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Two New Studies Find Cannabis Reduces Opioid Prescriptions

April 2, 2018
More studies, more findings that cannabis reduces opioid use. (FatCamera/iStock)
Can legalizing cannabis fight the problem of opioid addiction and fatal overdoses? Two new studies in the debate suggest it may.

Medical marijuana legalization led to a 6% drop in opioid prescriptions to Medicaid patients. Adult-use legalization led to an additional 6% decrease.

Cannabis can relieve chronic pain in adults, so advocates for liberalizing marijuana laws have proposed it as a lower-risk alternative to opioids. But some research suggests cannabis may encourage opioid use, and so might make the epidemic worse.

The new studies don’t directly assess the effect of legalizing marijuana on opioid addiction and overdose deaths. Instead, they find evidence that legalization may reduce the prescribing of opioids. Over-prescribing is considered a key factor in the opioid epidemic.

Both studies were released Monday by the journal JAMA Internal Medicine.

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Medicaid Patients: 6% Fewer Opioids

One looked at trends in opioid prescribing under Medicaid, which covers low-income adults, between 2011 and 2016. It compared the states where cannabis laws took effect versus states without such laws. The comparison was done each quarter, so a given state without a law at one point could join the other category once a law kicked in.

Results showed that laws that let people use cannabis to treat specific medical conditions were associated with about a 6 percent lower rate of opioid prescribing for pain. That’s about 39 fewer prescriptions per 1,000 people using Medicaid.

And when states with such a law went on to also legalize cannabis use by all adults, there was an additional drop averaging about 6 percent. That suggests the medical marijuana laws didn’t reach some people who could benefit from using cannabis instead of opioids, said Hefei Wen of the University of Kentucky in Lexington, one of the study authors.

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Medicare: 14% Fewer Daily Opioid Doses

The other study looked at opioid prescribing nationwide for people using Medicare, which covers people 65 years or older and those with disabilities. Every year from 2010 through 2015, researchers compared states with a medical marijuana law in effect to those without one. Fourteen states plus the District of Columbia had such a law from the beginning of that time; nine other states joined them during the years the study covered.

Researchers found that Medicare patients in states with medical cannabis dispensaries filled prescriptions for about 14 percent fewer daily doses of opioids than those in other states. Patients in states that only allowed them to grow pot at home showed about 7 percent fewer doses.

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‘Hard To Ignore’ Evidence

W. David Bradford, an economist at the University of Georgia in Athens who’s an author of the second study, said the results add to other findings that suggest to experts that cannabis is a viable alternative to opioids. The weight of that evidence is “now hard to ignore,” said Bradford, who said he thinks federal regulations should be changed to allow doctors to prescribe marijuana for pain treatment.

The two studies have some limitations, Dr. Kevin Hill of Harvard Medical School and Dr. Andrew Saxon of the University of Washington in Seattle wrote in an accompanying editorial.

For one thing, they don’t reveal whether individual patients actually reduced or avoided using opioids because of the increased access to cannabis. The findings in Medicaid and Medicare patients may not apply to other people. And the results may have been skewed by some characteristics of the state populations studied, they wrote.

They called for states and the federal government to pay for more studies to clarify the effect of marijuana use on opioid use, saying such research is needed for science to guide policy-making.

Related

How Cannabis Enhances the Effects of Opioids

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  • BudtenderMark

    I recently had a customer in the shop who traveled to WA from Wisconsin. In our brief conversation she made a comment to me. She stated that she had known 32 individuals who died from an opiate overdose. she also stated she felt many of those people might still be living if cannabis laws in Wisconsin were like the laws in WA. BudtenderMark

    • 360dunk

      The Wisconsin lady probably saw firsthand how Brett Favre got addicted to Vicodin and almost threw away his career.

      Alcohol and opiate deaths – millions and counting.
      Marijuana deaths – zero and not bothering to count.

  • Rob Woodside

    And the Reefer Madness Choir sing, “No medical benefit…” Honestly how many papers showing medical benefit have to be published before Americans wake up?

  • Mike the bike

    Nice. JAMA is a left wing tool. This article must have been paid for by those proponents that want all opioids confiscated (except for themselves and the medical profession). Dig it. DEA rulings say anyone who has ever smoked ANYTHING is an addict and will never get painkillers (Federal Register ruling). Want surgery? No painkillers. Need a colonoscopy? no painkillers. etc. Advance directive? Why bother? end of life you get 2 ibuprofen and 2 Tylenol. Dont be brainwashed. TFY/QA.

    • Lee Butcher

      I’ve never known anyone who’s been refused painkillers for any of the things you’ve listed. As a retired Ironworker who has had 9 separate surgeries for work injuries, and who has smoked cannabis since I was 13 (now almost 60), I’ve never had a doctor refuse me because I smoke pot. I have been forced to take hydrocodone for 9 years since the last injury that knocked me out of the trade for good. (It’s the ONLY thing that has helped, until recently) I’ve related to my physician that I think it does help and shouldn’t be outlawed, and he agrees. I’ve told him consistently every 3 months when I am required to go in and get my script refilled that I hate taking painkillers and it’s side effects (opiates ruin a man’s ability to get it up, for as long as it’s doing it’s job. Your choice, killer headaches and backaches- or sex. ): I don’t know where you get your information, but you might want to do some more research, although the your first sentence about JAMA being a “left wing tool” (seriously??) kind of shows where you are at in this debate. BTW, since finding good, medical grade cannabis from Kali, I’ve dropped my use of opioid painkillers from (4) 10mg pills a day to (2). And now that I’ve found a place that sells Kratom, I expect to be completely off of them soon. I think this is a good article, and from personal experience, I say it’s provable.

  • EW_drew

    From the annals of Internal Medicine Aug, 2017. “Limited evidence suggests that cannabis may alleviate neuropathic pain in some patients, but insufficient evidence exists for other types of chronic pain. Among general populations, limited evidence suggests that cannabis is associated with an increased risk for adverse mental health effects.

    The problem Dr Gupta has, and the person who quoted the JAMA Article and conlcuded it was evidnece are not sceintists. Fact–crude cannabis contains CBD and over 100 other canabionoids and cheicals that might have medicinal value, but smoking weed and concluding that the THC is benefiting sick people is sophmorioc and biassed. CBD, is the principal endogenous ligand for CB2-R is 2-arachidonoylglycerol (2-AG). Current double blind, placebo controlled clinical trials have demonstrated efficacy and safety of CBD (NOT THC) for treating children with a debilitating and rare seizure disorder, called Dravet syndrome, which cause drug-resistant seizures that are nearly continuous in the most severe cases. Over the course of 14-week trial, children receiving CBD experienced a median number of 5.9 convulsive seizures per month (down from 12.4) compared with 14.1 convulsions per month (down from 14.9) for the placebo group.This is without any THC. A 2016 study, published the Journal of the American Medical Association (JAMA) conducted at the University of Colorado revealed that emergency room visits in Colorado for children 9 and younger who consumed a THC product rose sharply in 2014 and 2015 compared to years prior to legalization of recreational marijuana. Moreover, annual poison-control cases increased five-fold during the same time period. Edible THC products accounted for nearly half of all accidental toxicity cases for children seen in hospitals and now a recent death of a todler who atr one of daddy’s potent gummy bears. Intake evaluations revealed that the source of the THC in these poisonings was nearly always attributed to the child’s parent, who was too stoned to monitor their todler. Lastly, Males age 18 or 19, who use cannabis regularly are 40% more likely to die by age 60 than their peers with no history of cannabis use. Published in the (American Journal of Psychiatry, 2017), lLead author, Edison Manrique-Garcia, MD, PhD, commented. “This is the first study to show that mortality rate among heavy cannabis users in adolescence is significantly higher than that of individuals who never used cannabis,” Why doesn’t Dr Gupta know this. Maybe he does, and would rather assert anecdotes and his opinion, that high grade evidence..

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