As more and more states legalize medical and recreational marijuana, healthcare providers may be replacing opioid prescriptions with suggestions to visit a local cannabis dispensary. Two papers published this month in JAMA Internal Medicine analyzing more than five years of Medicare Part D and Medicaid prescription data found that after states legalized weed, the number of opioid prescriptions and the daily dose of opioids went way down. This indicates that some people may be shifting away from prescription drugs to cannabis, though the studies can’t say whether this substitution is actually happening or if patients or doctors are the driving force.
“In this time when we are so concerned — rightly so — about opiate misuse and abuse and the mortality that’s occurring, we need to be clear-eyed and use evidence to drive our policies,” said W. David Bradford, an economist at the University of Georgia and an author of one of the studies. “If you’re interested in giving people options for pain management that don’t bring the particular risks that opiates do, states should contemplate turning on dispensary-based cannabis policies.”
Previous research has pointed to a similar correlation. A 2014 paper found that states with medical marijuana laws had nearly 25 percent fewer deaths from opioid overdoses. But the new research is the first to connect marijuana legalization to prescription painkillers with such large datasets
Those findings are somewhat positive from a public health angle. Opioids, in addition to an addictive potential much greater than that of marijuana, have other unappealing side effects. “The effect of opioids chronically — they wreak havoc on your GI tract,” said Marie Hayes, a psychologist at the University of Maine. Of course, medical cannabis is a drug with side effects, too. Obviously, people can get high, though that does depend on the concentration of the psychoactive compound, tetrahydrocannabinol, in the strain or formulation that someone is using.
Marijuana’s safety profile isn’t really at issue. “People are convinced of its safety,” Hayes said. But there’s just not a lot of evidence supporting marijuana as a chronic pain treatment in its own right. “I would say the evidence has been very modest up until about 10 years ago, because nobody would fund the research,” she said. Still, opioids as a chronic pain treatment have a checkered reputation as well: One recent study found opioids didn’t provide any more relief for chronic arthritis pain than over-the-counter painkillers.
Americans seem more willing than ever to accept marijuana. A recent Pew survey found that 61 percent of Americans favor legalizing pot. Nine states and the District of Columbia allow adults to use it for whatever reason they want, while more than 20 other U.S. states permit residents to use marijuana for medicinal purposes. But not all states with medical marijuana laws are created equal, the studies found. States with dispensaries that are open for business saw the greatest decrease in opioid prescriptions, while states without active dispensaries saw a far less dramatic decline — about 7 percent instead of about 14.
It is clear that cannabis is a potentially-major ally to battling the ongoing opioid epidemic. Time will tell if policymakers decide to listen to evidence and constituents in this matter. Lives are at stake, and every year around 60,000 die from the over-prescribed and often abused opioids.