The opioid crisis has profoundly impacted communities across the United States, prompting a $50 billion opioid resolution framework approved by a consortium of Attorneys General and the US Department of Justice.¹ This landmark deal holds drug and health insurance companies accountable for their involvement in the opioid epidemic.

However, the picture could also have wider implications, potentially shaping the distribution of cannabis in large pharmacies and its integration into mainstream health plans. This article explores the potential impact of the opioid regulatory framework on the future of cannabis distribution and its role in healthcare.

Correlation between cannabis and opioid seizures

New and existing research has suggested a potential correlation between the availability of medical cannabis and a reduction in opioid-related deaths and overdoses.² As the opioid crisis continues, some states have legalized medical cannabis as an alternative option for pain relief and as a possible means of addressing opioid abuse. The Opioid Resolution Framework acknowledges this connection, providing an opportunity to consider cannabis as a potential pain management tool in mainstream health care.

Regulatory changes and legalization

The opioid resolution framework is still under evaluation and is broken down into 3 categories: (1) substantial multi-billion dollar settlements, (2) rehabilitation coverage, and (3) developing alternative diversion plans. This paves the way for further regulatory changes regarding cannabis.

As public opinion and popularity shifts towards legalizing cannabis, 68% of US adults are in favor of legalizing marijuana.³ This agreement could encourage more states to legalize medical and/or recreational cannabis. Establishing a legal precedent may facilitate legislative support for cannabis as a safer alternative to opioids for pain management.

For example, the Compassionate Care Act and similar laws in various states allow for the legal use of cannabis for medical purposes. These laws aim to offer legal protections and accessibility to cannabis for people suffering from specific medical conditions that its therapeutic qualities can alleviate. Importantly, these legal measures generally ensure that employees who are part of state-sanctioned cannabis programs are protected from being fired for their participation, and this aspect of the legislation is unlikely to change.

Cannabis in Big Box Pharmacies

The financial repercussions of the opioid deal framework are prompting pharmaceutical companies to explore diversifying their product lines, focusing on entering the medical cannabis market and potentially emerging as prominent suppliers. This transition is underway, especially evident in major pharmacy chains, which have reported nearly $1 billion in retail sales of CBD products.

When federal legalization eventually comes, these companies may consider adding medical cannabis items to their inventories to generate new revenue streams.⁴ This change could have a substantial impact on the distribution of cannabis, potentially improving its accessibility to the general public. However, consumers may face a significant challenge in the form of high tax rates, reaching as high as 37% in some states, placing a financial burden on cannabis users.

Traditional health plans to the rescue

The opioid regulatory framework has sparked debate about including cannabis in conventional health plans. With growing evidence supporting the therapeutic benefits of medical cannabis, health insurance companies are starting to incorporate coverage for cannabis-based treatments targeting specific conditions for which efficacy is well established. This supplementation has the potential to reduce patient expenses, making medical cannabis a recognized and viable option for medical care.

Research and development

Allocating funds in the opioid accord to fight addiction and support treatment centers can indirectly benefit cannabis research.5 With more financial resources available, scientists and researchers can conduct more comprehensive studies of medical applications, safety and on the efficacy of cannabis. This research could form a stronger basis for integrating cannabis into mainstream health plans to reduce the consumer’s out-of-pocket expenses.

Public perception and education

A major challenge in integrating cannabis into mainstream healthcare is overcoming public skepticism and misinformation. In light of the opioid regulatory framework, pharmaceutical companies could launch public education campaigns to educate the population about the medical benefits and risks of cannabis. Such proactive efforts could foster a more informed and welcoming environment for the inclusion of cannabis in mainstream health plans and large pharmaceutical companies.

Conclusion

The $50 billion opioid resolution framework marks a substantial step in addressing the opioid crisis in the United States. Beyond its immediate implications, this deal has the potential to affect how cannabis is distributed within pharmaceutical chains and how it finds its place in conventional health care plans.⁶

As awareness of the therapeutic value of medical cannabis grows among the public and policy makers, it becomes imperative to base decisions on robust evidence to ensure its safe and efficient integration into mainstream health care.

About the author

Frank Labrozzi, CEO of Novus Cannabis MedPlan, supplemental health insurance company.

References

1. US Department of Justice: Comprehensive resolution of criminal and civil investigations with opioid manufacturers. United States Department of Justice. Press release. October 21, 2020. https://www.justice.gov/opa/pr/justice-department-announces-global-resolution-criminal-and-civil-investigations-opioid

2. Balu A, Mishra D, Marcu J, Balu G. Medical cannabis certification is associated with decreased opioid use in chronic pain patients: a retrospective cohort study in Delaware. I care. 7 December 2021;13(12):e20240. doi: 10.7759/cureus.20240. PMID: 35004055; PMC ID: PMC8730800.

3. Jones J.’s views on marijuana related to ideology, religiosity, age. Gallup. November 15, 2022. https://news.gallup.com/poll/405086/marijuana-views-linked-ideology-religiosity-age.aspx#:~:text=Using%20this%20aggregate%2C%20Gallup%20finds, Gli Americans%20are%20i%20most%20 favorable.

4. Wiley JL, Gourdet CK, Thomas BF. Cannabidiol: science, marketing and legal perspectives [Internet]. Research Triangle Park (NC): RTI Press; 2020 April. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565434/doi:10.3768/rtipress.2020.op.0065.2004.

5. Dentons: Cannabis Customer Alert Week July 7, 2023: Federal government considers further cannabis reforms for veterans. Press release. big teeth. July 7, 2023. https://www.dentons.com/en/insights/newsletters/2023/july/7/us-cannabis-newsletter/cannabis-client-alert-week-of-july-7th-2023

6. Shulman H, Sewpersaud V, Thirlwell C. Evolving global perspectives of pharmacists: medical cannabis distribution. Cannabis Cannabinoids Res. 2022 Apr;7(2):126-134. doi: 10.1089/can.2020.0144. Epub 2021 April 16th. PMID: 33998897; PMC ID: PMC9070745.

The opioid overdose antidote Narcan will be available over the counter in the coming days, a move that is hoped to increase access to the life-saving drug in the context of the country’s worsening opioid epidemic.

Emergent BioSolutions, which makes the drug, said Wednesday that shipments were on the way to major retailers, including Walgreens, Walmart, Rite Aid and CVS. It may also be available to purchase online from select companies this week.

Dr. Scott Hadland, an addiction specialist at Mass General for Children in Boston, said the shift to over-the-counter drugs will help spread Narcan, make it more normal for people and their families to carry around and have a home for safety, which is critical to reducing the growing number of overdose deaths occurring nationwide.

The drug’s cost, however, $44.99 for a two-dose box, may make it out of reach for some.

Unfortunately, for many people who are living with addiction or want to protect a loved one living with addiction, this cost will be too high, Hadland said. I know, because I see it in my own practice, where drugs that cost this much are just out of reach.

Overdoses are the leading cause of accidental death in the United States and the fourth leading cause of death overall in the country. In 2021, according to the Centers for Disease Control and Prevention, there were more than 107,000 overdose deaths, an all-time high. Fentanyl, a potent synthetic opioid, was involved in more than 71,000 of these deaths.

Narcan can quickly reverse overdoses of fentanyl and other opioids, including heroin and prescription pain relievers.

It was previously prescription-only, although many states created workarounds that allowed people to get it directly from pharmacists. In many places, it is also available free of charge at community centers, local health departments, and needle exchange programs.

The Food and Drug Administration’s approval of Narcan for over-the-counter use this year means it can be sold in even more places, including convenience stores, airports, and even vending machines.

Emergent will ship several hundred thousand boxes of Narcan to major retail chains in the first week, followed by more boxes to smaller chains in September, said Paul Williams, senior vice president. Any company wishing to supply the drug can purchase it directly through a wholesaler.

In addition to being available on store shelves, the product will be available for online ordering, which is important for those who don’t want to interact with other people to get the drug.

The time is right, Williams said of the shift to over-the-counter use, particularly in the past two years with the number of opioid-related deaths rising significantly.

Tricia Moriarty, a spokeswoman, said Walmart will have over-the-counter Narcan in some of its stores and online as early as this weekend.

Walgreens will begin selling the over-the-counter version in some of its retail stores on Sept. 5, followed by the entire fleet on Sept. 7, said Dr. Kevin Ban, its chief medical officer.

However, Narcan will not be sold directly on Walgreens shelves. Instead, people who want to buy it will need to get a card from the pain management section and give it to an employee, who will then supply the drug, Ban said. Walgreens has taken a similar approach with other products, including Sudafed.

Heather Saunders, postdoctoral researcher in the Medicaid and the Uninsured program at KFF, a nonpartisan group that studies health policy issues, said offering Narcan over-the-counter has the potential to reduce stigma around opioid use. , but that its price raises concerns.

Insurance, he said, typically doesn’t cover the cost of over-the-counter products.

At around $45, its cost may be too high for many, including friends and family who wish to carry Narcan with them as a precaution.

Williams, of Emergent, said many people will still be able to get rid of Narcan from community organizations and local health departments.

The opportunity to have Narcan available in the form of what retailers can supply, online and expanding, is critically important, he said.

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