The State of the Evidence on the Association Between State Cannabis Laws and Opioid-related Outcomes: A Review

Overview

Journal Curr Addict Rep

Date 2022 Jun 7

PMID 35668861

Authors

Kayla N Tormohlen

Mark C Bicket

Sarah White

Colleen L Barry

Elizabeth A Stuart

Lainie Rutkow

Emma E McGinty

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: This review summarizes studies examining impacts of medical and recreational cannabis laws on opioid prescribing, opioid use, opioid use disorder, opioid-related service utilization, and opioid-involved mortality. We also discuss research challenges and recommendations for future work.

Recent Findings: Twenty-one U.S. based studies published between 2014-2021 that assessed state cannabis laws' association with opioid-related outcomes were reviewed. Study results were largely inconclusive. We identified six challenges of existing work: 1) inability to directly measure cannabis/opioid substitution; 2) use of general population samples and lack of individual-level longitudinal studies; 3) challenges disentangling effects of cannabis laws from other state laws; 4) methodological challenges with staggered policy implementation; 5) limited consideration of cannabis law provisions; 6) lack of triangulation across data sources.

Summary: While existing research suggests the potential for cannabis laws to reduce high-risk opioid prescribing and other opioid-related adverse outcomes, studies should be interpreted in light of limitations.

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References

Schuchat A, Houry D, Guy Jr G . New Data on Opioid Use and Prescribing in the United States. JAMA. 2017; 318(5):425-426. PMC: 5703201. DOI: 10.1001/jama.2017.8913. View

Ben-Michael E, Feller A, Stuart E . A Trial Emulation Approach for Policy Evaluations with Group-level Longitudinal Data. Epidemiology. 2021; 32(4):533-540. PMC: 8162442. DOI: 10.1097/EDE.0000000000001369. View

Davis C, Carr D . State legal innovations to encourage naloxone dispensing. J Am Pharm Assoc (2003). 2017; 57(2S):S180-S184. DOI: 10.1016/j.japh.2016.11.007. View

Williams A, Olfson M, Kim J, Martins S, Kleber H . Older, Less Regulated Medical Marijuana Programs Have Much Greater Enrollment Rates Than Newer 'Medicalized' Programs. Health Aff (Millwood). 2016; 35(3):480-8. PMC: 4845727. DOI: 10.1377/hlthaff.2015.0528. View

Shi Y . Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever. Drug Alcohol Depend. 2017; 173:144-150. PMC: 5385927. DOI: 10.1016/j.drugalcdep.2017.01.006. View

Feingold D, Goor-Aryeh I, Bril S, Delayahu Y, Lev-Ran S . Problematic Use of Prescription Opioids and Medicinal Cannabis Among Patients Suffering from Chronic Pain. Pain Med. 2017; 18(2):294-306. DOI: 10.1093/pm/pnw134. View

Dowell D, Haegerich T, Chou R . CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep. 2016; 65(1):1-49. DOI: 10.15585/mmwr.rr6501e1. View

Bao Y, Pan Y, Taylor A, Radakrishnan S, Luo F, Pincus H . Prescription Drug Monitoring Programs Are Associated With Sustained Reductions In Opioid Prescribing By Physicians. Health Aff (Millwood). 2016; 35(6):1045-51. PMC: 5336205. DOI: 10.1377/hlthaff.2015.1673. View

Bradford A, Bradford W . Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees. Health Aff (Millwood). 2017; 36(5):945-951. DOI: 10.1377/hlthaff.2016.1135. View

10.

Humphreys K, Saitz R . Should Physicians Recommend Replacing Opioids With Cannabis?. JAMA. 2019; 321(7):639-640. DOI: 10.1001/jama.2019.0077. View

11.

Liang D, Bao Y, Wallace M, Grant I, Shi Y . Medical cannabis legalization and opioid prescriptions: evidence on US Medicaid enrollees during 1993-2014. Addiction. 2018; 113(11):2060-2070. PMC: 6190827. DOI: 10.1111/add.14382. View

12.

Haffajee R, Jena A, Weiner S . Mandatory use of prescription drug monitoring programs. JAMA. 2015; 313(9):891-2. PMC: 4465450. DOI: 10.1001/jama.2014.18514. View

13.

Dowell D, Zhang K, Noonan R, Hockenberry J . Mandatory Provider Review And Pain Clinic Laws Reduce The Amounts Of Opioids Prescribed And Overdose Death Rates. Health Aff (Millwood). 2016; 35(10):1876-1883. PMC: 6583870. DOI: 10.1377/hlthaff.2016.0448. View

14.

Shih R, Rodriguez A, Parast L, Pedersen E, Tucker J, Troxel W . Associations between young adult marijuana outcomes and availability of medical marijuana dispensaries and storefront signage. Addiction. 2019; 114(12):2162-2170. DOI: 10.1111/add.14711. View

15.

McMichael B, Van Horn R, Viscusi W . The impact of cannabis access laws on opioid prescribing. J Health Econ. 2019; 69:102273. DOI: 10.1016/j.jhealeco.2019.102273. View

16.

Voelker R . States Move to Substitute Opioids With Medical Marijuana to Quell Epidemic. JAMA. 2018; 320(23):2408-2410. DOI: 10.1001/jama.2018.17329. View

17.

Chapman S, Spetz J, Lin J, Chan K, Schmidt L . Capturing Heterogeneity in Medical Marijuana Policies: A Taxonomy of Regulatory Regimes Across the United States. Subst Use Misuse. 2016; 51(9):1174-84. PMC: 4979574. DOI: 10.3109/10826084.2016.1160932. View

18.

Jayawardhana J, Fernandez J . The associations of medical marijuana policies with opioid-related health care utilization. Health Serv Res. 2021; 56(2):299-309. PMC: 7969206. DOI: 10.1111/1475-6773.13632. View

19.

Shah A, Hayes C, Lakkad M, Martin B . Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use. J Gen Intern Med. 2019; 34(8):1419-1426. PMC: 6667507. DOI: 10.1007/s11606-018-4782-2. View

20.

Kennedy-Hendricks A, Richey M, McGinty E, Stuart E, Barry C, Webster D . Opioid Overdose Deaths and Florida's Crackdown on Pill Mills. Am J Public Health. 2015; 106(2):291-7. PMC: 4985852. DOI: 10.2105/AJPH.2015.302953. View