A new study shows that legalizing medical marijuana is associated with a significant decrease in the prescribing of opioids.
Researchers at University of Georgia, University of Colorado and the University of Colorado examined prescription claims of 15-20 million insured Americans each year from 2007 to 2020. They compared opioid prescriptions between states with medical cannabis programs or without.
We find it [medical cannabis laws, or MCLs] This study was published in American Journal of Health Economics. In treated states, opioid prescribing rates fell on average by 16%, despite substantial differences between states. Individual state decreases reached 22%.
Researchers found that the margins for intensive care, including the prescriptions and daily supplies per patient, had also decreased significantly. The researchers found that the decreases in subpopulations was relatively consistent across gender, race, and age. However, cancer patients and non-cancer Blacks experienced larger reductions (over 20 %).”).
It was also found that the use of NSAIDs for pain has increased, which “suggests that MCLs have been associated with substitution of opioids towards safer alternatives.”
These findings suggest that MCLs can be an effective policy tool to reduce opioid consumption and promote safer pain management, according to the authors of the study.
We find that the average rate of opioid prescriptions has decreased by 15.8% since the legalization of cannabis. This is equivalent to 107.1 less patients per 10,000 patients enrolled in non-cancer care who fill opioid prescriptions each quarter. The average result is that all twelve MCL adopting States of our time frame experience decreases. However, this masks substantial heterogeneity between implementing state, with some showing negligible drops (e.g. Illinois, while other states have seen opioid prescription rates drop by over 20%. Minnesota, New York).”
Researchers write that this study offers one of first estimations of impact on medical marijuana legalization laws adopted on the basis of “patient characteristics”.
The paper states that “we document the decrease in the opioid use affected most subpopulations fairly evenly across race/ethnicity, sex and age.” The paper states that “we also document the greater decrease in cancer patients and black noncancer patients following MCL implementation, with drops exceeding 20%.”
Researchers said that their findings expand upon previous studies in “multiple important ways”
Our approximation is more accurate because we have documented variations across the states. Moreover, our study is the first one to show variation in patients’ characteristics. Our results, compared to previous estimates, are similar, if not slightly greater, as we see a decrease in opioid prescriptions by 15.8% after MCL adoption. The previous studies did not use patient-level data, and were therefore unable to analyze changes in prescribing at the extensive and intensive margins or how availability of medical marijuana affects patients differently.
Although the study had some limitations, its authors stated that the legalization of medical marijuana could be a useful tool to enable patients and doctors to decrease the prescriptions for opioid analgesics.
Our results are also contributing to the wider discussion of the use of medical cannabis as an alternative medication to potentially dangerous or riskier medications, such as opioids prescribed by doctors. The study found that NSAIDs were used more after MCL adoption. It is likely to be a result of the addition of cannabis.
This study shows that MCLs are associated with significant decreases in the opioid prescription rate among commercially insured individuals. We found that, using a dataset of up to 20 millions commercially insured people per year between 2007 and 2020 as well as a synthetic control designed for each state, MCLs reduced the number of opioid prescriptions received by patients in treated states on average by 16%. The reductions in opioid prescriptions can also be seen at the margin of intensive care: Patients receive fewer and shorter prescriptions.
It continues: “Importantly these effects are found in almost all states. They are statistically significant and are resistant to different sensitivity tests, such as alternative definitions of policy timing or other inference strategies, like cross-validation or placebo.
The opioid reductions are widespread among all demographic groups, but they were most pronounced in cancer patients and Black non-cancer patients. Their reductions of the prescription rate for opioids exceeded 20%. There is also evidence that non-opioid alternative medications are being prescribed more often, especially among racial and ethnic minorities. The results show that MCLs can support better pain management and their effect varies by state and patient characteristics.
Australian researchers, however, published in August a study that showed marijuana could be used as an alternative to opioids for pain relief.
Another study published earlier this year in the journal Drug and Alcohol Review found that, among drug users who experience chronic pain, daily cannabis use was linked to a higher likelihood of quitting the use of opioids—especially among men.
Research published late last year also found that legalizing medical cannabis appeared to significantly reduce monetary payments from opioid manufacturers to doctors who specialize in pain, with authors finding “evidence that this decrease is due to medical marijuana becoming available as a substitute” for prescription painkillers.
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.
This report stated that “our findings suggest that broader access to recreational marijuana could help combat the opioid epidemic.” The report stated that “previous research shows marijuana can be used to reduce opioid prescriptions and may reduce overdose mortality.”
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. The study concluded that cannabis has an important role in the management of pain and reduction of opioid usage.
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. The majority of those in that group reported using cannabis to replace other pain medication, such as 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 opioid painkillers.
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.