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J Gen Intern Med. 2019 Aug;34(8):1419-1426. doi: 10.1007/s11606-018-4782-2. Epub 2019 Jan 25.

Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use.

Author information

1
Pharmerit International, Bethesda, MD, USA.
2
Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
3
Division of Health Services Research, Psychiatric Research Institute, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
4
Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA. bmartin@uams.edu.

Abstract

OBJECTIVE:

To determine the association of medical marijuana legalization with prescription opioid utilization.

METHODS:

A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006-2014. Adults with pharmacy and medical benefits for the entire calendar year were included in the population for that year. Multilevel logistic regression analysis, controlling for patient, person-year, and state-level factors, were used to determine the impact of medical marijuana legalization on the three opioid use measures. Sub-group analysis among cancer-free adults and cancer-free adults with at least one chronic non-cancer pain condition in the particular year were conducted. Alternate regression models were used to test the robustness of our results including a fixed effects model, an alternate definition for start date for medical marijuana legalization, a person-level analysis, and a falsification test.

RESULTS:

The final sample included a total of 4,840,562 persons translating into 15,705,562 person years. Medical marijuana legalization was found to be associated with a lower odds of any opioid use: OR = 0.95 (0.94-0.96), chronic opioid use: OR = 0.93 (0.91-0.95), and high-risk opioid use: OR = 0.96 (0.94-0.98). The findings were similar in both the sub-group analyses and all the sensitivity analyses. The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR = 1.00; CI 0.99-1.01) or antihypertensives (OR = 1.00; CI 0.99-1.01).

CONCLUSIONS:

In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use. However, further research assessing risk versus benefits of medical marijuana legalization and head to head comparisons of marijuana versus opioids for pain management is required.

KEYWORDS:

chronic opioid use; marijuana; medical marijuana legalization; opioids; pain

PMID:
30684198
PMCID:
PMC6667507
[Available on 2020-08-01]
DOI:
10.1007/s11606-018-4782-2

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