Cannabis legalization shows potential to fight the opioid crisis—but it has limitations

In 2017, doctors in the United States wrote 191 million opioid prescriptions. That same year, more than 47,000 people died at the hands of prescription and illicit opioids, according to the Center for Disease Control and Prevention (CDC). Now, new research published in the Journal of Health Economics suggests that cannabis access laws could lead to fewer opioid prescriptions.

Using data pulled from 1.5 billion individual opioid prescriptions issued between 2011 and 2018, the study’s authors tied recreational cannabis use (currently legal in 10 U.S. states) with a 11.8 percent lower rate of opioids prescriptions each day, compared to a 4.2 percent lower rate with the use of medical marijuana. In addition, both uses were found to diminish the number of days a prescription was given for, the overall number of patients who received an opioid prescription, and the likelihood of a doctor writing the prescription in the first place.

“No study has had access to the depth of information we had access to,” Benjamin McMichael, an author of the study and assistant law professor at the University of Alabama School of Law. “We had information from all different insurance carriers. We had private insurance people, we had Medicare beneficiaries, we had Medicaid beneficiaries, cash-paying patients (which you almost never get information on), as well as other government assistance patients. So we really had a very granular picture of what opioid prescriptions look like. And because we could trace them to the individual healthcare provider who wrote the prescription, we had a lot more information than other studies have.”

However, it’s important to note that the study does have limitations. “The main problem with this study is that it doesn’t take into account the efforts made by many states and prescribers at reducing opiate prescriptions in light of the record numbers overdosing on opiates,” Ian Hamilton, a drug use expert at Department of Health Sciences at the U.K.’s University of York, tells Newsweek. “Over the last few years awareness of inappropriate opiate prescribing has increased, so it could be that some of the reduction in opiate prescriptions is due to concern by doctors and healthcare providers rather than individuals switching to cannabis.”

Indeed, in early 2019, CDC chief medical officer Deborah Dowell, MD, MPH, wrote a letter reiterating the importance of the organization’s opioid prescribing guidelines (written in 2016). “The Guideline was developed to provide recommendations for primary care physicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care,” Dowell wrote. The American Medical Association‘s Opioid Task Force progress report found that many states—including Missouri, Colorado, Vermont, New York, and Arkansas have made concerted efforts in 2019 to limit opioid’s influence on patient health care.

More research needs to be done to definitively decide whether the legalization of cannabis is having a positive effect on the opioid crisis. “To really get an idea of the role of cannabis access in the opioid crisis, we need information, we need more studies on the outcomes,” says McMichael. “The time is right to start calling for the federal government, or other entities with significant resources, to start investigating those resources in more clinical studies. It’s time to get an answer on whether cannabis really can substitute for opioids.”

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