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Laws covering medical or recreational use of marijuana are associated with reduced rates of opioid prescribing among federal health care program enrollees, results of two recently published investigations show.
In one study, researchers investigated whether medical cannabis access affected opioid prescribing in Medicare Part D, the federal program that subsidizes cost of prescription drugs and drug insurance premiums.
“Medical cannabis policies may be one mechanism that can encourage lower prescription opioid use and serve as a harm abatement tool in the opioid crisis,” Ms. Bradford and her coauthors wrote in JAMA Internal Medicine.
Medical marijuana laws were associated with a decrease of 2.11 million daily opioid doses yearly from an average of 23.08 million doses yearly in the Medicare Part D population, according to results of the longitudinal analysis daily opioids doses filled in Medicare Part D from 2010 through 2015.
In a second study, medical marijuana laws were associated with lower opioid prescribing rates among Medicaid enrollees.
That finding was consistent with earlier studies looking more broadly at pain prescriptions covered by Medicaid that also showed a reduction, researchers Hefei Wen, PhD, and Jason M. Hockenberry, PhD, wrote in their JAMA Internal Medicine article.
However, adult-use marijuana laws were associated with “even-lower” opioid prescribing rates, something that had not been investigated previously, according to Dr. Wen, who is with the University of Kentucky, Lexington, and Dr. Hockenberry of Emory University, Atlanta.
“Medical and adult-use marijuana laws have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose,” Dr. Wen and Dr. Hockenberry wrote in their report on the study, a cross-sectional analysis including all Medicaid fee-for-service and managed care enrollees during 2011-2016.
The rate of opioid prescribing in the study was –5.88% lower (95% confidence interval, –11.55% to approximately –0.21%) in association with medical marijuana laws, and –6.38% lower (95% CI, –12.20% to approximately –0.56%) for adult-use laws, they reported.
Based on those findings, policy discussions about the opioid epidemic should include the potential for liberalization of marijuana policies to reduce prescription opioid use and consequences in Medicaid enrollees, Dr. Wen and Dr. Hockenberry concluded.
However, legal marijuana alone won’t solve the opioid epidemic, they cautioned.
“As with other policies evaluated in the previous literature, marijuana liberalization is but one potential aspect of a comprehensive package to tackle the epidemic,” they said in the article.
None of the study authors reported conflicts of interest.
SOURCES: Bradford AC et al. JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.0266; Wen H, Hockenberry JM. JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.1007.
Results of these two investigations suggest that the legalization of marijuana may help combat the opioid crisis, but more rigorous investigations are needed, according to Kevin P. Hill, MD, and Andrew J. Saxon, MD.
The new studies show an association between state marijuana laws and fewer opioid prescriptions in Medicare and Medicaid populations.
Those findings do support previous investigations of administrative data sets suggesting that cannabis legalization policies are associated with reductions in opioid use and mortality, Dr. Hill and Dr. Saxon said in an editorial.
However, not all studies suggest that cannabis replaces opioid use, according to the authors, who cited a study suggesting an association between illicit cannabis use and subsequent cannabis use.
“The association between illicit cannabis use and opioid use may be different than the association of legalized cannabis use and opioids,” the editorial authors wrote. “Nevertheless, the findings demonstrating that cannabis use is associated with initiation of or increase in opioid use underscores the fact that rigorous scientific studies are needed.”
Those studies should focus not only analysis of policies on legal medical and recreational cannabis but also on clinical trials of cannabis and cannabinoids for chronic pain and other conditions where opioids are used, they added.
One limitation of the studies is that , according to the authors.
Nevertheless, the authors wrote, a decrease tied to legal marijuana availability would “dovetail” with preclinical evidence that cannabinoid and opioid receptor systems mediate signaling pathways involved in tolerance, dependence, and addiction.
“These concepts support anecdotal evidence from patients who describe a decreased need for opioids to treat chronic pain after initiation of medical cannabis pharmacotherapy,” the authors wrote.
Kevin P. Hill, MD, is with the division of addiction psychiatry at Harvard Medical School and Beth Israel Deaconess Medical Center, both in Boston. Andrew J. Saxon, MD, is with the Center of Excellence in Substance Abuse Treatment and Education at the VA Puget Sound Healthcare System, and the department of psychiatry and behavioral sciences at University of Washington, both in Seattle. These comments are derived from their editorial (JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.0254). The authors reported no conflicts of interest.
Results of these two investigations suggest that the legalization of marijuana may help combat the opioid crisis, but more rigorous investigations are needed, according to Kevin P. Hill, MD, and Andrew J. Saxon, MD.
The new studies show an association between state marijuana laws and fewer opioid prescriptions in Medicare and Medicaid populations.
Those findings do support previous investigations of administrative data sets suggesting that cannabis legalization policies are associated with reductions in opioid use and mortality, Dr. Hill and Dr. Saxon said in an editorial.
However, not all studies suggest that cannabis replaces opioid use, according to the authors, who cited a study suggesting an association between illicit cannabis use and subsequent cannabis use.
“The association between illicit cannabis use and opioid use may be different than the association of legalized cannabis use and opioids,” the editorial authors wrote. “Nevertheless, the findings demonstrating that cannabis use is associated with initiation of or increase in opioid use underscores the fact that rigorous scientific studies are needed.”
Those studies should focus not only analysis of policies on legal medical and recreational cannabis but also on clinical trials of cannabis and cannabinoids for chronic pain and other conditions where opioids are used, they added.
One limitation of the studies is that , according to the authors.
Nevertheless, the authors wrote, a decrease tied to legal marijuana availability would “dovetail” with preclinical evidence that cannabinoid and opioid receptor systems mediate signaling pathways involved in tolerance, dependence, and addiction.
“These concepts support anecdotal evidence from patients who describe a decreased need for opioids to treat chronic pain after initiation of medical cannabis pharmacotherapy,” the authors wrote.
Kevin P. Hill, MD, is with the division of addiction psychiatry at Harvard Medical School and Beth Israel Deaconess Medical Center, both in Boston. Andrew J. Saxon, MD, is with the Center of Excellence in Substance Abuse Treatment and Education at the VA Puget Sound Healthcare System, and the department of psychiatry and behavioral sciences at University of Washington, both in Seattle. These comments are derived from their editorial (JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.0254). The authors reported no conflicts of interest.
Results of these two investigations suggest that the legalization of marijuana may help combat the opioid crisis, but more rigorous investigations are needed, according to Kevin P. Hill, MD, and Andrew J. Saxon, MD.
The new studies show an association between state marijuana laws and fewer opioid prescriptions in Medicare and Medicaid populations.
Those findings do support previous investigations of administrative data sets suggesting that cannabis legalization policies are associated with reductions in opioid use and mortality, Dr. Hill and Dr. Saxon said in an editorial.
However, not all studies suggest that cannabis replaces opioid use, according to the authors, who cited a study suggesting an association between illicit cannabis use and subsequent cannabis use.
“The association between illicit cannabis use and opioid use may be different than the association of legalized cannabis use and opioids,” the editorial authors wrote. “Nevertheless, the findings demonstrating that cannabis use is associated with initiation of or increase in opioid use underscores the fact that rigorous scientific studies are needed.”
Those studies should focus not only analysis of policies on legal medical and recreational cannabis but also on clinical trials of cannabis and cannabinoids for chronic pain and other conditions where opioids are used, they added.
One limitation of the studies is that , according to the authors.
Nevertheless, the authors wrote, a decrease tied to legal marijuana availability would “dovetail” with preclinical evidence that cannabinoid and opioid receptor systems mediate signaling pathways involved in tolerance, dependence, and addiction.
“These concepts support anecdotal evidence from patients who describe a decreased need for opioids to treat chronic pain after initiation of medical cannabis pharmacotherapy,” the authors wrote.
Kevin P. Hill, MD, is with the division of addiction psychiatry at Harvard Medical School and Beth Israel Deaconess Medical Center, both in Boston. Andrew J. Saxon, MD, is with the Center of Excellence in Substance Abuse Treatment and Education at the VA Puget Sound Healthcare System, and the department of psychiatry and behavioral sciences at University of Washington, both in Seattle. These comments are derived from their editorial (JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.0254). The authors reported no conflicts of interest.
Laws covering medical or recreational use of marijuana are associated with reduced rates of opioid prescribing among federal health care program enrollees, results of two recently published investigations show.
In one study, researchers investigated whether medical cannabis access affected opioid prescribing in Medicare Part D, the federal program that subsidizes cost of prescription drugs and drug insurance premiums.
“Medical cannabis policies may be one mechanism that can encourage lower prescription opioid use and serve as a harm abatement tool in the opioid crisis,” Ms. Bradford and her coauthors wrote in JAMA Internal Medicine.
Medical marijuana laws were associated with a decrease of 2.11 million daily opioid doses yearly from an average of 23.08 million doses yearly in the Medicare Part D population, according to results of the longitudinal analysis daily opioids doses filled in Medicare Part D from 2010 through 2015.
In a second study, medical marijuana laws were associated with lower opioid prescribing rates among Medicaid enrollees.
That finding was consistent with earlier studies looking more broadly at pain prescriptions covered by Medicaid that also showed a reduction, researchers Hefei Wen, PhD, and Jason M. Hockenberry, PhD, wrote in their JAMA Internal Medicine article.
However, adult-use marijuana laws were associated with “even-lower” opioid prescribing rates, something that had not been investigated previously, according to Dr. Wen, who is with the University of Kentucky, Lexington, and Dr. Hockenberry of Emory University, Atlanta.
“Medical and adult-use marijuana laws have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose,” Dr. Wen and Dr. Hockenberry wrote in their report on the study, a cross-sectional analysis including all Medicaid fee-for-service and managed care enrollees during 2011-2016.
The rate of opioid prescribing in the study was –5.88% lower (95% confidence interval, –11.55% to approximately –0.21%) in association with medical marijuana laws, and –6.38% lower (95% CI, –12.20% to approximately –0.56%) for adult-use laws, they reported.
Based on those findings, policy discussions about the opioid epidemic should include the potential for liberalization of marijuana policies to reduce prescription opioid use and consequences in Medicaid enrollees, Dr. Wen and Dr. Hockenberry concluded.
However, legal marijuana alone won’t solve the opioid epidemic, they cautioned.
“As with other policies evaluated in the previous literature, marijuana liberalization is but one potential aspect of a comprehensive package to tackle the epidemic,” they said in the article.
None of the study authors reported conflicts of interest.
SOURCES: Bradford AC et al. JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.0266; Wen H, Hockenberry JM. JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.1007.
Laws covering medical or recreational use of marijuana are associated with reduced rates of opioid prescribing among federal health care program enrollees, results of two recently published investigations show.
In one study, researchers investigated whether medical cannabis access affected opioid prescribing in Medicare Part D, the federal program that subsidizes cost of prescription drugs and drug insurance premiums.
“Medical cannabis policies may be one mechanism that can encourage lower prescription opioid use and serve as a harm abatement tool in the opioid crisis,” Ms. Bradford and her coauthors wrote in JAMA Internal Medicine.
Medical marijuana laws were associated with a decrease of 2.11 million daily opioid doses yearly from an average of 23.08 million doses yearly in the Medicare Part D population, according to results of the longitudinal analysis daily opioids doses filled in Medicare Part D from 2010 through 2015.
In a second study, medical marijuana laws were associated with lower opioid prescribing rates among Medicaid enrollees.
That finding was consistent with earlier studies looking more broadly at pain prescriptions covered by Medicaid that also showed a reduction, researchers Hefei Wen, PhD, and Jason M. Hockenberry, PhD, wrote in their JAMA Internal Medicine article.
However, adult-use marijuana laws were associated with “even-lower” opioid prescribing rates, something that had not been investigated previously, according to Dr. Wen, who is with the University of Kentucky, Lexington, and Dr. Hockenberry of Emory University, Atlanta.
“Medical and adult-use marijuana laws have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose,” Dr. Wen and Dr. Hockenberry wrote in their report on the study, a cross-sectional analysis including all Medicaid fee-for-service and managed care enrollees during 2011-2016.
The rate of opioid prescribing in the study was –5.88% lower (95% confidence interval, –11.55% to approximately –0.21%) in association with medical marijuana laws, and –6.38% lower (95% CI, –12.20% to approximately –0.56%) for adult-use laws, they reported.
Based on those findings, policy discussions about the opioid epidemic should include the potential for liberalization of marijuana policies to reduce prescription opioid use and consequences in Medicaid enrollees, Dr. Wen and Dr. Hockenberry concluded.
However, legal marijuana alone won’t solve the opioid epidemic, they cautioned.
“As with other policies evaluated in the previous literature, marijuana liberalization is but one potential aspect of a comprehensive package to tackle the epidemic,” they said in the article.
None of the study authors reported conflicts of interest.
SOURCES: Bradford AC et al. JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.0266; Wen H, Hockenberry JM. JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.1007.
FROM JAMA INTERNAL MEDICINE
Key clinical point: State laws governing medical and adult use of marijuana may lower prescription opioid use in Medicaid enrollees – a population at high risk for chronic pain and opioid overdose – and in the Medicare Part D population.
Major finding: Medical and adult-use marijuana laws were associated with lower opioid prescribing rates in Medicaid prescription data (–5.88% and –6.38%, respectively). Medical marijuana laws were associated with a decrease of 2.11 million daily doses yearly from an average of 23.08 million doses yearly in the Medicare Part D population.
Study details: A cross-sectional, quasiexperimental study of opioid prescribing trends between 2011 and 2016 for all Medicaid fee-for-service and managed care enrollees, and a longitudinal analysis daily opioids doses filled in Medicare Part D from 2010 through 2015.
Disclosures: None of the study authors reported conflicts of interest.
Sources: Bradford AC et al. JAMA Intern Med. 2018 Apr 2. doi:10.1001/jamainternmed.2018.0266; Wen H, Hockenberry JM. JAMA Intern Med. 2018 Apr 2. doi:10.1001/jamainternmed.2018.1007.