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Opioid Prescribing in Canada following the Legalization of Cannabis: A Clinical and Economic Time-Series Analysis

Abstract

Purpose

On 17 October 2018 recreational cannabis became legal in Canada, thereby increasing access and reducing the stigma associated with its use for pain management. This study assessed total opioid prescribing volumes and expenditures prior to and following cannabis legalization.

Methods

National monthly claims data for public and private payers were obtained from January 2016 to June 2019. The drugs evaluated consisted of morphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, oxycodone, tramadol, and the non-opioids gabapentin and pregabalin. All opioid volumes were converted to a mean morphine equivalent dose (MED)/claim, which is analogous to a prescription from a physician. Gabapentin and pregabalin claims data were analyzed separately from the opioids. Time-series regression modelling was undertaken with dependent variables being mean MED/claim and total monthly spending. The slopes of the time-series curves were then compared pre- versus post-cannabis legalization.

Results

Over the 42-month period, the mean MED/claim declined within public plans (p < 0.001). However, the decline in MED/claim was 5.4 times greater in the period following legalization (22.3 mg/claim post vs. 4.1 mg/claim pre). Total monthly opioid spending was also reduced to a greater extent post legalization ($Can267,000 vs. $Can95,000 per month). The findings were similar for private drug plans; however, the absolute drop in opioid use was more pronounced (76.9 vs. 30.8 mg/claim). Over the 42-month period, gabapentin and pregabalin usage also declined.

Conclusions

Our findings support the hypothesis that easier access to cannabis for pain may reduce opioid use for both public and private drug plans.

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Authors

Corresponding author

Correspondence to George Dranitsaris.

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Funding

This study was sponsored in part by Scientus Pharma Inc.

Conflicts of interest

LM and BPE are employees of Scientus Pharma Inc. All authors had full access to the data, participated in the design of the study, interpretation of the results, and preparation of the final manuscript. There are no other conflicts of interest to declare.

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Not applicable.

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Not applicable.

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All authors have provided their consent for publication.

Availability of data and material

All original data are available from the primary author upon request.

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Not applicable.

Authors’ contributions

GD: Study design, data analysis, preparation of the manuscript. CD: Study design, contribution from a clinical perspective, revisions to the manuscript. BP: Study design, contribution from a clinical perspective, revisions to the manuscript. LM: Study design, data analysis, preparation of the manuscript. BPE: Study design, contribution from a clinical perspective, revisions to the manuscript.

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Dranitsaris, G., DeAngelis, C., Pearson, B. et al. Opioid Prescribing in Canada following the Legalization of Cannabis: A Clinical and Economic Time-Series Analysis. Appl Health Econ Health Policy 19, 537–544 (2021). https://doi.org/10.1007/s40258-021-00638-4

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