Who Gets Pot Recommendations? 

A new RAND study reveals that it might not be who you think.

Judging from the breathless coverage that California's medical cannabis industry gets in places like Arizona and the Midwest, you'd think the average "patient" is a strapping, healthy 18-year-old stoner looking to score an eighth before a night of intoxicated driving and unprotected sex with a minor. But there's actually very little research on just who gets cannabis recommendations in the state. Privacy advocates proudly note that California residents needn't share medical records with authorities to obtain the drug — unlike Colorado, Arizona, and other alleged libertarian strongholds.

But this week, a new study from the independent think tank RAND Corporation shines a light on some of the hundreds of thousands of medical cannabis patients in California. Released in the April issue of the Journal of Drug Policy Analysis, "An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California" shows that more than half of patients are over 35, and 67.8 percent of them brought medical records to their appointment. Seventy-three percent have health insurance and 68.7 percent are employed. Most sought relief from pain, insomnia, and tension, and 79.5 percent of patients had previously tried prescription medications. More than 50 percent of the sample reported they had used or were using marijuana as a substitute for prescription drugs.

For the study, RAND obtained 2006 data from MediCann of Oakland, one of the larger medical-cannabis-chain clinics, and reviewed information on 1,655 patients from a three-month period at nine locations across California. Dr. Helen Nunberg, lead author of the RAND paper, worked at MediCann as a physician from 2005 to 2010. A former family practice doctor with a masters degree in public health from UC Berkeley, Nunberg said she saw an opportunity for some live epidemiology at MediCann. "It's rare to get a data set like this," she explained. "It's significant. It's large, and with the help of RAND, it was well done."

But there are some qualifications to the study, starting with whether the data can be generalized. In California, medical cannabis patients must first see a licensed physician and get a recommendation. That physician can be the patient's primary doctor, but is often a specialist at a clinic such as MediCann, which has 21 locations. However, to scientifically understand California's medical cannabis patients, you'd need to randomly sample the entire population, not just one chain clinic. As a result, "the [MediCann] sample is not generalizable to all individuals applying for a medical marijuana recommendation as it only represents those individuals selecting this particular network of physicians," RAND noted.

Clinics tend to be for people who are not undergoing treatment for AIDS and cancer, so "I definitely think there's going to be sampling bias," said UC lecturer Amanda Reiman, who has a doctorate in social work and is research director of Berkeley Patients Group, a large East Bay dispensary. "You're probably going to track patients with less serious illnesses."

It's still valuable information, Reiman said. MediCann's sample paints a portrait that looks surprisingly benign — like the same people you'd see buying Tylenol or Advil at the drug store. "Lower back pain, insomnia , anxiety, are very, very common in the general population," Reiman said. "Remember that, head-to-head, cannabis really is one of the safest substances for someone to take as a remedy for pain or insomnia or anxiety or depression, compared to some of the other treatments that are out on the market.

"It's not surprising that more people are looking to cannabis — as it becomes less stigmatized and more of a normative practice — to deal with some of these more common ailments," she continued. "Before, maybe they'd go get a Vicodin prescription or prescription-strength Tylenol. Now they may be going to cannabis as a first method of treatment." Indeed, substituting pot for pills "is a very common occurrence," she said.

The sample also showed about 12 percent of women respondents were on six prescription medications or more, a notably large amount. "It is a lot," she said.

"That has spurred this interest in using cannabis as a substitute for prescription drugs. Not only because they are on so many drugs, but because they can use cannabis as a substitute for more than one type of medication," she added. "For example, I've heard from patients who are on two separate prescription medications for both insomnia and pain that are able to just use cannabis and eliminate both of them."

RAND said more study would be needed to find out if pot could create health-care savings.

The data also buttresses the idea of a persistent gender gap in patients. Of those seeking recommendations, 73 percent were male. That's roughly equal to the black market — 70 percent male. The biggest reason for the gender gap is fear, Reiman theorizes. Women using pot while pregnant or taking care of a child can get in trouble over medical marijuana. "Many don't feel as safe as a male in going and being 'out' about cannabis use, given what might happen if child protective services found out," she said.

Also, dispensaries appear to be fast-replacing baby boomers' kids as a hook-up for pot. A third of MediCann patients were over 45. By comparison, the median age of black market pot buyers' is about 26, according to federal drug use statistics on adults.

Most of all, the report shows the need for more unbiased scientific data on who is getting cannabis recommendations in California, the researchers said. Otherwise important public policy and health-care choices will be made without the facts.

The National Institute on Drug Abuse recently issued its first-ever call for researchers to analyze the trends and impacts of "quasi-natural experiments" in medical marijuana.

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