Association of US Medical Marijuana Laws With Nonmedical Prescription Opioid Use and Prescription Opioid Use Disorder

Segura, Luís; Mauro, Christine; Levy, Natalie S.; Khauli, Nicole; Philbin, Morgan M.; Mauro, Pia M.; Martins, Sílvia S.

doi:10.1001/jamanetworkopen.2019.7216

Cited by 41 publications

(28 citation statements)

References 33 publications

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“…However, the role of more permissive Cannabis legislation in the opioid crisis is not yet fully understood. One individual‐level analysis of national survey data found that medical Cannabis laws were not associated with changes in the prevalence of opioid use disorder, and in fact were associated with a small increase in opioid use [13]. At the same time, numerous ecological studies suggest that state medical and recreational Cannabis laws are associated with reductions in opioid prescriptions, opioid‐related hospitalizations and overdose deaths [14–20].…”

Section: Introductionmentioning

confidence: 99%

“…At the same time, numerous ecological studies suggest that state medical and recreational Cannabis laws are associated with reductions in opioid prescriptions, opioid‐related hospitalizations and overdose deaths [14–20]. Although ecological studies cannot establish causality [21], authors have drawn upon the substitution hypothesis to interpret these findings, positing that individuals may substitute Cannabis for prescription and illicit opioids, particularly to manage pain [13,15,16,18,20].…”

Section: Introductionmentioning

confidence: 99%

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Is Cannabis being used as a substitute for non‐medical opioids by adults with problem substance use in the United States? A within‐person analysis

et al. 2020

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Background and Aims Ecological studies have suggested that Cannabis legalization might have led to a decrease in opioid overdose deaths. Such studies do not provide information about whether individuals are substituting Cannabis for opioids at different points in time. The current study assessed the magnitude of the daily association between Cannabis and opioid use in individual adults with and without pain who use non‐medical opioids. Design Prospective cohort study. Setting The greater New York area and a suburban inpatient addiction program. Participants Adults with problem substance use who use non‐medical opioids, recruited from May 2016–June 2019. The analytical sample included 13 271 days of observation among 211 participants (64% male, 41% white, 78% unmarried, 80% unemployed, mean age 43 years). Measurements Participants completed interviewer‐ and self‐administered computerized surveys, and then responded to an interactive voice response (IVR) system daily for the following 90 days. The main exposures, Cannabis use and pain, were defined as responding affirmatively to the IVR question: ‘Did you use Cannabis yesterday?’ and endorsing moderate or severe pain at baseline, respectively. The main outcome, non‐medical or illicit opioid use during 90‐day follow‐up, was defined as responding affirmatively to IVR question: ‘Did you use heroin yesterday?’ or ‘Did you use prescription opioids more than prescribed or without a prescription yesterday?’. Findings The mean IVR completion rate was 70%. The unadjusted odds ratio (aOR) indicating same‐day use of Cannabis and opioids was 2.00 [95% confidence interval (CI) = 1.54–2.59]. Controlling for demographic characteristics, recruitment method, opioid types at baseline and pain, the aOR was 1.86 (95% CI = 1.44–2.41). A test of interaction between pain and Cannabis use to determine if the association of Cannabis with opioid use differed between people with moderate‐to‐severe pain and less‐than‐moderate pain was inconclusive. Conclusions Among US adults with problem substance use who use non‐medical opioids, the odds of opioid use appear to be approximately doubled on days when Cannabis is used. This relationship does not appear to differ between people with moderate or more severe pain versus less than moderate pain, suggesting that Cannabis is not being used as a substitute for illegal opioids.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is Cannabis being used as a substitute for non‐medical opioids by adults with problem substance use in the United States? A within‐person analysis

et al. 2020

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“…103 Two additional studies in 2019 on medical marijuana policies found lower rates of opioid use in areas with legalized medical marijuana policy than in areas without such policy, consistent with our results. 104,105 However, a replication of the article by Bachhuber et al 78 that used more recent data concluded that associations between opioidrelated overdose mortality and cannabis laws may be "spurious": the association between opioid-related overdose mortality and medical marijuana laws reversed direction, and mortality increased during the longer time horizon, but no association was found between recreational marijuana laws and the number of overdoses. 106 Studies of prescribing guidelines and educational interventions published after our review were consistent with studies we reviewed.…”

Section: Discussionmentioning

confidence: 98%

A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018

et al. 2020

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Objectives In the United States, rising rates of overdose deaths and recent outbreaks of hepatitis C virus and HIV infection are associated with injection drug use. We updated a 2014 review of systems-level opioid policy interventions by focusing on evidence published during 2014-2018 and new and expanded opioid policies. Methods We searched the MEDLINE database, consistent with the 2014 review. We included articles that provided original empirical evidence on the effects of systems-level interventions on opioid use, overdose, or death; were from the United States or Canada; had a clear comparison group; and were published from January 1, 2014, through July 19, 2018. Two raters screened articles and extracted full-text data for qualitative synthesis of consistent or contradictory findings across studies. Given the rapidly evolving field, the review was supplemented with a search of additional articles through November 17, 2019, to assess consistency of more recent findings. Results The keyword search yielded 535 studies, 66 of which met inclusion criteria. The most studied interventions were prescription drug monitoring programs (PDMPs) (59.1%), and the least studied interventions were clinical guideline changes (7.6%). The most common outcome was opioid use (77.3%). Few articles evaluated combination interventions (18.2%). Study findings included the following: PDMP effectiveness depends on policy design, with robust PDMPs needed for impact; health insurer and pharmacy benefit management strategies, pill-mill laws, pain clinic regulations, and patient/health care provider educational interventions reduced inappropriate prescribing; and marijuana laws led to a decrease in adverse opioid-related outcomes. Naloxone distribution programs were understudied, and evidence of their effectiveness was mixed. In the evidence published after our search’s 4-year window, findings on opioid guidelines and education were consistent and findings for other policies differed. Conclusions Although robust PDMPs and marijuana laws are promising, they do not target all outcomes, and multipronged interventions are needed. Future research should address marijuana laws, harm-reduction interventions, health insurer policies, patient/health care provider education, and the effects of simultaneous interventions on opioid-related outcomes.

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“…Some prior studies suggest that state medical cannabis laws may be associated with reductions in opioid prescribing, opioid use disorder, and opioid overdose [8][9][10][11][12][13][14][15][16], while others suggest that medical cannabis laws may lead to increased nonmedical opioid use and overdose [17,18]. The available research is limited by five key factors, which the study described in this protocol is designed to overcome:…”

Section: Introductionmentioning

confidence: 99%

Protocol: mixed-methods study of how implementation of US state medical cannabis laws affects treatment of chronic non-cancer pain and adverse opioid outcomes

et al. 2021

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Background Thirty-three US states and Washington, D.C., have enacted medical cannabis laws allowing patients with chronic non-cancer pain to use cannabis, when recommended by a physician, to manage their condition. However, clinical guidelines do not recommend cannabis for treatment of chronic non-cancer pain due to limited and mixed evidence of effectiveness. How state medical cannabis laws affect delivery of evidence-based treatment for chronic non-cancer pain is unclear. These laws could lead to substitution of cannabis in place of clinical guideline-discordant opioid prescribing, reducing risk of opioid use disorder and overdose. Conversely, state medical cannabis laws could lead to substitution of cannabis in place of guideline-concordant treatments such as topical analgesics or physical therapy. This protocol describes a mixed-methods study examining the implementation and effects of state medical cannabis laws on treatment of chronic non-cancer pain. A key contribution of the study is the examination of how variation in state medical cannabis laws’ policy implementation rules affects receipt of chronic non-cancer pain treatments. Methods The study uses a concurrent-embedded design. The primary quantitative component of the study employs a difference-in-differences design using a policy trial emulation approach. Quantitative analyses will evaluate state medical cannabis laws’ effects on treatment for chronic non-cancer pain as well as on receipt of treatment for opioid use disorder, opioid overdose, cannabis use disorder, and cannabis poisoning among people with chronic non-cancer pain. Secondary qualitative and survey methods will be used to characterize implementation of state medical cannabis laws through interviews with state leaders and representative surveys of physicians who treat, and patients who experience, chronic non-cancer pain in states with medical cannabis laws. Discussion This study will examine the effects of medical cannabis laws on patients’ receipt of guideline-concordant non-opioid, non-cannabis treatments for chronic non-cancer pain and generate new evidence on the effects of state medical cannabis laws on adverse opioid outcomes. Results will inform the dynamic policy environment in which numerous states consider, enact, and/or amend medical cannabis laws each year.

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Association of US Medical Marijuana Laws With Nonmedical Prescription Opioid Use and Prescription Opioid Use Disorder

Cited by 41 publications

References 33 publications

Is Cannabis being used as a substitute for non‐medical opioids by adults with problem substance use in the United States? A within‐person analysis

Is Cannabis being used as a substitute for non‐medical opioids by adults with problem substance use in the United States? A within‐person analysis

A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018

Protocol: mixed-methods study of how implementation of US state medical cannabis laws affects treatment of chronic non-cancer pain and adverse opioid outcomes

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