Characteristics of OMMP Patients Served by Compassion Center

By Cheryl K. Smith
Compassion Center is a Eugene-based nonprofit medical marijuana clinic that has been
serving patients throughout the state of Oregon for more than 10 years. We hold two
clinics each week, where we provide physical exams by MDs and determine whether
patients have qualifying, debilitating conditions under the Oregon Medical Marijuana Act
(OMMA). We also provide educational services relating to the OMMA and help patients
navigate the less-than-perfect system. We provide clinic services nearly 1500 patients
each year, as well as answering questions from people throughout the US, and assisting
with paperwork for patients whose own doctors have signed for a medical marijuana
card.
We did an online anonymous survey of patients in May 2011, using e-mail addresses that
patients provided as part of our clinic registration information. We sent an initial e-mail,
and then two follow-up e-mails to patients who had not yet responded to the survey. We
received 141 complete survey responses—approximately 10% of our annual patients. All
of those who completed the survey either had or were in the process of obtaining an
Oregon medical marijuana card.
Limitations. Limitations of the survey included that only patients who had an e-mail that
they had disclosed at registration were able to participate. This may have skewed survey
results toward higher-income patients, who are more likely to be able to afford a
computer or have more than limited access to a computer. In addition, our patients who
are extremely ill may not have been able to complete the survey. Although the survey
was anonymous, the federal legal status of medical marijuana may have had an effect on
the veracity of responses; and we had to rely on self-reporting rather than objective
determinations.
Demographics. All of the respondents were Oregon residents, two-thirds were male and
more than 60% were age 50 or older, while none were under the age of 21 and only 5%
were between 22 and 29 years old. This is an indication that medical marijuana patients,
at least those who are served by Compassion Center, do not fit the common stereotype of
reasonably healthy young men who just want to get “high.”
A quarter of patients indicated that they were US military veterans. Considering that
veterans make up only 10% of the US population over the age of 21 (it is slightly higher
in Oregon), the number of veterans being served by the Compassion Center is
disproportionate to the population at large. This is not surprising, considering the physical
and mental health issues they face.
Approximately 1/3 of those responding had a card for less than a year, 2.9% had cards for
9-11 years, and the remaining 60% were fairly evenly distributed over more than one but
less than nine years. This is consistent with our patient pattern, which is about 2/3
renewals and 1/3 new patients.
We wanted to determine how many patients were eligible for the OMMP low-income
rate, so we asked whether patients were on SNAP (food stamps) or OHP (Oregon Health
Plan), making the assumption that individuals receiving the less than $700 in SSI benefits
would also be participating in these programs. We found that 29% of patients were
receiving SNAP benefits and 16% were on the Oregon Health Plan. This number was
lower than we had expected, and is also much lower than OMMP percentages.
(According to June data from OMMP, low-income cardholders account for about twothirds
of all cardholders.)
We also wanted to get an idea of what percentage of patients received any kind of
disability payment, because of our perception that a large number of those we serve are
quite ill or disabled. Of those responding to the survey, 37% receive disability payments
of some type. This number wasn’t surprising, because of the level of disability we see in
the clinic. (This information is not tracked by the OMMP.)
Qualifying Conditions. We knew from statewide statistics and our experience in dealing
with patients that severe pain is the most common qualifying, debilitating condition for
which patients use medical marijuana (often in addition to other conditions). Our survey
found that 91% of respondents reported severe pain as one of their qualifying conditions,
33% had muscle spasms, 11% had severe nausea, 7% had glaucoma and 6% had cancer.
None reported HIV/AIDS or cachexia, only 3% reported seizures and 1% reported
agitation due to Alzheimer’s.
Other Conditions. For a number of years, individuals and groups have petitioned and
requested that the OMMP add PTSD, anxiety and other mental health diagnoses to the
list of qualifying debilitating conditions. We know, for example, that often patients—
many of whom are veterans—use medical marijuana for relief of symptoms and
conditions that are not covered by the Oregon statute, as well as those allowed under the
law. We asked our qualified patients whether they used medical cannabis for other
conditions that were not covered, and found the following results: 27% medicate for
insomnia, 15% for PTSD, 31% for depression, 38% for anxiety and 21% for other
conditions. (Note that patients may be medicating for more than one of these conditions.)
Only 36% of patients reported that they do not use medical marijuana for any nonqualifying
conditions.
Other Treatments Used. Some individuals who believe that medical marijuana is
harmful and has no medical use suggest that patients should try other modalities to
control their conditions. (There is no dispute that other methods can also help, which is
why Compassion Center developed the brochure “Alternative Pain Control Methods” for
our patients with pain.) Because nearly all patients tell us that they have tried other
methods, we wanted to get an idea about what specific methods they had used to treat
their conditions. We found that the majority of patients had tried one or more of these
methods. Responses were as follows:
Prescription Drugs 89%
Massage 56%
Chiropractic 46%
Meditation/deep breathing 46%
Dietary supplements 41%
Acupuncture 38%
Surgery 33%
Naturopathic medicine 26%
Other 17%
Harm Reduction. According to the Harm Reduction Coalition, “Harm reduction is a set
of practical strategies that reduce negative consequences of drug use, incorporating a
spectrum of strategies from safer use to managed use to abstinence.” Prior studies have
shown the positive effects of medical cannabis as a harm reduction method, in that many
patients use it to decrease or quit other substances. Compassion Center’s survey echoed
these findings. (We knew this was occurring because many patients who come into the
clinic state that they want to avoid taking opiates, or get off of opiates or other
medications because of adverse side effects.) Only 23% of patients indicated that they
had not used cannabis to help them decrease or quit other substances.
Of those who did use medical marijuana to decrease or eliminate their use of other
substances, 66% substituted it for pain medications,18% for alcohol, 15% for tobacco,
2% for anti-seizure medication, less than 0.5% for methamphetamine or heroin, and 5%
for other substances. These are impressive numbers that may make drug manufacturers
shudder, but eliminating various pharmaceuticals has the potential to help patients with
both their finances and their health. In addition, substituting cannabis for alcohol,
tobacco, or illegal drugs can only have a positive effect.
Obtaining Medical Marijuana. Because the OMMP only allows patients to grow their
own marijuana or have another person grow it for them, many complain that patients are
unable to obtain their medicine. We provide a monthly class to educate patients on the
law around this and to introduce growers and patients to each other, so we knew some
patients had a problem growing or finding a grower.
In response to the question, “How do you most often obtain your medical marijuana?”,
37% indicated that they grow their own and 44% that they obtained it from a grower—
which is a total of 81% of our patients for whom the current system is working. Less than
1% reported that they purchased it from a dispensary, 4% bought it on the black market,
6% received it from other patients, 2% belonged to a cooperative, and only 6% reported
that they were unable to obtain medical marijuana.
On the survey question that asked patients how difficult they found it to obtain medical
marijuana, more than half reported that it is somewhat or very easy, while only about
22% found it somewhat difficult and 7% found it very difficult. This 7% is consistent
with the 6% who reported that they are not able to obtain medical marijuana. This
number is smaller than estimates that were bandied about to show the need for
dispensaries, but they do show that for a percentage of medical marijuana patients the
current system is not working.
One other way that the OMMP allows patients to obtain medical marijuana is from
another patient who is either growing it or has a grower and is able to obtain more than
they need. In response to our question “Do you help any other patients by giving them
excess medical marijuana?”, about 47% said yes, while about 53% said no. We didn’t ask
about why or why not, but clearly this aspect of the OMMP is working for some patients.
(It would be interesting to whether this changed after threats from the federal government
led some medical marijuana-related organizations to eliminate programs that coordinated
the exchange of medicine between patients.)
Method of Use. There is a belief, perpetrated by the media and those opposed to medical
marijuana, as well as its historical use, that medical cannabis is only used by smoking.
Many people—even physicians—who are not involved in the field are not even aware
that medical cannabis can be administered other than by smoking. Compassion Center
advises patients not to smoke cannabis if at all possible. This is especially true for those
with chronic lung or immune system diseases. In order to determine whether this advice
is working, we asked our patients “What method do you use or plan to use for taking your
medical marijuana?” The results show that most patients use multiple methods, and that
vaporizing and edibles are just as common as smoking. The survey showed the following
percentages for each method:
Smoking 69.5%
Vaporizing 69.5%
Edibles 69.5%
Tincture 29%
Hash, honey or Rick Simpson oil 23%
Ointment or lotion 18%
Recreational Use. One of the claims made by law enforcement in Oregon is that the
OMMP is just a cover for recreational use of marijuana. We are aware that this may be
true in some cases, but our experience didn’t lead us to believe that it was more than a
minor problem. Many patients who come to Compassion Center tell us that they haven’t
used marijuana at all, or since they were younger when they experimented. We also get a
lot of requests from patients who want the relief that they believe they will get for their
symptoms, but do not want to get “high.” So our survey asked about recreational use of
marijuana. Backing up these anecdotal reports, we found that nearly 85% of respondents
reported that they do not use marijuana recreationally—a direct contradiction to law
enforcement allegations. Another important point is that even if 15% of patients use
cannabis recreationally, that alone does not invalidate their medical use.
Conclusion. This survey was a preliminary effort to ascertain who our patients are and
how they use medical marijuana. The results reinforce much of what we already knew
based on individual patient reporting and adds new information to our knowledge base.
They also show that the claims and biases of law enforcement and others about who
medical marijuana patients are and why they use this medicine are not really accurate. It
also gives us a great starting point for learning more about where the Oregon Medical
Marijuana Program and our services are working and failing, and how we can better
serve our patients.
Cheryl K. Smith is Executive Director of Compassion Center and is Secretary of the
board of the Institute for Cannabis Therapeutics. She is an attorney with a BS in Health
Information Management.