Download Underwriting Medicinal and Recreational Marijuana

Government Personnel Mutual
Life Insurance Company
Underwriting Recreational &
Medicinal Marijuana Users
Wally Taylor, FALU CLU ChFC FLMI
VP & Chief Underwriter
 Known
medical facts regarding
recreational and medicinal marijuana use.
 The
mortality risks of recreational and
medicinal marijuana use.
 Underwriting
implications of applicants’
with recreational or medicinal marijuana
use.
 An
argument for or against legalizing
marijuana use.
 Discussion
of the ethics of marijuana use.
 Discussion
of the legal implications of
marijuana use.
 Underwriting
heavy use.
implications of chronic or
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Began with college
research project.
Published as two-part
article in On The Risk.
AHOU “Point-CounterPoint.”
Advent of legal
medicinal use.
Continued research on
the topic.
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1936 propaganda film
financed by church group.
“Documents” inevitable
outcomes of marijuana
use:
• Hit and run accident
• Manslaughter
• Suicide
• Attempted rape
• Descent into madness
Recreational marijuana use defined
as:
“Use of marijuana up to 8 to 10 times
per month.”
Medicinal use defined as:
“Marijuana use in locales where its use
medically is legal and where the user
has known debilitating symptoms of
medical conditions. These may include
severe pain, cancer, anorexia weight
loss, and/or nausea, as well as glaucoma
and seizure disorder.”
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Marijuana most commonly used illegal drug in
the U.S. and most other countries as well.
• More than 70 million Americans have used it.
• Some 20 million within the past 12 months.
• 35% of Americans aged 26 and over have tried
it.
• 20% still smoke it, at least occasionally.
Experimental use common, but progression to
daily use rare.
• Less than 1% of Americans admit using it
daily.
 Chief
hallucinogenic agent
tetrahydrocannabinol (THC) delivered to
brain.
 Less than 1% of THC reaches the brain
where it binds to neuroreceptors.
 When the amount in the brain exceeds a
threshold dose, psychoactive effects
occur.
 Maximum effects reached within 15 to 30
minutes and last up to 2 to 4 hours.
 Popular
press touts “highly potent pot.”
 Since 1980 researchers at Univ. of Mississippi
found no consistent potency trend upward.
 More potent MJ not necessarily more
dangerous:
• No possibility of fatal overdose.
• Higher potency has not been shown to pose any
greater health hazard than lower potency.
 No
scientific support for MJ potency greater
now than in 1960’s and 1970’s.
 Ambiguities
around medical hazards of MJ
caused by:
• Most research done with animal subjects using
doses many times greater than those used by
humans over very short time frame.
• MJ typically used by healthy young people
underestimating potential health impact.
• MJ often combined with alcohol and tobacco
use.
• Entire field of MJ research HIGHLY emotional.
 India
Hemp Commission of 1893:
“…the moderate use of hemp drugs is practically
attended by no evil results at all.”
 U.S. Government
1925 study of solders in the
Panama Canal Zone found MJ effects:
“…greatly exaggerated.”
 1970’s
British Wootten Report:
“…long term consumption of cannabis in
moderate doses has no harmful effect.”
 1970
formation of the National
Commission on Marijuana and Drug
Abuse.
 To date it’s the largest, most complete
review of the effects of MJ.
 The Committee found no convincing
evidence that MJ caused crime, insanity,
sexual promiscuity, “amotivational
syndrome,” or was a stepping stone to
other drugs.
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1982 committees of the Institute of Medicine
and the World Health Organization (WHO)
published reviews on MJ.
Neither committee found any evidence of
biological harm, psychological impairment, or
social dysfunction among moderate users.
Found that long-term heavy users had
problems, but no study confirmed that MJ use
caused them.
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In 1950’s it was said to lead to heroin.
In 1960’s and ‘70’s it was said to lead to LSD.
In 1980’s it was said to lead to cocaine.
Very few MJ users progress to other drugs.
Those that do tend to be:
• Poor, live in areas where illicit drug use prevalent.
• Less likely to come from stable homes.
• Less likely to be successful at school or jobs.
• More likely to have psychological problems.
• Engage in deviant/criminal behavior PRIOR to using
legal or illegal drugs.
 1994
report the U.S. Dept. of Health and
Human Services followed high school
students into their 30’s and found that of
those who tried MJ:
• 75% had not used it in the past year.
• 85% had not used it in the past month.
 For
vast majority of MJ users, their usage
is confined to MJ and no other drug.
 “Gateway
theory” a description of
typical sequence of multiple drug
use. It doesn’t prove causality.
 There
are similar statistical
relationships among other kinds of
commonly and uncommonly
related activities.
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No evidence of brain damage demonstrated by
CAT scans (even smoking 9 joints/day).
Brain wave patterns as measured by EEG
cannot be distinguished.
In one animal study rhesus monkeys exposed to
equivalent of 4 or 5 joints/day for a year.
On autopsy there was no MJ related CNS
abnormalities at all.
 Traditional
research taken two
approaches:
• Examine subjects while they are “high”
• Examine sober subjects to look for long term
or permanent effects of MJ on cognition.
 Memory
impairments when “high”
• Only tests that consistently show adverse
effect are tests of short term memory with
learned info.
• No effects on tests of attention, perception,
information processing and problem solving.
 Findings
of past 30 years worth of
research…
• There are, at most, minor cognitive
differences between MJ users and nonusers.
• It doesn’t appear that long term MJ use
causes significant permanent damage to
cognitive ability.
• Even animal studies which have shown short
term memory impairments with high dose
THC have failed to provide evidence of
permanent damage.
 Most
studies show MJ use more likely to
follow rather than precede onset of psych
symptoms.
 MJ has been shown to exacerbate symptoms
in users with existing psych disorders.
 Personality traits in MJ users of nonconformity, thrill seeking and
unconventionality.
• These traits precede rather than follow MJ use.
 World
Health Organization Conference on
Marijuana:
“…there is no conclusive evidence that cannabis
predisposes man to immune dysfunction.”
 When
FDA approved oral THC for use
medicinally it found no evidence that it
caused immune impairment.
 In 1992 FDA approved THC for use as
appetite stimulant for AIDS patients.
 Results
of San Francisco Men’s Health
Study showed no negative association
between MJ use and development of
AIDS among HIV infected men.
 MJ
use associated with decreased rate
of progression to AIDS.
 Tobacco
smoke and MJ smoke similar,
except for active ingredients (nicotine and
THC).
 MJ users inhale more deeply depositing
more dangerous material in the lungs.
 Still, it’s the volume of inhaled toxic
material over time that matters—not the
amount inhaled per cigarette.
 Even heavy MJ users never reach smoke
consumption of heavy tobacco smokers.
 Recent
published study analyzed association
between MJ use and pulmonary function.
“Occasional and low cumulative marijuana use was
not associated with adverse effects on pulmonary
function.”
“Association Between Marijuana Exposure and Pulmonary Function
Over 20 Years”
JAMA, 2012
 Kaiser
Permanente Medical Center Study
• Daily MJ smokers who don’t also smoke tobacco
only slightly more likely than nonsmokers to
make outpatient visits for respiratory illness.
 36% of MJ users sought treatment for
respiratory diseases
 Rate for nonsmokers was 33%.
 Australian
researchers followed weekly MJ
users over 19 years.
• Cannabis users had lower rate of emphysema
and asthma than the general population.
 Over
time tobacco smokers have
increasing obstructions of lungs and
small airways…
 …MJ users do not.
 No study has shown association between
MJ smoking and development of COPD.
 Canadian Medical Association Journal,
April 14,2009.
• MJ smoking conferred no COPD risk.
 After
evaluating subjects who smoked
average of 3 to 4 joints/day for about 15
years, UCLA researchers concluded:
“…marijuana smokers probably will not
develop emphysema.”
L. Gagnon et al.
“Marijuana less Harmful to Lungs than Cigarettes.”
Med Post, Sept. 6, 1994.
 No
epidemiological or clinical data
showing higher rates of lung cancer in
people who smoke only MJ.
 Studies
indicate that THC is not
carcinogenic.
 It
is possible that people who smoke both
MJ and tobacco heavily have increased risk
of lung cancer.
 Kaiser
Permanente Medical Center study
of 64,855 patients aged 15 to 49 years.
 Most
comprehensive study of risk of lung
cancer in MJ users.
 When
compared with nonusers MJ users
not associated with increased risk of lung
cancer.
So why do we continue to
consider MJ only users on a
smoker/tobacco basis?
 Research
has demonstrated medicinal
uses of MJ in a number of areas:
• Shown to stimulate appetite and promote
weight gain.
• Useful in reducing nausea and vomiting.
• Aids in diminishing intra-ocular pressure due
to glaucoma.
• Reduces muscle spasticity from spinal cord
injuries and multiple sclerosis.
 Diminishes
tremors in multiple sclerosis
patients.
 Shown
to provide benefits to patients
suffering from migraine headaches,
depression, seizures, insomnia, and
chronic pain.
 Provides
relief from nausea and vomiting
due to AIDS or cancer chemotherapy.
State
Year Passed
Possession Limit
Alaska
1998
1 oz, 6 plants
Arizona
2010
2.5 oz, 0-12 plants
California
1996
8 oz, 6 plants
Colorado
2000
2 oz, 6 plants
DC
2010
2 oz
Delaware
2011
6 oz
Hawaii
2000
3 oz, 7 plants
Maine
1999
2.5 oz, 6 plants
State
Year Passed
Possession Limit
Michigan
2008
2.5 oz, 12 plants
Montana
2004
1 oz, 4 plants
Nevada
2004
1 oz, 7 plants
New Jersey
2010
2 oz
Oregon
1998
24 oz, 24 plants
Rhode Island
2006
2.5 oz, 12 plants
Vermont
2004
2 oz, 9 plants
Washington
1998
24 oz, 15 plants
The federal prohibition of medical
marijuana is “corrupting the intent of
state laws and depriving thousands of
glaucoma and cancer patients of the
medical care promised by their
legislatures.”
Newt Gingrich
“Legal Status of Marijuana”
JAMA, Vol. 247: 1563, 1982.
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Cannabis does not profoundly alter cardiovascular
and respiratory functions.
It appears that no dose is fatal to humans.
There have been no confirmed published cases
worldwide of human deaths from cannabis
poisoning.
In the Swedish Conscript Study subjects followed for
15 years.
• Relative risk for mortality statistically insignificant when
compared to nonuser control group.
 Kaiser
Permanente Hospital study of 65,171
HMO enrollees aged 15 to 49.
 Researchers
conducted mortality followups on all subjects.
 When
compared with nonusers current MJ
use was not associated with increased
mortality.
“…there is no risk of death from
smoking marijuana.”
J.P. Kassirer, MD
New England Journal of Medicine
 Based
on all the empirical data, MJ use
(even daily) does not result in
increased mortality provided that:
• No underlying psychiatric or personality
disorder.
• No poly-drug abuse—including alcohol.
• No significant history of risk taking
behaviors—such as driving criticisms or
hazardous avocations.
 Based
on all the empirical data, MJ use
(even daily) does not result in
increased mortality provided that:
• No occupational or financial criticism.
• No criminal record.
 Most
reinsurance manuals not as
liberal.
• Review shows most offer standard SMOKER
rates with use up to 8 to 10 times per month.
 Valid
prescription.
 Verification of legal use (state of
residency)
 Attending physician’s documentation
of reason for MJ script.
 Rate for underlying disorder.
 Treat as “chronic pain” treatment.
 Watch
for “Red Flags”
• Use without valid prescription.
• Associated psychiatric disorder.
• Associated with alcohol or substance misuse
or abuse.
• Remote history of alcohol or substance abuse
treatment.
• Prior drug convictions.
“Cannabis is not very physically toxic….It mainly effects
mood, consciousness, and memory and its effect is
dependent on the amount used….Neither fatal overdose
nor physical dependency can occur….Cannabis use
generates less aggression than drinking alcohol and it is
certainly not an automatic step on the road to the use of
hard drugs….Everything we now know leads to the
conclusion that the risks of cannabis use cannot in
themselves be described as ‘unacceptable.’”
Drug Policy in the Netherlands
Ministry of Health, Welfare and Sport
“…the smoking of cannabis,
even long term, is not harmful
to health.”
Lancet, Vol. 346: 1241