TRUCE Medical Minute – Dec. 8, 2019

Cannabis and the opioid crisis.

In those states which have legalized medical cannabis, a longitudinal analysis of the number of opioid prescriptions filled under Medicare Part D, showed that when medical cannabis laws went into effect, opioid prescriptions fell by 2.21 million daily doses filled per year. The same studies found that in those same states, once medical cannabis dispensaries opened, prescriptions fell by 3.74 million daily doses per year.

A second study found that states that have implemented medical cannabis laws have seen a 5.88% lower rate of opioid prescribing, and that number rose to 6.38% as a number of states implemented adult-use cannabis.

A third study in 2014 found “states with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws.”

To avoid an obvious confirmation bias or assume association is causation, it isn’t clear whether patients avoided or reduced opioid use because of increased access to cannabis. “However, given that millions of prescriptions for opiates were not written, and consequently there were millions fewer bottles of prescription opiates consumed, sold, diverted, or abused, it does not seem to be too big a leap to infer that opiate use was avoided, or at least reduced.”

These findings can easily be explained by the fact that narcotics and cannabinoids have overlapping signaling systems in the body having to due with drug tolerance, pain and dependence. Many patients have reduced or eliminated their use of narcotics once starting medical cannabis, further supporting a common mechanism of action. This topic will be covered in my next installment of Medical Minute.

Thanks for reading,

Derek Johnson DO, MBA
Board Certified Anesthesiologist