Effects of U.S. State Medical Cannabis Laws on Treatment of Chronic Noncancer Pain

McGinty, Emma E.; Tormohlen, Kayla N.; Seewald, Nicholas J.; Bicket, Mark C.; McCourt, Alexander D.; Rutkow, Lainie; White, Sarah; Stuart, Elizabeth A.

doi:10.7326/m23-0053

Cited by 5 publications

(2 citation statements)

References 41 publications

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“…Current smoking was classified as smoking cigarettes every day or some days, versus past (smoked at least 100 cigarettes in entire life but does not currently smoke) and never smoked. We controlled for vital exhaustion which is characterized by loss of energy, demoralization, and irritability (Appels and Mulder 1989 ; Meesters and Appels 1996 ). We adjusted for ability to participate in social roles via the PROMIS SR (Hahn et al 2010 ) and high social support via the PROMIS ES ( http://www.healthmeasures.net/search-view-measures?task=Search.search .…”

Section: Methodsmentioning

confidence: 99%

Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana

Davidson,

Mahavni,

Chrusciel

et al. 2024

J Cannabis Res

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Objective Marijuana use is increasingly common among patients with chronic non-cancer pain (CNCP) and long-term opioid therapy (LTOT). We determined if lifetime recreational and medical marijuana use were associated with more frequent and higher dose prescription opioid use. Design Cross-sectional Subjects Eligible patients (n=1,037), who had a new period of prescription opioid use lasting 30-90 days, were recruited from two midwestern health care systems to a study of long-term prescription opioid use and mental health outcomes. The present cross-sectional analyses uses baseline data from this on-going cohort study. Methods Primary exposures were participant reported lifetime recreational and medical marijuana use versus no lifetime marijuana use. Prescription opioid characteristics included daily versus non-daily opioid use and ≥50 morphine milligram equivalent (MME) dose per day vs. <50 MME. Multivariate, logistic regression models estimated the association between lifetime recreational and medical marijuana use vs. no use and odds of daily and higher dose prescription opioid use, before and after adjusting for confounding. Results The sample was an average of 54.9 (SD±11.3) years of age, 57.3% identified as female gender, 75.2% identified as White, and 22.5% identified as Black race. Among all participants, 44.4% were never marijuana users, 21.3% were recreational only, 7.7% medical only and 26.6% were both recreational and medical marijuana users. After controlling for all confounders, lifetime recreational marijuana use, as compared to no use, was significantly associated with increased odds of daily prescription opioid use (OR=1.61; 95%CI:1.02-2.54). There was no association between lifetime recreational or medical marijuana use and daily opioid dose. Conclusion Lifetime medical marijuana use is not linked to current opioid dose, but lifetime recreational use is associated with more than a 60% odds of being a daily prescription opioid user. Screening for lifetime recreational marijuana use may identify patients with chronic pain who are vulnerable to daily opioid use which increases risk for adverse opioid outcomes. Prospective data is needed to determine how marijuana use influences the course of LTOT and vice versa.

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Section: Methodsmentioning

confidence: 99%

Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana

Davidson,

Mahavni,

Chrusciel

et al. 2024

J Cannabis Res

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“…Empirical work examining the association between cannabis legalization and opioid-related outcomes in the US has yielded mixed conclusions. Some evidence suggests that medical cannabis legalization has been associated with reductions in opioid prescribing, 9 , 10 , 11 and in some cases, opioid-related mortality, 12 whereas other evidence suggests that medical cannabis legalization was not associated with changes in opioid prescriptions 13 or has been associated with increased, rather than decreased, opioid-related mortality. 14 , 15 , 16 , 17 Studies examining the effect of recreational cannabis laws have found reductions in opioid prescriptions associated with recreational cannabis legalization, 18 , 19 , 20 , 21 , 22 and evidence on the effects of recreational cannabis laws is mixed, with studies indicating either no association with or an increase in opioid mortality.…”

Section: Introductionmentioning

confidence: 99%

Recreational and Medical Cannabis Legalization and Opioid Prescriptions and Mortality

Nguyen,

McGinty,

Mital

et al. 2024

JAMA Health Forum

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ImportanceWhile some have argued that cannabis legalization has helped to reduce opioid-related morbidity and mortality in the US, evidence has been mixed. Moreover, existing studies did not account for biases that could arise when policy effects vary over time or across states or when multiple policies are assessed at the same time, as in the case of recreational and medical cannabis legalization.ObjectiveTo quantify changes in opioid prescriptions and opioid overdose deaths associated with recreational and medical cannabis legalization in the US.Design, Setting, and ParticipantsThis quasiexperimental, generalized difference-in-differences analysis used annual state-level data between January 2006 and December 2020 to compare states that legalized recreational or medical cannabis vs those that did not.InterventionRecreational and medical cannabis law implementation (proxied by recreational and medical cannabis dispensary openings) between 2006 and 2020 across US states.Main Outcomes and MeasuresOpioid prescription rates per 100 persons and opioid overdose deaths per 100 000 population based on data from the US Centers for Disease Control and Prevention.ResultsBetween 2006 and 2020, 13 states legalized recreational cannabis and 23 states legalized medical cannabis. There was no statistically significant association of recreational or medical cannabis laws with opioid prescriptions or overall opioid overdose mortality across the 15-year study period, although the results also suggested a potential reduction in synthetic opioid deaths associated with recreational cannabis laws (4.9 fewer deaths per 100 000 population; 95% CI, −9.49 to −0.30; P = .04). Sensitivity analyses excluding state economic indicators, accounting for additional opioid laws and using alternative ways to code treatment dates yielded substantively similar results, suggesting the absence of statistically significant associations between cannabis laws and the outcomes of interest during the full study period.Conclusions and RelevanceThe results of this study suggest that, after accounting for biases due to possible heterogeneous effects and simultaneous assessment of recreational and medical cannabis legalization, the implementation of recreational or medical cannabis laws was not associated with opioid prescriptions or opioid mortality, with the exception of a possible reduction in synthetic opioid deaths associated with recreational cannabis law implementation.

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Does cannabis use substitute for opioids? A preliminary exploratory survey in opioid maintenance patients

Bekier,

Frischknecht,

Eidenmueller

et al. 2024

Eur Arch Psychiatry Clin Neurosci

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Effects of U.S. State Medical Cannabis Laws on Treatment of Chronic Noncancer Pain

Cited by 5 publications

References 41 publications

Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana

Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana

Recreational and Medical Cannabis Legalization and Opioid Prescriptions and Mortality

Does cannabis use substitute for opioids? A preliminary exploratory survey in opioid maintenance patients

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