Who Knew? Legal Marijuana Leads to Fewer Opioid Prescriptions

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Should legal cannabis be part of the country’s response to the opioid emergency?

Legalizing marijuana leads to fewer opioid prescriptions, according to a pair of new studies published this week in JAMA Internal Medicine. Using more than five years of prescription data from Medicaid patients and those enrolled in Medicare Part D prescription drug benefits, investigators found that in states with legalized cannabis, the number of prescriptions for opioid painkillers and the average daily doses taken fell significantly.

The study following Medicare patients found that in states with active medical cannabis dispensaries, the number of daily opioid painkiller prescriptions being filled went down 14 percent. Even in states that only legalized growing marijuana at home, 7 percent fewer daily doses of opioid prescriptions were filled. Usage of hydrocodone and morphine fell the most among the drugs studied, but prescriptions of fentanyl—a potent painkiller that has accounted for increasing overdose deaths in recent years—fell more than 8 percent in states with legal medical marijuana.

Among Medicaid enrollees, who were studied separately, state medical marijuana legalization correlated with a 5.88 percent lower rate of opioid painkiller prescriptions, and state laws that allow recreational cannabis use had an even larger drop of such prescriptions, of 6.38 percent.

These studies are being published at a time when the future of legalized marijuana is in question, as U.S. Attorney General Jeff Sessions announced in January that the Justice Department would stop discouraging U.S. authorities from cracking down on the pot business in states where it’s legal. According to federal law, growing, buying, and using marijuana is illegal anywhere in the country, but nine states and the District of Columbia have passed laws legalizing its use among adults for any reason; more than 20 others allow medicinal use of the plant. Under the Obama administration, the Justice Department took a hands-off approach, but Sessions really hates pot and has called it a gateway drug to heroin.

That’s obviously wrong, and with new studies showing that legalizing marijuana actually mitigates prescription opioid use on the state level, legislators are increasingly supporting new laws. New Jersey governor Phil Murphy has vowed to legalize pot, and New York lawmakers are discussing it as well—particularly since Cynthia Nixon declared her candidacy against Andrew Cuomo and started discussing legal pot in her appearances.

“I’m absolutely for the legalization of marijuana,” Nixon told Wendy Williams on her show. “Let’s capture some of that revenue.”

And it’s not just politicians: a Pew Research Center study released in January showed that more than six in every ten Americans say marijuana should be legalized—nearly double the number who said so back in 2000.

The effectiveness of pot against pain hasn’t been well-studied, but compared with opioids, marijuana is considered by researchers to be vastly safer and less addictive. Plus, the effectiveness of opioids has recently been questioned, since a study found they didn’t provide better pain relief for chronic arthritis than over-the-counter medications.

David Bradford, an economist at the University of Georgia who is an author of one of the new studies, tells STAT, “In this time when we are so concerned—rightly so—about opiate misuse and abuse and the mortality that’s occurring, we need to be clear-eyed and use evidence to drive our policies.” And maybe we could save some lives while we are at it?