Relationship Between Marijuana and Opioids

Cannabis access is associated with reduced rates of opioid use and abuse, opioid-related hospitalizations, opioid-related traffic fatalities, opioid-related drug treatment admissions, and opioid-related overdose deaths

  • "We used an interrupted time-series design (2000-2015) to compare changes in level and slope of monthly opioid-related deaths before and after Colorado stores began selling recreational cannabis. ... Colorado's legalization of recreational cannabis sales and use resulted in a 0.7 deaths per month reduction in opioid-related deaths. This reduction represents a reversal of the upward trend in opioid-related deaths in Colorado." (Recreational cannabis legalization and opioid-related deaths in Colorado, 2000-2015, American Journal of Public Health, 2017)
  • "This paper uses a unique marijuana dispensary dataset to exploit within- and across-state variation in dispensary openings to estimate the effect increased access to marijuana has on narcotic-related admissions to treatment facilities and drug-induced mortalities. [It] finds that core-based statistical areas (CBSAs) with dispensary openings experience a 20 percentage point relative decrease in painkiller treatment admissions over the first two years of dispensary operations ... [and] provides suggestive evidence that dispensary operations negatively affect drug-induced mortality rates." (The effects of marijuana dispensaries on adverse opioid outcomes. SSRN Working Paper, 2017)
  • "Medical marijuana policies were significantly associated with reduced opioid pain reliever-related hospitalizations but had no associations with marijuana-related hospitalizations. ... Medical marijuana legalization was associated with 23% (p=0.008) and 13% (p=0.025) reductions in hospitalizations related to opioid dependence or abuse and OPR overdose, respectively; lagged effects were observed after policy implementation." (Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever, Drug and Alcohol Dependence, 2017)
  • "[The] review of the current literature suggests states that implement medical cannabis policies could reduce prescription opioid medication associated mortality, improve pain management, and significantly reduce health care costs." (The use of cannabis in response to the opioid crisis: A review of the literature, Nursing Outlook, 2017)

Cannabis access is associated with reductions in overall prescription drug spending

  • "We conducted a pragmatic historical cohort study to measure the effect of enrollment in a state-authorized United States' Medical Cannabis Program (MCP) on scheduled II-V drug prescription patterns. ... Our pragmatic preliminary study found that enrollment in the NM MCP was associated with significant reductions in scheduled II-V prescription drug activity and associated use of conventional pharmacies and prescribing providers. ... 34% of the MCP patients cease to exhibit any evidence of scheduled drug consumption and an additional 36% reduce the number of prescriptions filled for scheduled drugs by the last 6 months of our sample period. ... In conclusion, a shift from prescriptions for other scheduled drugs to cannabis may result in less frequent interactions with our conventional healthcare system, and potentially improved patient health." (Effects of legal access to cannabis on Schedule II-V prescriptions, Journal of Post-Acute and Long-Term Care Medicine, 2017)
  • "Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007-14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied. If all states had had a medical marijuana law in 2014, we estimated that total savings for fee-for-service Medicaid could have been $1.01 billion." (Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees, Health Affairs, 2017)
  • "Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. National overall reductions in Medicare program and enrollee spending when states implemented medical marijuana laws were estimated to be $165.2 million per year in 2013." (Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D, Health Affairs, 2016)

Patients often use cannabis as a substitute for other controlled substances, including prescription medications, alcohol, and tobacco

  • "[O]ur results indicate that MC (medical cannabis) may be used intentionally to taper off prescription medications. These findings align with previous research that has reported substitution or alternative use of cannabis for prescription pain medications dues to concerns regarding addiction and better side-effect and symptom management, as well as complementary use to help manage side-effects of prescription medication." (Preferences for medical marijuana over prescription medications among persons living with chronic conditions, The Journal of Alternative and Complementary Care, 2017)
  • Among patients with a musculoskeletal injury who acknowledged having used cannabis to assist in recuperating from injury over the past six months, 90 percent said that it was effective at reducing their pain. Eighty-one percent said that the use of cannabis reduced their intake of opioids. "[I]n the subset of patients who used marijuana during their recovery, a majority indicated that it helped alleviate symptoms of pain and reduced their level of opioid intake." (Perceptions of the use of medical marijuana in the treatment of pain following musculoskeletal trauma, Journal of Orthopaedic Trauma, 2017)
  • "[F]indings on cannabis substitution effect and the biological mechanisms behind it strongly suggest that cannabis could play a role in reducing the public health impacts of prescription and non-prescription opioids. ... The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to consider the implementation and assessment of cannabis-based interventions in the opioid crisis." (Rationale for cannabis-based interventions in the opioid overdose crisis, Harm Reduction Journal, 2017)
  • "Ninety-seven percent of the sample 'strongly agreed/agreed' that they are able to decrease the amount of opioids they consume when they also use cannabis. ... In addition, 80% of patients reported that cannabis by itself was more effective than their opioids. ... Supporting the results of previous research, this study can conclude that medical cannabis patients report successfully using cannabis along with or as a substitute for opioid-based pain medication." (Cannabis as a substitute for opioid-based pain medication: patient self-report, Cannabis and Cannabinoid Research, 2017)
  • "Among respondents that regularly used opioids, over three-quarters (76.7%) indicated that they reduced their use since they started medical cannabis. This was significantly ( p < 0.0001) greater than the patients that reduced their use of antidepressants (37.6%) or alcohol (42.0%). Approximately two-thirds of patients decreased their use of anti-anxiety (71.8%), migraine (66.7%), and sleep (65.2%) medications following medical cannabis." (Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep, Journal of Psychopharmacology, 2017)
  • "Findings include high self-reported use of cannabis as a substitute for prescription drugs (63%), particularly pharmaceutical opioids (30%), benzodiazepines (16%), and antidepressants (12%). Patients also reported substituting cannabis for alcohol (25%), cigarettes/tobacco (12%), and illicit drugs (3%)." (Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients, International Journal of Drug Policy, 2017)
  • "These patient-reported outcomes support prior research that individuals are using cannabis as a substitute for prescription drugs, particularly, narcotics/opioids, and independent of whether they identify themselves as medical or non-medical users. This is especially true if they suffer from pain, anxiety and depression." (Cannabis as a substitute for prescription drugs - a cross-sectional study, Journal of Pain Research, 2017)
  • "Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances. ... The finding that cannabis was substituted for all three classes of substances suggests that the medical use of cannabis may play a harm reduction role in the context of use of these substances, and may have implications for abstinence-based substance use treatment approaches." (Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors, Drug and Alcohol Review, 2015)

Chronic pain patients are less likely to abuse medicinal cannabis as compared to opioids

Chronic pain patients are less likely to become depressed using medical cannabis

  • "Prevalence of depression among patients in the OP (opioids), MM (medical marijuana) and OPMM groups was 57.1%, 22.3% and 51.4%, respectively and rates of anxiety were 48.4%, 21.5% and 38.7%, respectively. ... Levels of depression and anxiety are higher among chronic pain patients receiving prescription opioids compared to those receiving MM. Findings should be taken into consideration when deciding on the most appropriate treatment modality for chronic pain, particularly among those at risk for depression and anxiety." (Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana, Journal of Affective Disorders, 2017)