The relationship between cannabis laws and opioid misuse has been a growing area of interest among researchers, healthcare professionals, and policymakers. States with medical cannabis laws have frequently reported declines in opioid prescription rates. This reduction is attributed to cannabis serving as an alternative for chronic pain management, which decreases the need for prescription opioids. Studies have demonstrated that Medicare and Medicaid patients in states with legalized cannabis often receive fewer opioid prescriptions compared to those in states without such laws.
Cannabis legalization has also been associated with a decrease in opioid-related overdose deaths. Many states with medical or recreational cannabis programs report fewer fatal opioid overdoses, likely due to individuals substituting cannabis for opioids. However, the extent of this reduction varies across states and is influenced by factors such as accessibility, local regulations, and the type of cannabis programs in place.
A new study conducted at Columbia University Mailman School of Public Health reveals mixed outcomes regarding the relationship between cannabis legalization and opioid misuse. The research, published in the International Journal of Drug Policy, found no significant changes in opioid misuse among the general population following the enactment of medical marijuana laws (MCLs) and adult-use/recreational cannabis laws (RCLs). However, decreases in opioid misuse were observed among cannabis users in states with MCLs alone.
Cannabis Laws and Opioid Misuse
By the end of 2019, 32 U.S. states had implemented MCLs, while states adopting RCLs had already established medical cannabis programs. Researchers analyzed data from the National Survey on Drug Use and Health (NSDUH) between 2015 and 2019 to assess the impact of cannabis laws on opioid misuse and opioid use disorder (OUD).
Key objectives included:
- Investigating opioid misuse trends in states with MCLs versus RCLs.
- Evaluating the influence of cannabis laws on individuals with a history of cannabis use.
Highlights of the Findings on Cannabis Laws and Opioids
1. General Population Trends
- The adoption of MCLs and RCLs showed no significant association with changes in opioid misuse or OUD across the general population.
- Approximately 4% of survey respondents reported past-year opioid misuse, while 3% met the criteria for OUD.
2. Impact Among Cannabis Users
- Decreased odds of opioid misuse were observed among individuals reporting past-year cannabis use in states with MCLs.
- These reductions were not evident in states with both MCLs and RCLs, suggesting a more pronounced effect of medical-only cannabis laws.
The survey population was 282,768 participants (2015–2019). It found that the Opioid Misuse Prevalence was 4% (past year), 1.3% (past month) in the general population, and it was 15% (past year) in cannabis consumers. The Opioid Use Disorder prevalence was 3% of all participants, higher among cannabis consumers.
Implications for Cannabis Policy and Future Research
The study underscores the need for:
- Continued Monitoring: Tracking opioid-related outcomes as more states adopt RCLs.
- Long-Term Analysis: Assessing the cumulative effects of cannabis laws over time.
- Targeted Interventions: Exploring the role of cannabis dispensaries in reducing opioid misuse among medical and adult-use users.
While medical cannabis laws show potential in reducing opioid misuse among cannabis users, adult-use laws do not demonstrate similar benefits. Further research is needed to unravel the complexities of cannabis legalization and its implications for opioid-related outcomes.
Cannabis legalization is being considered as a component of strategies to address the opioid crisis. Policymakers are exploring ways to expand access to medical cannabis programs, support further research on cannabis as a tool for harm reduction, and ensure that regulations provide equitable access while minimizing risks. Although research is ongoing, early evidence suggests that cannabis laws could play a significant role in mitigating the opioid epidemic’s impact on individuals and communities.
