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Is legalizing marijuana an answer to combating opioid abuse?
Increasingly, there are studies in the medical literature regarding the potential use of marijuana in reducing opioid use and even in curbing the opioid epidemic of addiction and overdose. The media is tuning in to this intriguing prospect highlighted by a CNN report by Dr. Sanjay Gupta. The upshot of these reports is that the legalization of cannabis, both medical and recreational, might have unanticipated positive consequences and implications for public policy.
In 2014, an 11-year study from the Montefiore Medical Center in New York City found states that legalized medical cannabis over an 11 year period had nearly 25 percent fewer opioid overdose deaths each year compared to states where marijuana remained illegal. Other studies have demonstrated similar reductions in numbers of opioid prescriptions.
More recently, two studies of note were published in the Journal of the American Medical Association Internal Medicine. The first found that states that legalized medical or adult-use marijuana had about a 6 percent reduction in Medicaid opioid prescribing compared to the remaining states.
The other study, of Medicare patients, found an average 2.2 million fewer daily opioid doses prescribed in states that instituted a medical cannabis statute as compared to other states. Further reductions in opioid use (up to 10 percent) were seen when a state progressed from medical to recreational marijuana legalization. Greatest reductions were realized in states that used medical marijuana dispensaries.
Another study conducted by the Minnesota Department of Health looked at more than 2,200 patients with intractable pain on various pain medications. Fifty-eight percent of these patients were able to reduce the use of these medications when they started taking cannabis, including 38 percent of patients using opioids. Sixty percent were able to reduce their opioid dose 50 percent and some completely eliminated their use.
In a paper delivered at the annual meeting of the American Geriatrics Society, 138 medical-marijuana users were asked about use of pain medications, including opioids. Eighteen percent reported decreasing use moderately, 20 percent extremely, and 27 percent completely.
Another study in the Clinical Journal of Pain followed a group of 176 patients and found 44 percent stopped their opioids within seven months of starting medical cannabis. Finally, in a study in the European Journal of Internal Medicine, 36 percent of 344 cancer patients receiving medical marijuana stopped their opioids and nearly 10 percent reduced their dosage.
Additional studies have also demonstrated marijuana’s ability to improve chronic pain and decrease opioid use. One study revealed that it can also increase the analgesic effect of very low (non-pain-relieving) opioid doses comparable to higher doses without increasing the abuse potential of either substance. Other reports suggest cannabis as a real possibility for use in weaning patients off opioids.
These studies, although compelling, are mostly observational and involve small patient numbers that indicate a strong association, but not a definitive cause-and-effect relationship between medical cannabis and decreased opioid dependence, addiction and overdose deaths. More research is needed.
The legalization of medical marijuana is certainly not the principal solution to the opioid epidemic. And from a public health perspective, it’s always controversial to use a measure that is not completely harmless to address a more serious problem. Substituting e-cigarettes for tobacco is a good example.
But broader access to medical cannabis could be part of the answer and should at least weigh in the balance in considering both legalizing medical marijuana and intervening in the opioid crisis gripping our nation.•
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Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.
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