A new federally funded study shows that legalization of marijuana in U.S. states is associated with reduced prescriptions for opioid pain medications among commercially insured adults—indicating a possible substitution effect where patients are choosing to use cannabis instead of prescription drugs to treat pain.
The authors concluded that “these results indicate that the substitution of traditional pain medication with cannabis is increasing as recreational cannabis availability increases.” They noted that “there appears to be a slight shift when recreational cannabis is legalized, but that we see better results once cannabis can be purchased at recreational dispensaries.”
The report published in Cannabis states that “reductions in prescription fills caused by recreational marijuana legalization can prevent patients from being exposed to opioids for pain.” It also says, “and reduce the rate of opioid addiction and harms associated with it.”
A grant from the National Institute on Drug Abuse supported a new research that examined prescription records for opioids and non-steroidal analgesics. The analysis showed that the number of prescriptions for opioids decreased after legalization, while non-opioid medications were prescribed at “marginally higher levels.”
Our study is a further confirmation of the fact that cannabis can be used as a substitute for non-opioid and opioid pain medication.
We find statistically significant reductions in opioid prescriptions once recreational cannabis dispensaries are open (13 percent decrease from baseline). The p < .05),” the study says, “and marginally significant decreases in the average daily suThe pThe ply of opioids (6.3% decrease, p < .10) and number of opioid prescriptions per patient (3.5% decrease, p < .10).”
A five-person team of researchers at the University of Chicago and Indiana University Bloomington authored these findings.
The researchers noted that because NSAIDs tend to be available over-the counter, their “analyses involving these medications were under-powered.”
Our findings could support cannabis’ analgesic effects, as patients take fewer opioids and non-opioid medications without statistically increasing the number of them when it is available.
A second explanation is that healthcare providers may reduce their prescriptions of opioids in the wake of cannabis legalization. This was acknowledged by the team, which referred to data that shows that adding marijuana into state prescription drug monitor programs (PDMPs), impacts provider prescribing habits for controlled substances like opioids.
The reduction in opioid fillings is primarily driven by the healthcare provider or patient. [recreational cannabis legalization] Implementation could prevent opioid exposure for patients suffering from pain, the report says. “And lead to reductions in new opioid users and rates of addiction disorder.”
The article refers to a late-last-year study that examined the effects of including medical marijuana in PDMPs. It concluded that adding the tracking was mixed, reducing both the prescriptions of drugs that may cause cannabis complications and exposing a potential bias among medical marijuana patients.
Researchers from the study noted that “previous research shows that some people will use marijuana when it’s legal to do so, but many others will wait for dispensaries to open.” Even more are waiting until the dispensaries open.
The team pointed out that prior research was primarily focused on the legalization of medical marijuana. They wrote: “We extend this literature by looking at recreational cannabis legislation.” The authors also included a new examination of nonopioid medications.
The study contributes to the growing research that indicates cannabis reform can help patients reduce their use of painkillers and opioids.
Researchers recently found evidence that the legalization of medical cannabis as a replacement for painkillers has led to significant reductions in payments by opioid companies to physicians who are specialists in pain.
Another recent study also found a decrease in opioid fatal overdoses when marijuana for adults was legalized. That study found a “consistent negative relationship” between legalization and fatal overdoses, with more significant effects in states that legalized cannabis earlier in the opioid crisis. The authors estimated that legalizing recreational marijuana “is associated” with a reduction of approximately 3.5 fatalities per 100,000 people.
The report concluded that, “Our results suggest that expanding recreational marijuana use could be a way to combat the opioid crisis.” The report stated that “previous research shows marijuana can be used to reduce opioid prescriptions and may reduce overdoses.”
This effect is heightened with early implementation [recreational marijuana legalization]This relationship appears to be relatively stable over the years,” it said.
Another recently published report into prescription opioid use in Utah following the state’s legalization of medical marijuana found that the availability of legal cannabis both reduced opioid use by patients with chronic pain and helped drive down prescription overdose deaths statewide. It concluded that the results showed “cannabis plays a significant role in pain management, and reducing opioid use.”
Yet another study, published in 2023, linked medical marijuana use to lower pain levels and reduced dependence on opioids and other prescription medications. And another, published by the American Medical Association (AMA) last February, found that chronic pain patients who received medical marijuana for longer than a month saw significant reductions in prescribed opioids.
About one in three chronic pain patients reported using cannabis as a treatment option, according to a 2023 AMA-published report. A majority of this group claimed to have used cannabis in place of other pain medicines, including opioids.
Other research published that year found that letting people buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 percent to 8.1 percent fewer opioid prescriptions.
A 2022 research paper that analyzed Medicaid data on prescription drugs, meanwhile, found that legalizing marijuana for adult use was associated with “significant reductions” in the use of prescription drugs for the treatment of multiple conditions.
A 2023 report linked state-level medical marijuana legalization to reduced opioid payouts to doctors—another datapoint suggesting that patients use cannabis as an alternative to prescription drugs when given legal access.
Researchers in another study, published last year, looked at opioid prescription and mortality rates in Oregon, finding that nearby access to retail marijuana moderately reduced opioid prescriptions, though they observed no corresponding drop in opioid-related deaths.
Recent research has also shown that cannabis can be an alternative to opioids for pain relief.
A report published recently in the journal BMJ Open, for instance, compared medical marijuana and opioids for chronic non-cancer pain and found that cannabis “may be similarly effective and result in fewer discontinuations than opioids,” potentially offering comparable relief with a lower likelihood of adverse effects.
Separate research published found that more than half (57 percent) of patients with chronic musculoskeletal pain said cannabis was more effective than other analgesic medications, while 40 percent reported reducing their use of other painkillers since they began using marijuana.
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Side Pocket Images. Photo by Chris Wallis.