more efficient delivery methods may require the company to determine their liability for abuse as well as their efficacy and physiological characteristics. Unimed estimates that each new formulation will cost between $7 million and $10 million to develop.

These additional research costs are likely to affect the price of new dronabinol formulations. In capsule form, dronabinol (Marinol) currently costs about $200 per month for its most common use—to combat AIDS wasting; the cost of treating chemotherapy-induced nausea is lower, since it is not a chronic condition. Several patients who spoke at the IOM's public workshops found Marinol's price to be prohibitive and said that one of the advantages of using marijuana for medical purposes was its relatively low cost. But this is a deceptive comparison, for the indirect costs of marijuana use—criminal penalties (see Chapter 11)—can be prohibitive. Moreover, marijuana users assume the risks of using a substance of uncertain quality and composition.

In fact, it is almost impossible to directly compare the costs of Marinol and medical marijuana use. The cost of Marinol varies, depending on the patient's situation. Public and private health insurance plans generally reimburse for all or part of the cost of Marinol but not, of course, for marijuana. Roxane Laboratories also sponsors an assistance program to provide Marinol for indigent patients. The price of marijuana is also quite variable; at California buyers' clubs, the IOM team learned, patients typically paid $2 to $16 per gram, depending on the grade of marijuana. (An average marijuana cigarette weighs approximately 1 gram.) Street prices are even less consistent, as is the quality of the product. The THC concentration of marijuana can easily vary from 2 to 15 percent. And while home cultivators can produce quality marijuana at low cost they also bear an increased risk of criminal penalty.

Based on the above considerations, Unimed has estimated that Marinol is in fact cheaper than marijuana for patients with health insurance or for those eligible for financial assistance from Roxane. For those who must assume the entire cost of Marinol out of pocket, it may still be cheaper than using whole marijuana if the patient smokes two or more average-sized joints per day. If medical marijuana were to become legally available, these comparisons would no longer hold. But for the moment Unimed be-



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