Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use
To determine the association of medical marijuana legalization with prescription opioid utilization.
A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006–2014. Adults with pharmacy and medical benefits for the entire calendar year were included in the population for that year. Multilevel logistic regression analysis, controlling for patient, person-year, and state-level factors, were used to determine the impact of medical marijuana legalization on the three opioid use measures. Sub-group analysis among cancer-free adults and cancer-free adults with at least one chronic non-cancer pain condition in the particular year were conducted. Alternate regression models were used to test the robustness of our results including a fixed effects model, an alternate definition for start date for medical marijuana legalization, a person-level analysis, and a falsification test.
The final sample included a total of 4,840,562 persons translating into 15,705,562 person years. Medical marijuana legalization was found to be associated with a lower odds of any opioid use: OR = 0.95 (0.94–0.96), chronic opioid use: OR = 0.93 (0.91–0.95), and high-risk opioid use: OR = 0.96 (0.94–0.98). The findings were similar in both the sub-group analyses and all the sensitivity analyses. The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR = 1.00; CI 0.99–1.01) or antihypertensives (OR = 1.00; CI 0.99–1.01).
In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use. However, further research assessing risk versus benefits of medical marijuana legalization and head to head comparisons of marijuana versus opioids for pain management is required.
KEY WORDSopioids marijuana chronic opioid use medical marijuana legalization pain
Data obtained for this project was supported by the Translational Research Institute (TRI), grant UL1TR000039. Dr. Hayes was supported by the Translational Training in Addiction [1T32 DA 022981].
Compliance with Ethical Standards
Conflict of Interest
Dr. Anuj Shah was a graduate student at the University of Arkansas for Medical Sciences the entire duration of time this study was conducted. Dr. Shah is now an employee of Pharmerit International which is a contract research organization which receives revenue from pharmaceutical companies. None of the research presented in this manuscript is in any way associated with Dr.Shah’s present employment. No conflict of interests exist for Dr. Corey Hayes. No conflict of interests exist for Miss Mrinmayee Lakkad. Bradley C. Martin receives royalties from TrestleTree, a healthcare coaching company, for the exclusive use of an opioid risk prediction tool that he and his colleagues developed.
- 1.Chou R, Deyo R, Devine B, et al. The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain. 2014. https://doi.org/10.23970/AHRQEPCERTA218.
- 4.Department of Health U, Services H, for Disease Control C. Annual surveillance report of drug-related risks and outcomes united states, 2017. https://www.cdc.gov/. Accessed October 19, 2018.
- 5.National Center for Health Statistics, CDC Wonder. Drug Involved in U.S. Overdose Deaths, 1999–2017. 2018. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed October 19, 2018.
- 6.Davis J. Trump Declares Opioid Crisis a ‘Health Emergency’ but Requests No Funds - The New York Times. The New York Times. https://www.nytimes.com/2017/10/26/us/politics/trump-opioid-crisis.html. Published 2017. Accessed October 19, 2018.
- 7.Kelly, Erin Groppe M. House passing bills to fight opioid addiction. Usa Today. http://www.indystar.com/story/news/politics/2016/05/11/house-passing-bills-fight-opioid-addiction/84250820/. Accessed October 19, 2018.
- 8.31 Legal Medical Marijuana States and DC - Medical Marijuana - ProCon.org. https://medicalmarijuana.procon.org/view.resource.php?resourceID=000881. Accessed October 19, 2018.
- 9.Qualifying Conditions for Medical Marijuana by State | Leafly. https://www.leafly.com/news/health/qualifying-conditions-for-medical-marijuana-by-state. Accessed October 19, 2018.
- 21.Powell D, Pacula RL, Jacobson M. Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers? Cambridge, MA; 2015. https://doi.org/10.3386/w21345.
- 25.HRSA Data Warehouse – Area Health Resource Files. https://datawarehouse.hrsa.gov/topics/ahrf.aspx. Accessed October 19, 2018.
- 26.The National Alliance for Model State Drug Laws (NAMSDL). http://www.namsdl.org/. Accessed October 19, 2018.
- 30.31 Legal Medical Marijuana States and DC - Medical Marijuana - ProCon.org. http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881. Accessed October 19, 2018.
- 31.Sullivan MD, Edlund MJ, Fan MY, Devries A, Brennan Braden J, Martin BC. Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study. Pain. 2010;150(2):332–339. https://doi.org/10.1016/j.pain.2010.05.020[doi].
- 35.Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012;125(1–2):8–18. https://doi.org/10.1016/j.drugalcdep.2012.07.004[doi].
- 38.National Academies of Sciences and Medicine E. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. National Academies Press; 2017.Google Scholar
- 42.Kuepper R, van Os J, Lieb R, Wittchen H-U, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. 2011;342:d738. http://www.ncbi.nlm.nih.gov/pubmed/21363868. Accessed October 19, 2018.CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Dominguez M-G, Saka MC, Lieb R, Wittchen H-U, van Os J, van Os J. Early Expression of Negative/Disorganized Symptoms Predicting Psychotic Experiences and Subsequent Clinical Psychosis: A 10-Year Study. Am J Psychiatry. 2010;167(9):1075–1082. https://doi.org/10.1176/appi.ajp.2010.09060883.CrossRefPubMedGoogle Scholar