It’s more common than ever for Americans to believe that cannabis is safer than opioids. This may be obvious for younger generations accustomed to medical or adult-use cannabis stores in strip malls for half of their lives. But there was a point when most people believed the plant was as bad as its DEA scheduling implies. As the tides shift on this public perception of the plant, science continues to support the movement.
The Journal of General Internal Medicine published a study to understand how cannabis legalization at the medical and recreational level impacted opioid use, prescriptions, and prescription refills. While the end results are mixed, some are promising.
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The setup
Researchers focused on data from Colorado, an ideal choice for this study for numerous reasons. The state legalized medical cannabis in 2000 and adult use in 2012. Additionally, counties and cities were given the right to prohibit cannabis business. These factors allowed researchers to better understand the impact of cannabis as it relates to opioid use..
They looked at this problem from a variety of perspectives, analyzing how many dispensaries were in each locality using records from the Department of Revenue. They matched this information against data from the CO Prescription Drug Monitoring Program from 2013 to 2018, tracking the number of 30-day refills of prescribed opioids per county resident per quarter.
To understand the outcomes of opioid-related inpatient stays, and emergency department visits, they took information from Colorado Hospital Association (CHA) data from 2011 to 2018. A total of 2048 observations were taken.
The study did have some limitations, the first of which is focusing on the county level, putting the information in danger of aggregation bias. That means that looking at counties as one data set overlooks other relevant factors like the average age of a county, homelessness, and poverty levels.
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There are also varying opioid ordinances and prescribing campaigns in each county, which wasn’t accounted for. Additionally, not all hospitals send comprehensive reports to CHA, and the CHA data set used only accounted for “heavy or hazardous use of opioids.” Data on non-prescribed opioid use was not utilized.
The outcome
The bad news is that emergency department visits weren’t affected by cannabis legalization. However, 30-day refills on opioids decreased significantly with access to recreational cannabis, and inpatient visits also reduced slightly. Counties that opted out of medical cannabis before recreational use took effect saw a more dramatic decrease in 30-day refills compared to counties with medical cannabis access.
Less 30-day refills in places where cannabis is available are worth exploring, which was echoed by the research team who discovered this correlation. Researchers concluded this study with hopes that future teams would put the data under a microscope, analyzing how cannabis access impacts opioid use at the community and citizen levels.
With normalization comes more access to cannabis, and in Colorado, that has had at least one positive effect on the opioid crisis. As more states implement cannabis programs, hopefully, more research will be conducted on how cannabis programs and opioid outreach programs could work together to battle addiction.