The legalization of cannabis is associated with fewer filled prescriptions for opioid painkillers, according to the results of a recent study. The findings indicate that people may be substituting cannabis for prescription pain medicines in areas where legal cannabis is available to patients.
“These results suggest that substitution of cannabis for traditional pain medications increases as the availability of recreational cannabis increases,” the authors of the study wrote, according to a report from online cannabis news source Marijuana Moment. The researchers noted that there “appears to be a small shift once recreational cannabis becomes legal, but we see stronger results once users can purchase cannabis at recreational dispensaries.”
“Reductions in opioid prescription fills stemming from recreational cannabis legalization may prevent exposure to opioids in patients with pain,” their report continues, “and lead to decreases in the number of new opioid users, rates of opioid use disorder, and related harms.”
The study, which was funded in part by a grant from the National Institute on Drug Abuse, was conducted by researchers at the University of Chicago, the University of Georgia, and Indiana University Bloomington. A report on the research was published this month by the peer-reviewed journal Cannabis.
The team of researchers analyzed prescriptions filled for opioid painkillers and other pain medications, including non-steroidal anti-inflammatory drugs (NSAIDs), among commercially insured adults. The analysis revealed that prescriptions filled for opioids dropped following cannabis legalization in U.S. states. At the same time, prescriptions for non-opioid pain medications saw “marginally significant increases.”
Researchers Found Significant Decreases in Opioid Prescriptions
The researchers found statistically significant decreases (13% reduction from baseline) in the rate of opioid prescriptions following the opening of recreational cannabis dispensaries. The researchers also observed “marginally significant decreases in the average daily supply of opioids” (6.3% decrease) and the number of opioid prescriptions per patient (3.5% decrease).
The researchers, noting that NSAIDs are typically available as over-the-counter medications, said their “analyses using these medications are under-powered.”
“Our findings may therefore support the analgesic properties of cannabis because patients are prescribed fewer opioids without a statistically significant increase in non-opioid pain medication when cannabis is available,” they wrote.
The team of researchers noted that the reduction could be caused by a reduction in the number of opioid prescriptions being written by healthcare providers following the legalization of cannabis. Previous research has shown that adding cannabis to state prescription drug monitoring programs (PDMPs) affects providers’ prescribing practices for other controlled substances, including opioids.
“Whether driven by patients or healthcare providers, reductions in opioid fills stemming from [recreational cannabis legalization] implementation may prevent exposure to opioids in patients with pain,” the report says, “and lead to decreases in the number of new opioid users, rates of opioid use disorder, and related harms.”
The authors of the new study also pointed out that previous research “shows that, while some subset of the population uses cannabis when it becomes recreationally legal, many wait until dispensaries open. Still, many more wait until dispensaries have been open for several years.”
The researchers also noted that earlier similar studies have mostly focused on the legalization of medical cannabis.
“We expand on this literature by examining recreational cannabis legislation,” they wrote. “Furthermore, we include a novel examination of non-opioid pain medications.”
Findings Consistent with Previous Research
The study is consistent with other research that has suggested cannabis legalization may impact the use of opioids and the incidence of opioid-related overdose deaths. The authors of a study published late last year found a “consistent negative relationship” between cannabis legalization and fatal overdoses, with more significant effects in those states that legalized cannabis earlier in the opioid crisis. The researchers estimated that recreational cannabis legalization “is associated with a decrease of approximately 3.5 deaths per 100,000 individuals.”
“Our findings suggest that broadening recreational marijuana access could help address the opioid epidemic,” that report said. “Previous research largely indicates that marijuana (primarily for medical use) can reduce opioid prescriptions, and we find it may also successfully reduce overdose deaths.”
“Further, this effect increases with earlier implementation of [recreational cannabis legalization],” it added, “indicating this relationship is relatively consistent over time.”
This also aligns with a NuggMD survey of 603 neuropathy patients who reported comparable levels pain relief from cannabis as from opioids like oxycodone, hydrocodone, and codeine.
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