A new federally funded study shows that legalization of marijuana in U.S. states is associated with reduced prescriptions for opioid pain medications among commercially insured adults—indicating a possible substitution effect where patients are choosing to use cannabis instead of prescription drugs to treat pain.
“These results suggest that substitution of cannabis for traditional pain medications increases as the availability of recreational cannabis increases,” authors wrote, noting 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, published in the journal Cannabis, continues, “and lead to decreases in the number of new opioid users, rates of opioid use disorder, and related harms.”
The new research, which was supported by a grant from the National Institute on Drug Abuse, looked at national records of opioid prescription fills as well as prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and other pain medications. Analysis showed that prescription opioid fills dropped following legalization in U.S. while prescribing of non-opioid pain medications saw “marginally significant increases.”
“Our study adds to the growing evidence of the substitutability of cannabis for opioids and non-opioid pain medications.”
“Once recreational cannabis dispensaries open, we find statistically significant decreases in the rate of opioid prescriptions (13% reduction from baseline, p < .05),” the study says, “and marginally significant decreases in the average daily supply of opioids (6.3% decrease, p < .10) and number of opioid prescriptions per patient (3.5% decrease, p < .10).”
The findings were authored by a five-person research team from the University of Chicago, University of Georgia and Indiana University Bloomington.
Notably, because NSAIDs are typically available as over-the-counter medications, researchers 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.
Another explanation could be that prescribing healthcare providers reduce opioid prescriptions following cannabis legalization, the team acknowledged, pointing to evidence that adding marijuana to state prescription drug monitoring programs (PDMPs) impacts providers’ prescribing practices around other controlled substances, such as 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.”
It references a study published late last year examining the effects of adding medical marijuana to PDMPs, which concluded that the additional tracking had mixed effects, both reducing the prescription of medications that could cause complications with cannabis and also exposing a possible bias against medical marijuana patients among healthcare providers.
Authors of the new study also pointed out that prior 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 team also noted that most prior research has focused on medical marijuana legalization. “We expand on this literature by examining recreational cannabis legislation,” they wrote. “Furthermore, we include a novel examination of non-opioid pain medications.”
The new study adds to a growing body of research indicating that cannabis reform may help lessen patients’ use of opioids and tamp down prescribing of prescription painkillers.
A study published late last year, for example, found that legalizing medical cannabis appeared to significantly reduce monetary payments from opioid manufacturers to doctors who specialize in pain, according to recently published research, with authors finding “evidence that this decrease is due to medical marijuana becoming available as a substitute” for prescription painkillers.
Other recent research also showed a decline in fatal opioid overdoses in jurisdictions where marijuana was legalized for adults. That study found a “consistent negative relationship” between legalization and fatal overdoses, with more significant effects in states that legalized cannabis earlier in the opioid crisis. Authors estimated that recreational marijuana 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 marijuana legalization],” it added, “indicating this relationship is relatively consistent over time.”
Another recently published report into prescription opioid use in Utah following the state’s legalization of medical marijuana found that the availability of legal cannabis both reduced opioid use by patients with chronic pain and helped drive down prescription overdose deaths statewide. Overall, results of the study indicated that “cannabis has a substantial role to play in pain management and the reduction of opioid use,” it said.
Yet another study, published in 2023, linked medical marijuana use to lower pain levels and reduced dependence on opioids and other prescription medications. And another, published by the American Medical Association (AMA) last February, found that chronic pain patients who received medical marijuana for longer than a month saw significant reductions in prescribed opioids.
About one in three chronic pain patients reported using cannabis as a treatment option, according to a 2023 AMA-published report. Most of that group said they used cannabis as a substitute for other pain medications, including opioids.
Other research published that year found that letting people buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 percent to 8.1 percent fewer opioid prescriptions.
A 2022 research paper that analyzed Medicaid data on prescription drugs, meanwhile, found that legalizing marijuana for adult use was associated with “significant reductions” in the use of prescription drugs for the treatment of multiple conditions.
A 2023 report linked state-level medical marijuana legalization to reduced opioid payouts to doctors—another datapoint suggesting that patients use cannabis as an alternative to prescription drugs when given legal access.
Researchers in another study, published last year, looked at opioid prescription and mortality rates in Oregon, finding that nearby access to retail marijuana moderately reduced opioid prescriptions, though they observed no corresponding drop in opioid-related deaths.
Other recent research also indicates that cannabis may be an effective substitute for opioids in terms of pain management.
A report published recently in the journal BMJ Open, for instance, compared medical marijuana and opioids for chronic non-cancer pain and found that cannabis “may be similarly effective and result in fewer discontinuations than opioids,” potentially offering comparable relief with a lower likelihood of adverse effects.
Separate research published found that more than half (57 percent) of patients with chronic musculoskeletal pain said cannabis was more effective than other analgesic medications, while 40 percent reported reducing their use of other painkillers since they began using marijuana.
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Photo courtesy of Chris Wallis // Side Pocket Images.
The post Opioid Prescriptions Drop In States That Legalize Marijuana, Federally Funded Study Shows, Suggesting Some Pain Patients Prefer Cannabis appeared first on Marijuana Moment.
