinley County. Tyson’s mother, grandmother, aunt and uncle also are enrolled in Medicaid.
Fifty-two percent of the county’s residents have coverage through the program. That’s the highest rate among U.S. counties with at least 65,000 people, according to a KHN analysis of Census data.
Tyson Toledo, his mother and grandmother are all are on Medicaid. Multigeneration Medicaid families are common in McKinley County, N.M., where 52 percent of residents are on Medicaid, the highest rate among U.S. counties. (Heidi de Marco/KHN)
“Pretty much everybody is on Medicaid here,” said Libby Garcia, 36, who lives in a trailer overlooking downtown Gallup.
Garcia, who works as a custodian at a local Head Start agency, quit a second job cleaning businesses because that extra income would put her over the eligibility level for coverage. She can’t afford private insurance, and Medicaid gives her free care at a community health center and insulin and other medicines for her diabetes without out-of-pocket costs, she said.
McKinley, where more than 40 percent of the population lives below the federal poverty level ($12,140 for an individual), is the nation’s only county of at least 65,000 people in which more than half the population is on Medicaid. Nationwide, about 23 percent of Americans are enrolled, with more than 16 million people added since the expansion.
In McKinley County, many residents see Medicaid as vital. There’s no stigma around it, and enrollees and providers speak positively about it.
“Pretty much everybody is on Medicaid here,” Libby Garcia says of her mobile home community in Gallup, N.M. Garcia, who lives in a trailer overlooking downtown Gallup says she had to quit her second job because she would make too much to qualify for Medicaid. The federal-state program for low-income people enables her to get free care at a nearby community health center and afford insulin and other diabetes medication. (Heidi de Marco/KHN)
The heavy concentration of Medicaid in this high-altitude desert is a result of two factors: the high poverty rate and the Indian Health Service’s relentless work to enroll patients in the program.
Large swaths of McKinley County lie within the Navajo Nation, the largest Indian reservation in the United States. Nearly 80 percent of McKinley County’s 75,000 residents are Native American.
Medicaid enrollees in Gallup say the coverage has opened up new opportunities for them to get more timely care, especially surgery and mental health services. It has been vital in combating high rates of obesity, teen birth, suicide and diabetes, according to local health officials.
Outside a local Dollar Tree store, Linda James, 55, who sells jewelry she makes, said Medicaid paid for her son’s braces and her teenage daughter’s drug rehabilitation. “It’s a lifesaver for us,” she said, noting it helps her get quicker care than waiting at Indian Health facilities.
‘Safety Net’ For Indian Health Service
For the Gallup Indian Medical Center — the main Indian Health Service facility in the area — Medicaid has stoked the local budget and eased overcrowding. When patients on Medicaid are treated there, the center is reimbursed by the program. That money supplements the Indian Health Service’s annual federal grant, which is set by Congress.
Last year, Medicaid funding made up 34 percent of the center’s $207 million budget. Among all U.S. hospitals, Medicaid provided only 18.5 percent of revenue. “Medicaid has become the safety net for the Indian Health Service,” said John Ratmeyer, deputy chief of pediatrics at the Gallup Indian Medical Center. “It’s providing an extra pod of money to pay for services not within our hospital system.”
Medicaid this year is projected to add more than $800 million to Indian Health Service hospital funding, supplementing the $4.8 billion in annual federal appropriation.
The medical center in Gallup looks like a relic of the 1960s, with fading-blue exterior walls, sandstone-colored outpatient trailers, cramped nursing stations and hard plastic seats in its emergency room waiting area. The hospital doesn’t have an MRI machine or any designated private patient rooms.
Native Americans can receive free care at Indian Health Service hospitals and its clinics, such as this facility in Gallup, N.M. (Heidi de Marco/KHN)
“One of our biggest challenges is just maintaining the building,” said Dr. Kevin Gaines, acting deputy clinical director at the hospital. The extra money coming from patients covered by Medicaid are helping the center pay for a badly needed $13 million modernization of its ER and urgent care unit, he said.
Another problem is a shortage of nurses and doctors, which leads to long wait times for patients — three or four months for primary care appointments or for dental services or eyeglasses. Some patients seeking specialized care need to go 140 miles to Albuquerque, a hardship for many Native Americans, some of whom don’t have access to cars or money for such transportation. But Medicaid will cover some non-emergency transportation for medical appointments.
State Feels The Pinch
The county has a host of medical challenges related to its economic problems. According to a 2016 report sponsored by Rehoboth McKinley, the county’s suicide rate for ages 10 and up is twice the U.S. average, alcohol-related deaths are nearly four times higher than the national rate, and teen birth rates are three times the U.S. average. Average life expectancy in McKinley is 74 years, four years less than the typical U.S. life span.
Without Medicaid covering doctor visits and substance abuse treatment, the situation would likely be worse, said Larry Curley, director of program development for Rehoboth McKinley.
This kind of care doesn’t come cheap. The federal government paid the full cost of the expansion through 2016, but now New Mexico and other states have to pick up a 5 percent share. To deal with rising costs, the state in 2017 began cutting the fees it pays hospitals, doctors and other providers.
Asked about her Medicaid health plan while at a popular doughnut shop, Corrine Rosales, 60, of Gallup, said it’s invaluable for her and her two young nieces, Mya and Destiny. Medicaid pays for her diabetes medications and helped Mya get treated for attention-deficit disorder.
“I don’t know what we would do without it,” she said.
Cost and Quality Insurance Medicaid
Medicaid Expansion Medicaid Nation New Mexico
If you or a loved one wants to beat an opioid addiction, first make sure you have a handy supply of naloxone, a medication that can reverse an overdose and save your life.
“Friends and families need to keep naloxone with them,” says Dr. David Kan, an addiction medicine specialist in Walnut Creek who is president of the California Society of Addiction Medicine. “People using opioids should keep it with them, too.”
More than 42,200 Americans died from opioid overdoses in 2016, victims of a crisis that’s being fueled by the rise of a powerful synthetic opioid called fentanyl, which is 30 to 50 times more potent than heroin. Rock stars Prince and Tom Petty had fentanyl in their systems when they died.
People can become addicted to opioids through long-term use, or misuse, of prescription painkillers. In most cases, that leads to heroin use, according to the National Institute on Drug Abuse.
If you’re ready to address your own addiction, or that of a loved one, know that you may not succeed — at first. You probably won’t be able to do it without outside help or medications. And you’ll probably have to take those medications for years — or the rest of your life.
“Getting over a drug addiction is a process. There are going to be ups and downs,” says Patt Denning, director of clinical services and training at the Center for Harm Reduction Therapy in San Francisco and Oakland. “We need to hang with people while they’re struggling. It might take awhile.”
That’s why Denning and others suggest you start with having naloxone on hand, which can help you stay alive through the process.
Last year in San Francisco, about 1,200 potentially fatal overdoses were reversed by regular folks administering naloxone, not doctors, police or paramedics, Kan says.
Naloxone, which can be administered as a nasal spray or injection, is available without a prescription in more than 40 states, including California. Ask your pharmacy if it stocks the drug. Needle exchange programs also offer the medication at no charge, Denning says, as do some public health clinics.
Rehab Alone Doesn’t Work
People addicted to opioids face staggering relapse rates of 80 to 90 percent within 90 days if they try short-term rehab or detox programs that wean them off the drugs without assistance from medications, says Richard Rawson, a UCLA psychiatry professor emeritus.
Rawson warns that rehab can also increase the risk of an overdose, because your body’s tolerance to opioids is lower after you withdraw from them.
“If you leave rehab and take the same dose you used to take, you’re not just going to get high, you’re going to be dead,” he says.
Instead of treating opioid addiction like a curable illness, he and other experts liken it to lifelong, chronic conditions such as diabetes that require ongoing management.
“This isn’t going to be one visit. If you have an addictive disorder, this is going to be the rest of your life,” says Dr. Stuart Gitlow, an addiction specialist in New York City who is past president of the American Society of Addiction Medicine.
Chronic illnesses often require medication. Rawson and others point to two drugs in particular that may help break your addiction: buprenorphine and methadone.
There is some unwarranted stigma attached to these drugs, along with a belief that “you’re just exchanging one addiction for another,” Kan says.
While these medications are actually opioids themselves, they control craving and withdrawal — and help prevent the compulsive and dangerous behavior often associated with addiction.
They also reduce your chances of an overdose, Rawson says. And they protect you from other risks that come with opioid addiction, such as exposure to blood-borne infections from sharing needles, including HIV and hepatitis C.
Essentially, the medications make you “comfortable enough physically” to confront the issues behind your addiction, from anxiety and depression to post-traumatic stress disorder, Denning says.
The federal government agrees.
“Abundant scientific data show that long-term use of maintenance medications successfully reduces substance use, risk of relapse and overdose, associated criminal behavior, and transmission of infectious disease, as well as helps patients return to a healthy, functional life,” according to the Surgeon General’s 2016 report on addiction in America.
To obtain methadone, you must visit a clinic governed by state and federal rules.
“These clinics are not particularly patient-friendly. You have to go every day. You can’t travel,” Denning says. “It takes over your life.”
Buprenorphine, on the other hand, can be obtained from doctors, including primary care physicians, who have undergone training and received federal approval.
“The beauty of buprenorphine is it can be prescribed like any medication out of a doctor’s office,” Denning says.
To find a doctor who prescribes buprenorphine, go to the Substance Abuse and Mental Health Services Administration website at www.samhsa.gov and click on the “Find Help & Treatment” link from the home page. You can search by state and ZIP code.
Though you can receive care from your primary care physician, Gitlow recommends that you also consult with an addiction specialist.
In California, find one by visiting the California Society of Addiction Medicine’s website at www.csam-asam.org and clicking on the “Physician Locator” tab.
If you do not live in California, check the American Academy of Addiction Psychiatry’s website at www.aaap.org and click on the “Patient Resources” tab on the home page.
After You Start The Medication …
Once patients start one of the medications, it’s not clear how long they should stay on — a question that deserves further research, Rawson says.
“The longer people stay on treatment, the lower the death rate is and the more they’re able to function,” he says.
Often patients face pressure from family members, who badger them to get off the medications even though it would be better for them to stay on them, Kan says.
“We don’t say to patients who suffer from diabetes … ‘Have you changed your diet enough so you can get off insulin?’” he says.
Kan and other addiction specialists generally don’t encourage medication treatment alone, no matter how long you stay on it. Pairing the medication with therapy or other support, including 12-step programs such as Narcotics Anonymous, can reduce relapse rates further, they say.
Al-Anon and Nar-Anon groups also can be helpful resources for families, Kan adds.
“12-step is something I encourage for everybody. I don’t consider it a treatment, per se. It’s like mutual support,” he says.
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This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.
Mental Health Public Health
Opioids Substance Abuse
WASHINGTON – The U.S. Supreme Court on Monday rejected a bid by anti-abortion activists to win the release of videos they surreptitiously recorded at meetings of abortion providers.
FILE PHOTO: Anti-abortion activist David Daleiden speaks at a news conference outside court in Houston, Texas, U.S., February 4, 2016. REUTERS/Ruthy Munoz/File Photo
The justices declined to take up appeals by the abortion opponents and left in place a lower court’s ruling blocking the release of videos that had the aim of exposing alleged illegal sales of aborted fetal tissue for profit. The trial judge in the case concluded there was no evidence of criminal wrongdoing by the abortion providers captured in the videos.
The activists, including anti-abortion group Center for Medical Progress founder David Daleiden, recorded the videos in 2014 and 2015 at annual meetings of the National Abortion Federation, a nonprofit organization representing abortion providers including affiliates of Planned Parenthood.
Planned Parenthood has said the videos were heavily edited to leave a false impression of wrongdoing.
The National Abortion Federation in 2015 sued Daleiden, the California-based Center for Medical Progress and former center board member Troy Newman to stop the release of videos.
The federation said the videos were illegally recorded at private meetings protected by confidentiality agreements and that the anti-abortion activists had infiltrated the meetings by posing as executives of a company that bought fetal tissue.
U.S. District Judge William Orrick in San Francisco blocked the release of the videos in 2016, ruling that enforcing the confidentiality agreements would not violate free speech rights under the U.S. Constitution’s First Amendment. Orrick discounted the claim by the abortion opponents that they were acting as “citizen journalists” in an undercover investigation.
Such confidentiality agreements help ensure privacy and safety for abortion providers given the increase in threats and violence they faced since the defendants’ release of other videos in July 2015, Orrick said.
The judge noted that in November 2015 a man fatally shot three people at a Planned Parenthood clinic in Colorado. The man told police he was upset with Planned Parenthood for performing abortions and “the selling of body parts,” according to court documents.
National Abortion Federation President Vicki Saporta said the video campaign has put abortion providers at risk. “We are grateful that the Supreme Court denied the defendants’ latest attempt to circumvent the very necessary security precautions NAF has in place,” Saporta said.
Daleiden’s attorney Catherine Short said, “The Supreme Court seems to have decided that the problems with Judge Orrick’s gag order are better addressed at lower court levels at this time.”
Orrick later found Daleiden, the Center for Medical Progress and two of his attorneys in contempt of court after they published some of the blocked material on the internet.
The San Francisco-based 9th Circuit Court of Appeals last year upheld the injunction against the videos’ publication, prompting Daleiden and Newman to appeal to the Supreme Court.
Daleiden and an associate, Sandra Merritt, last year were charged in California with filming Planned Parenthood workers without their consent.
(Reuters Health) – Opioid prescriptions may decline when states legalize marijuana, two U.S. studies suggest.
FILE PHOTO: Marijuana is seen for sale at Harborside, one of California’s largest and oldest dispensaries of medical marijuana, on the first day of legalized recreational marijuana sales in Oakland, California, U.S., January 1, 2018. REUTERS/Elijah Nouvelage/File Photo
One study focused on older adults with Medicare drug benefits. In each state, in an average year, doctors prescribed 23 million daily doses of opioids. Compared to states where cannabis was banned, states where medical marijuana was legal averaged 3.7 million fewer opioid doses annually, while states that permitted only home cultivation of marijuana had 1.8 million fewer doses.
A separate study of adults insured by Medicaid, the U.S. health program for the poor, found medical marijuana laws associated with an almost 6 percent decline in opioid prescriptions.
“These findings suggest that cannabis may play a role in fighting the opioid crisis by reducing some patients’ need for opioids,” said Dr. Kevin Hill, coauthor of an accompanying editorial and director of addiction psychiatry at Beth Israel Deaconess Medical Center in Boston.
“The evidence thus far does not suggest that cannabis should be a first-line or even a second-line treatment for pain,” Hill said by email. “But if a patient has tried to treat pain using multiple modalities without success, a trial of medical cannabis may make sense.”
Each day, 90 Americans die from opioid overdoses, Hill notes in JAMA Internal Medicine, where both studies were published. While some deaths may be due to illegal narcotics like heroin, others are caused by opioid medications like oxycodone, fentanyl, hydrocodone, morphine, and methadone.
In the Medicare study, conducted from 2010 to 2015, researchers didn’t find cannabis legalization associated with a meaningful reduction in prescriptions for fentanyl or oxycodone.
But annual hydrocodone use declined, on average, by 2.3 million daily doses in states with legal marijuana dispensaries and by 1.3 million daily doses in states that legalized only home growth of marijuana.
Legal dispensaries were also associated with an average of 361,000 fewer daily doses of morphine prescriptions each year, the study found.
“Patients and physicians seem to be responding to the introduction of medical cannabis as if it were medicine – in many ways as they would with the introduction of a new FDA-approved medical treatment,” said study coauthor W. David Bradford, a researcher at the University of Georgia in Athens.
“Of course, there may be diversion from medical cannabis sources to recreational purposes – our research can’t really speak to that,” Bradford said by email.
The study of Medicaid patients examined the association between opioid prescribing rates and state marijuana laws implemented from 2011 to 2016.
In states without medical marijuana laws, the annual opioid prescription rate was about 670 for every 1,000 people enrolled in Medicaid, the study found.
When states implemented medical marijuana laws, however, the annual opioid prescription rate declined by almost 6 percent, or approximately 39 fewer prescriptions for every 1,000 people enrolled in Medicaid each year.
Neither study proves that legalizing marijuana causes a decline in opioid prescriptions. Also, it’s unclear from the studies exactly how much marijuana use was for medical versus recreational purposes or how much people might have relied on other non-opioid painkillers.
“Marijuana is one of the potential, non-opioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose,” said Hefei Wen, co-author of the Medicaid study and a researcher at the University of Kentucky College of Public Health in Lexington.
“The potential of these marijuana (legalization) policies to reduce the use and consequences of addictive opioids deserves consideration especially in states that have been hit hard by the opioid epidemic,” Wen said by email.
SOURCE: bit.ly/2uIwdEI, bit.ly/2uGnCT1 and bit.ly/2uLErMo JAMA Internal Medicine, online April 2, 2018.