The Explosion of U.S. Cannabis Sales and its Effecton America’s Healthcare System

The Explosion of U.S. Cannabis Sales and its Effect on America’s Healthcare System

BY MICHAEL C. PATTERSON

The Marijuana Business Factbook, provided by Marijuana Business Daily, has recently projected that the U.S. Cannabis market (medical and adult use cannabis) will exceed $36 Billion in sales by 2024.

This overwhelming acceptance by the American public is changing the US healthcare system in unexpected ways. In 2019, the USA sold approximately $13.6 Billion in legal cannabis ($7.6 Billion- Adult Use, $6.0 Billion Medical Use). Cannabis sales continue to increase 30 percent per year on average across the country. With over 90 percent of Americans approving medical cannabis use and 67 percent approving adult use (recreational use), legal cannabis in our society is here to stay. In Florida, medical cannabis sales are projected to surpass over $1 Billion in 2020 with over 350,000 qualified medical cannabis patients as of July 2020, and patient counts steadily rising 3,000-5,000 per week.

With the continued increase in use and acceptance of cannabis, how is this currently affecting America’s healthcare system and what effect will cannabis have on the future of healthcare?

The sky is not falling

Prior to legalization, the prohibitionists attempted to squash legalization at every turn. Their most common tactic was turning to physicians and medical experts to publicly state that cannabis will be the downfall of our society. That people will become addicted at very high rates, crime will increase and overdose deaths from cannabis will become an epidemic.

In reality, the exact opposite is happening. No human has ever died from cannabis (in any form) in human history, which makes cannabis one of the safest medicines, if not the safest, on the planet. To put that figure of ZERO deaths in perspective, people die every year from water intoxication (drinking too much water). Furthermore, studies are beginning to demonstrate patients who use cannabis as a medicine decrease the use of two to three prescription drugs per month because they don’t need them anymore. Cannabis decreases inflammation at the cellular level across the body, which can decrease pain and keep the body closer to a homeostatic state.

Senior Citizens are the fastest growing demographic of cannabis users

On average, persons over 65 years old in the USA take 13 prescription medications per day. I have seen from first-hand experience that Seniors are tired of taking so many medications and dealing with a barrage of side effects from constipation, nausea, headache, fatigue, decrease in immune response, and more. As more Seniors are recommended medical cannabis, they see the benefits of its use and they tell their friends. As more Seniors continue to use cannabis as a medicine and have a positive experience, the acceptance of medicinal cannabis will continue to accelerate.

Furthermore, as adult use cannabis becomes legal in more states, more Seniors will be by-passing their physician and going directly to the cannabis dispensary in an attempt to self-medicate. Health care companies will need to acknowledge cannabis as a medicine and begin to look at recommending medicinal cannabis or eventually incorporating adult use cannabis into a treatment regimen (similar to using vitamins or nutritional supplements) in order to maintain or increase current patient services and revenue.

Big Pharma is on the sidelines, but ready to get into the game

Big Pharma companies are already involved in the global cannabis industry. Companies are performing research on cannabis (where legal) and studying current cannabis companies in the market. As the US moves toward legalization of cannabis, innovation will increase dramatically. You will see more interest and money flowing into the cannabis industry for R & D of the cannabis and hemp plant, the development and study of minor cannabinoids (CBG, CBN, THCA, THCV, etc.) for medicinal use, and the development of patented cannabis formulations which have proprietary blends of cannabinoids for a specific medical purpose. Also, there will be an increase in the use of non-euphoric cannabinoid formulations to be used as nutritional supplements (similar to fish oil, krill oil, resveratrol, and other natural supplements).

Insurance companies are already looking into how to reimburse cannabis as a medicine

Once cannabis goes legal at the federal level, federal insurance programs (Medicare, Medicaid) will begin paying for cannabis. This will lead to private insurance companies paying for medical cannabis as well (if it comes from a physician script). The FDA has already begun to study the Canadian market to see how Canada is covering medical cannabis prescriptions. In regard to insurance payment of cannabis medicine, it is different than any other medicine that has come before. There will have to be a lot of issues worked out to pay for cannabis via insurance due to the many forms of cannabis (flower, edibles, oil-based medicine, tinctures, spray, patch, etc.), implementing cannabis into the current CPT code payment system, and payment amounts per gram of product.

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CONTINUED ... Cannabis Sales and its Effect on America’s Healthcare System

Healthcare companies who begin to embrace all types of cannabis (medical and adult use) will be rewarded with more patients and more revenue

Cannabis is already becoming a value-add service to many physician group practices. Cannabis physician recommendations have the ability to offer a new private pay revenue stream for a physician practice that did not exist before. This new service has the potential to bring in new patients for cannabis related recommendations, but also offering traditional healthcare services (lab, x-ray, general medicine, consultation, etc.). Also, cannabis patients who have a very pleasant experience with their recommending physician, are more likely to recommend other patients to their physician. The physicians that I personally know who write medical cannabis recommendations tell me that over 75 percent of their new patient referrals come from existing patients.

Furthermore, in adult use cannabis states, 40 percent of people using adult use cannabis are using it for medical reasons (sleep and chronic pain are the most common reasons for use). Therefore, many of the patients who are coming into the health care facilities are already using cannabis as a medicine, and not telling their physician. Healthcare groups that open up a mutual dialogue of education and respect for the cannabis plant as a medicine, will be able to offer “wellness services” related to adult use cannabis as a form of a supplement for wellness.

As I have seen for years in the cannabis industry, one of the most difficult issues for users is figuring out proper dosage of cannabis for each individual patient. Since our bodies have an endocannabinoid system (ECS) each person processes cannabis at different rates. This does not allow for consistent dosing across an entire population. The ECS creates a tremendous opportunity for physicians to educate and offer paid services which will assist patients in determining their best cannabis dose and delivery method (flower, edible, oil, vapor, etc.) to provide the most relief with the least amount of side effects.

One of the most consistent things in life is change. Cannabis is leading the charge in the healthcare world as being one of the biggest changes to modern healthcare in a generation. The healthcare companies who embrace this change will ultimately be more successful than companies that refuse to acknowledge that cannabis used as a medicine has gone mainstream and is here to stay.

Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally. He can be reached at mpatterson@uscprd.com

CONTINUED ... Robotic Surgery in the Treatment of Colorectal Cancer

Robotic assisted surgery, especially in the pelvis, provides many advantages over laparoscopic techniques. It eliminates many of the technical difficulties inherent to laparoscopic surgery, as its multiple, flexible surgical arms are not limited by lack of articulation or narrow spaces, such as in the male pelvis. It allows for 3-dimentional views, which makes it much easier to identify structures like the inferior hypogastric plexus. Surgeons are also able to directly control the camera and are not dependent on an assistant to “hold the camera steady.” Another advantage of the robotic system is that it allows surgeons to have more ergonomic positioning while operating, which then causes less physical strain and fatigue. All of these factors represent technical improvements over the laparoscopic technique. Therefore, in my practice I favor the use of the robotic system anytime that it is feasible.

Minimally invasive surgery, broadly speaking, has shown advantages for patient’s outcomes, in both the long and short term. However, the lack of complete adoption of minimally invasive techniques in colorectal surgery and other fields may be due to the difficulties associated with laparoscopy. Although robotic surgery technology was initially developed for telepresence surgery, it has evolved as an answer to the technical difficulties that surgeons face with laparoscopic surgery. Robotic colorectal surgery has developed to offer multiple approaches that include hybrid and non-hybrid operations (using the robot exclusively or with hand and/or laparoscopic assistance). There are multiple docking strategies and designs to improve mobilization and dissection. This technique continues to evolve over time and provides safety and flexibility to surgeons as they tackle the treatment of colorectal cancer. These benefits are notable in low rectal cancers and, in particular, with male patients. As a Colorectal Surgeon, I look forward to the improvement and evolution of robotic surgery, including areas such as single port systems and endoscopic robotic surgery. The increased adoption of this technique promises to improve the outcomes for colorectal cancer patients and help stem the tide of colon and rectal cancers.

Elisa Maria Bianchi, MD, is a Board-Certified general surgeon at Digestive and Liver Center of Florida who completed a colorectal surgery fellowship at Zucker School of Medicine at Hofstra/Northwell Health in New York where her specialty training encompassed a variety of small bowel, colon, rectal and anal pathologies which included malignant, benign and inflammatory disease (Crohn’s disease and ulcerative colitis). She previously completed her residency in general surgery at Loma Linda University Health with particular emphasis in robotic techniques. Bianchi completed her medical training at the University Illinois at Chicago. Prior to that she completed an undergraduate degree in bioengineering at the University of Illinois and worked as an engineer at Abbott Laboratories. Dr. Bianchi is fluent in Spanish. www.dlcfl.com

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