Opioid
Mortality Rates in States with Medical Cannabis Laws
Opioids are frequently used
in the United States to treat acute and chronic pain. In the 1990’s, pharmaceutical companies
assured the medical community that opioids were not commonly associated with
addiction. This led healthcare providers
to prescribe opioids as a common treatment for pain related issues. It soon became apparent that opioids were in
fact addictive to many, and by the mid 2010’s, the rate of people addicted to
opioids became a public health crisis.
The Health and Humans Services (HHS) department of the United States
Federal Government declared opioid addiction a public health emergency in 2017
(U.S. Department of Health and Human Services, 2018). In 2016, opioid overdoses were the cause of
more than 42,000 deaths in the United States.
Opioid overdoses increased by 30% in 45 states from 2016 to 2017. In the Midwestern states, that increase was
more than 70% (NIH, 2018). Both the HHS
and the National Institute of Health are looking for alternative methods to
treat acute and chronic pain. One of the
suggested alternatives is to consider safe and effective non-addictive drugs,
such as medical marijuana, to help manage pain.
Marijuana is labeled a
Schedule I drug by the United State’s Drug Enforcement Agency. Schedule I drugs are considered not to have
any medicinal purposes and are not legal to sell or carry across state lines
(DEA, 2018). In November of 1996,
California passed Proposition 215, which allowed for the harvest and
utilization of marijuana for medical purposes.
This opened the door for other states to do the same. By 2013, 19 other states and the District of
Columbia had passed similar legislation.
The Supreme Court and the federal government fought these laws until
2013 when the Justice Department announced it would no longer attempt to block
any states from implementation of medical marijuana laws. Currently, 30 states and the District of
Columbia allow marijuana to be used for medical purposes (New York Times,
2013). It is still illegal to carry
cannabis across state lines or sell it for recreational uses in most states,
however it is commonly used for various medical purposes.
One of the first studies to
look at medical cannabis laws and opioid overdose mortality rates was completed
in 2014 (Bachhuber, 2014). Results of the study indicate that states with
medical cannabis laws had a lower average number of deaths associated with
opioid overdose. In his study, Bachhuber (2014) indicated that there was a
correlation of lower opioid overdose mortality rates, but no established
causation. In addition, the increased
access to cannabis for medical purposes could influence opioid misuse in either
direction, which indicates a need for further study. A few limitations were noted, as well; the
study was limited to a specific time period, not all opioid overdose
mortalities are properly identified on death certificates, and the study does
not take into account characteristics of the individuals within the different
states (Bacchuber, 2014).
Bradford (2018) conducted a longitudinal
analysis of daily doses of opioid prescriptions filled by patients who utilize
Medicare Part D. The primary outcome of
the study focused on the total number of daily opioid doses prescribed. Results from this study indicate that from
2010 to 2015, 23.08 million daily doses of opioids were dispensed per year
under Medicare Part D. States with
medical marijuana laws had fewer doses filled than those without. Specifically, states with active dispensaries
had 3.7 million fewer doses filled on a daily basis. In addition, hydrocodone prescriptions
decreased by 2.3 million and morphine decreased by .3 million. In this study, the author concluded that
medical marijuana laws are associated with a significant reduction in opioid
prescriptions in the Medicare Part D population, especially in states with
active dispensaries (Bradford, 2018).
Hockenberry (2018) conducted
a cross-sectional study using quasi-experimental difference-in-difference
design comparing opioid prescribing trends between states with and without
medical marijuana laws from 2011 to 2016.
This study found that states with medical marijuana laws were associated
with a 5.88% lower rate of opioid prescriptions. States that allowed adult use of marijuana,
without or without medical reasons, found a reduction of 6.38%. The authors of this study concluded that
medical marijuana laws have the potential of reducing opioid use, which could
also reduce mortality rates.
As opioid addiction has been
declared a national public health emergency, it is important to consider viable
options to reduce the use of opioids as a method to control and manage both
acute and chronic pain. The studies
outlined in this literature review are not conclusive, but they do point to an
overall decrease of opioid use in states with medical marijuana laws. While these studies do not provide causation,
the correlation is enough to consider the benefits of alternative pain reducing
methods, including the use of medical marijuana.
Suggestions for future studies
would include an updated study similar to the one conducted by Bachhuber
(2014). Doctors have reduced access to
opioid painkillers since that time, which has led some patients to seek similar
drugs in the open market. Some states,
such as Colorado, have more strongly regulated access to medical marijuana
since the 2014 study, as well (Ingold, 2018).
This tighter control has made it more difficult for patients to obtain
cannabis as an alternative to opioids.
Finally, more states have legalized marijuana use, which would also
provide greater opportunity for obtaining new data.
References
Bachhuber, M.A.
(2014). Medical cannabis laws and opioid analgesic overdose mortality
in the United States. JAMA Internal Medicine 174(10) 1668-1673.
Doi:
0.1001/jamainternmed.2014.4005
Bradford, A.C.
(2018). Association between US state
medical cannabis laws and opioid
prescribing in the Medicare Part
D population. JAMA Internal Medicine
178(5):
667672.
Doi:10.1001/jamainternmed.2018.0266
DEA (2018). Drug scheduling. Retrieved from https://www.dea.gov/druginfo/ds.shtml
Hockenberry, W.H.
(2018). Association of medical and
adult-use marijuana laws with
opioid prescribing for Medicaid
enrollees. JAMA Internal Medicine
178(5); 67
679.Doi:10.1001/jamainternmed.2018.1007
Ingold, J. (2018,
February 22). Do medical marijuana laws
reduce opioid overdoses? A
new study adds a layer of
nuance. Denver Post. Retrieved from
overdoses/
abuse/opioids/opioid-overdose-crisis
U.S. Department
of Health and Human Services (2018).
What is the U.S. opioid
epidemic? Retrieved from https://www.hhs.gov/opioids/about-the
