Friday, 21 Feb 2020

You are here

Cannabis Laws Lessen the Opioid Crisis

Three reports from JAMA Internal Medicine demonstrate favorable trends with less opioid use when cannabis became legal.

Opioid-related mortality increased nearly 320% between 2000 - 2015 and by 15.6% between 2014 and 2015 alone. There is research showing that opioid and nonopioid pain prescriptions decreased in Medicare Part D and Medicaid populations with the introduction of medical cannabis. Researchers sought to assess any magnitude of opioid prescribing change with the introduction of medical cannibis laws (MCLs).

Researchers looked at the total number of daily opioid doses prescribed (in millions) in each US state for all opioids according to the establishement of laws and public consumption. 

Under Medicare Part D there were 23.08 million daily doses of any opioid dispensed per year in the average state between 2010 to 2015. Multiple regression analysis results found that patients filled fewer daily doses of any opioid in states with MCLs.

States with active dispensaries had 3.742 million fewer daily doses filled; states with home-cultivation-only MCLs saw 1.792 million fewer filled daily doses of opioids, especially for hydrocodone and morphine.

When looking only at Medicaid enrollees, MCLs were again associated with a 5.88% lower rate of opioid prescribing.

The cause and effect here are inferred and not directly relateable. Moreover, these data from Medicare Part D or Medicaid are limited and may not be generalizable to all demographic groups, since the data was derived in the disabled and elderly and low income levels individuals. 

Nonetheless, medical cannabis laws may be associated with significant reductions in opioid prescribing, especially for hydrocodone and morphine, and may add to strategies aimed at curtailing opioid use or abuse.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

Please resist the temptation to misuse headlines to attract readers! The headline "Cannabis Laws Lessen the Opioid Crisis" is misleading & possibly incorrect - the study referenced found an association found lower opioid prescribing in places where marijuana use had been legalized - that does NOT mean that the laws lessened the crisis. Association is not causation!

More Like This

Half of Opioids Rx Come from 1% of MDs

The BMJ reports that while most US providers are cautious in their prescribing, half of opioid prescriptions are written by 1% of providers.

Between 2003 and 2017, there was an annual average of 669495 providers prescribing 8.9 million opioid prescriptions.

In 2017, 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions; that's nearly 1000 times more than the middle 1% of prescribers.

Domestic Abuse Linked to Fibromyalgia and Chronic Fatigue

Domestic violence was found to predispose to a higher risk of fibromyalgia and those developing chronic fatigue syndrome.

Researchers studied the association between intimate partner violence (IPV) with fibromyalgia and CFS, using a retrospective open cohort design of patients entered into the “The Heath Improvement Network” database between 1995 and 2017.

A Potential Biomarker for Chronic Fatigue Syndrome Patients

Myalgic encephalomyelitis/chronic fatigue syndrome affects at least 2 million people in the United States and bears tremendous overlap with fibromyalgia - both being difficult to diagnosis because the symptom complex is often unrecognized and these conditions have no biomarker test. 

NIH Conference Review of Chronic Fatigue Syndrome

The current issue of JAMA reviews recent advances on chronic fatigue syndrome, also known as myalgic encephalomyelitis/(ME/CFS), based on a 2-day conference held at the NIH in an April 2019. The NIH 2-day conference reviewed recent progress and new research in several areas described below.

Study Looks at Opioid Use After Knee Surgery

A small study looked at whether reducing the number of opioid tablets prescribed after knee surgery would reduce postoperative use and if preoperative opioid-use education would reduce it even more.