A newly published study on cannabis as a treatment for post-traumatic stress disorder (PTSD) finds that medical marijuana—especially non-flower formulations—”represent a cost-effective adjunctive therapy for moderate PTSD under various reimbursement scenarios.”
The findings indicate that given certain assumptions about the efficacy and cost of medical cannabis for PTSD, it would be worthwhile for health insurance providers and other healthcare payors to include coverage of marijuana alongside other standard forms of treatment.
“This article suggests that, for the vast majority of types of products, there is pretty solid evidence that medical cannabis is cost-effective,” lead author Mitchell Doucette told Marijuana Moment, “meaning that…adding these items to [patients’] drug formulary would be advantageous for not only the patient—because of the lowering of the cost—but also advantageous for health insurance.”
The study, published in the journal Clinical Drug Investigation, says that products such as edibles, oral solutions and tablets “consistently demonstrated cost-effectiveness” under a standard model of insurers’ willingness to pay.
The five-person research team from Leafwell, a company that helps patients obtain medical cannabis cards, drew on efficacy findings from a 2022 study on the efficacy of marijuana for PTSD as well as prices from Curaleaf, one of the largest multi-state cannabis operators in the country.
“Our findings suggest that medical cannabis may be a cost-effective adjunct to standard care for patients with moderate PTSD,” authors wrote, “particularly when payor reimbursement partially or fully offsets treatment costs.”
As nearly all patients in the U.S. have discovered, health plans don’t always cover full medical costs. Medical marijuana patients currently pay for cannabis themselves, without reimbursement or cost-sharing from medical plans. The study says that given the apparent utility of the substance as a PTSD treatment, medical marijuana is a worthwhile investment for health insurers even if they cover costs in full.
Notably, that finding applies only to non-flower medical cannabis formulations. Because cured flower was more expensive than edibles, tinctures or tablets, the analysis only found it to be a cost-effective treatment when payors covered it at lower amounts—50 percent to 75 percent, depending on the type of flower.
While additional study is still needed on the efficacy of medical marijuana for PTSD—as well as on details such as dosing, product formulations and potential adverse events—authors wrote that their work “highlights the importance of continued research and informed policy decisions to optimize the therapeutic value of medical cannabis in the treatment of PTSD.”
As a Leafwell blog post explains the study’s results, “Overall, these findings suggest that traditional PTSD treatment plus medical cannabis was less costly than traditional treatment alone.”
“While health insurance providers don’t currently cover medical cannabis,” it adds, “they may want to consider it.”
Doucette, who has a doctorate in health and public policy from Johns Hopkins and is now senior research director at Leafwell, explained that there are certain limitations to the findings—for example the still relatively low-resolution research available into marijuana as a treatment for PTSD. Because the team didn’t have reliable data on how effective different formulations of cannabis were as a treatment for PTSD and its symptoms, the study assumes various forms are equally effective.
“This was the lone study that looked at something called ‘utility’”—a measure of benefit per unit of cost, he said of the 2022 research that served as the basis for the team’s assumptions about effectiveness. “That’s really the only one that, specifically for PTSD, measured the utility of treatments when they started and then a six-month follow-up.”
Authors said that to their knowledge, only three studies have estimated the cost-effectiveness of cannabis-based medical products, and all of them had to do with chronic pain. As more information becomes available on product formulation and dosing, researchers should be able to better determine what types of cannabis a cost-conscious healthcare company might want to cover—and to what degree.
One limitation, authors acknowledged, was that “our analysis assumes uniform efficacy across different cannabis formulations; in real-world settings, treatment outcomes and tolerability may vary significantly by product composition, cannabinoid profile, or route of administration.”
For now, the new study says of non-flower products, findings suggest policymakers may want to “prioritize reimbursement policies that that support these cost-effective options while recognizing the limited cost effectiveness of dried flower under certain conditions.”
“This study finds the dried flower is likely less cost effective compared to other medical cannabis products,” it says. “While medical patients may have preferences towards using dried flower, from a payor perspective, it may not make sense to reimburse for all types of medical cannabis products. Evidence here, combined with existing body of literature examining the impact of smoke inhalation on lungs, suggests payors may reduce some of the negative harms and promote some of the positive benefits from medical cannabis through strategic reimbursement strategies that are cost effective, largely safe, and likely efficacious.”
In order to keep its cost-effectiveness analysis on the conservative side, the team assumed cannabis would not take the place of other PTSD medications or therapies. If it did, that could make medical marijuana even more cost-effective on paper.
“The possibility that medical cannabis could substitute for other PTSD medications, such as opioids and benzodiazepines, also warrants deeper investigation,” the study says, “as it may yield further health and economic benefits.”
“There is real potential for medication substitution to occur for PTSD patients after starting medical cannabis,” it continues. “Prior literature suggests that starting medical cannabis, and even the presence of medical cannabis laws, decreases the prescribing of prescription opioids.”
More broadly, Doucette said the question of whether and how health plans should cover medical marijuana is about ensuring that patients have access to the best medicine for the job.
“There’s been a large influx of research—some high-quality and some not—that have kind of all pointed in the same causal direction: that medical cannabis has shown to be beneficial for specific conditions or…specific symptoms, for example pain or potentially insomnia,” Doucette said. “The underpinning of this article is, well, if that’s true—which, again, a large body of research is showing that it is—the next question is, ‘How do we make this accessible and affordable to ensure that people have equitable access to this type of resource?’”
Beyond its latest report, Leafwell is a regular backer of research into medical marijuana, with a number of studies published in recent months.
A study by the company last fall, for example, concluded that state-level medical marijuana legalization appeared to significantly reduce health insurance costs. In states with legal medical cannabis, companies paid 3.4 percent less for health insurance premiums compared to where marijuana remained illegal—a savings of about $238 per employee per year.
If all states were to implement medical cannabis programs, that study said, the country could save an estimated $29 billion in health insurance costs annually.
In December, meanwhile, Leafwell authors had a scientific review in the journal Medical Cannabis and Cannabinoids indicating that high-CBD, low-THC cannabis products have the potential to “significantly improve the quality of life” for children with autism and epilepsy. It said the cannabis products also showed “promising results in reducing key symptoms” of other conditions experienced by young people, including cancer—all with mostly “mild, manageable side effects.”
Other research, from authors at DePaul University in Chicago, used Leafwell data to examine what conditions qualify minors for state-legal medical cannabis programs, concluding that younger people enroll in the programs for many of the same reasons that older adults do, including anxiety, PTSD and chronic pain. Other common conditions included insomnia and depression.
Among minor patients—those under 18—cancer and epilepsy were more common reasons for obtaining a medical marijuana recommendation than they were among young adults, ages 18 to 20. Patients in the older age group, meanwhile, were comparatively more likely to cite depression, chronic pain or insomnia as their primary qualifying condition.
Meanwhile, researchers and policymakers continue to look into the use of cannabis and other psychoactive substances as potential treatments for PTSD and related conditions.
Late last year, the Food and Drug Administration (FDA) approved a landmark clinical trial meant to evaluate the efficacy of smoked medical marijuana to treat PTSD in military veterans.
Organizers at the Multidisciplinary Association for Psychedelic Studies, or MAPS, described Phase 2 of that research as “a randomized, placebo-controlled study of 320 Veterans suffering from moderate to severe PTSD who have previously used cannabis.”
MAPS’s past research has included not just cannabis but also, as the group’s name suggests, psychedelics. It created a spinoff drug development company, Lykos Therapeutics (formerly MAPS Public Benefit Corporation), that sought FDA approval last year of MDMA to treat PTSD.
Last August, FDA declined to approve the MDMA-assisted therapy. Separate research, published in the Journal of Psychedelic Studies, found that while results of clinical trials have been “encouraging,” more robust research is needed before MDMA-assisted therapy sees widespread adoption over currently available forms of treatment
Some health officials said afterward that the effort nevertheless reflected progress at the federal level.
Representatives of a number of federal agencies also convened last year to discuss other alternative treatments for PTSD, including psychedelics, MDMA, ketamine and other drugs. While the officials acknowledged the substances’ potential to help treat PTSD and underlying symptoms, they also emphasized the need for further research to ensure efficacy and patient safety.
Veteran advocates in support of expanding access to psychedelic-assisted therapy released an informational guidebook in October that backers said “responds to the demand for alternative treatment solutions and equips veterans with practical, clinically-backed strategies to safely explore these therapies.”
The group Heroics Heart Project, which helps connect veterans with psychedelic-assisted therapy in jurisdictions where it’s permitted, partnered with author Matt Zemon on the project, titled “The Veteran’s Guide to Psychedelics: A Preparation and Integration Workbook.” It touches on substances including ayahuasca, ibogaine, ketamine, MDMA, psilocybin and 5-MeO-DMT.
In an interview with Marijuana Moment last year, meanwhile, Sen. John Hickenlooper (D-CO) touted the therapeutic potential of psychedelics, saying that there are “really compelling success stories” in the treatment of PTSD with entheogenic substances such as psilocybin.
“The country’s got to move forward,” Hickenlooper said. “It’s funny. We make progress in fits and starts. Not every place is moving forward at the same time. But our attitude toward marijuana and hallucinogens, it’s gotta continue to evolve. It can’t get stuck.”
A newly published study on cannabis as a treatment for post-traumatic stress disorder (PTSD) finds that medical marijuana—especially non-flower formulations—”represent a cost-effective adjunctive therapy for moderate PTSD under various reimbursement scenarios.” The findings indicate that given certain assumptions about the efficacy and cost of medical cannabis for PTSD, it would be worthwhile for health insurance Read More
