Legalization of Medical Marijuana and Opioid Overdose

As of 2010, 13 states had legalized medical marijuana at some level. A study published in Sept of 2014 examined the relationship between the legalization of medical marijuana and opioid overdose deaths in those states.

If you listen to the news there is a huge opioid problem in this country, that’s if you listen to the news. What the news doesn’t report is that there is a huge problem with chronic pain in this country. 1-2% of the population has Fibromyalgia, and that doesn’t even take into account other sources of chronic pain; many of those with Fibromyalgia also suffer from other issues that result in chronic pain  (including spinal disk issues, joint problems, endometriosis, IBD, and chronic migraines, just to name a few). Opioids will not help all types of chronic pain, and when it comes to Fibromyalgia opioids likely help as many as not. Most of those suffering from Fibromyalgia really have no desire to take pain medications, whether because they don’t like the way they affect them, or because they are concerned about the stigma attached to the medications.

Some studies have indicated that medical marijuana is more helpful for easing chronic pain from Fibromyalgia, than any of the existing Fibromyalgia meds; that may be the case for many other forms of chronic pain, as well. So, has opioid use been reduced in states where medical marijuana is legal? This study doesn’t look at that, but based on what it does look at and the results, I’d say yes. What this study examines is the mortality rate due to opioid use from 1999 to 2010. The authors used multiple models to make the comparisons between states where marijuana was legal vs states where it was not, as well as to compare expected opioid mortality to actual opioid associated mortality in states where medical marijuana was legalized. In a second model they looked at changes over time, to see if opioid deaths decreased over time as the laws were enacted. Four other state variables were included:

1. State-level drug monitoring programs
2. Laws requiring patient identification prior to the pharmacist dispensing medications
3. unemployment rates/ economic climate
4. regulations for state oversight of pain management clinics

Taking these four things into consideration was important as each of these would impact not only the level of opioid use in that state, but the overall likelihood of suicide (economic climate). They also focused specifically on non-suicide deaths, removing known intentional overdoses from the equation. They also looked back at the two years prior to the implementation of medical marijuana laws to ensure that any changes did coincide with the changes, and were not simply coincidental. They did, however, include heroin overdoses in their numbers (“because heroin and prescription opioid use are interrelated for some individuals”).

Does Legalization of Medical Marijuana Decrease Opioid Overdose Related Deaths?

States with legalized medical marijuana use had an overall reduced rate of opioid related deaths by more than 24%. This reduction also increased over time from the date that the laws were enacted. The results of this review show that medical marijuana laws are associated with a reduced risk of opioid related deaths. This study does not show if there was also an overall reduction in the use of opioids, but I would say it’s probably a good assumption. Considering the inclusion of heroin overdose information, they authors did clarify that the reduced overdose of opioids was not offset by increased heroin use.

A couple of other points worth noting the article:

• Use of marijuana is associated with reduced rates of opioid withdrawal symptoms. This may make it easier for people using marijuana to reduce the amount of opioids they are taking.
• There was some evidence in their models that the reduction of opioid use/overdose in those states may have been a result of overall health attitudes in those states, rather than the introduction of medical marijuana.

Overall, there is a correlation between the legalization of medical marijuana and state-level reduction in deaths due to opioid overdose; however, it’s always important to remember that correlation does not equal causation.

References:
Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668-1673. doi:10.1001/jamainternmed.2014.4005.