From 2015-2019, US medical marijuana use rose from 1.6% to 2.4% while prescription pain reliever use declined, but both appropriate and inappropriate painkiller users were about twice as likely to also use medical marijuana.
Read this if you are interested in the relationship between medical marijuana and prescription painkillers at the population level.
2x more likelyBoth appropriate and inappropriate painkiller users were twice as likely to use medical marijuana
What the researchers found
Using five years of NSDUH data, researchers found that medical marijuana use increased from 1.6% to 2.4% while appropriate prescription pain reliever use decreased from 33.4% to 27.5% and misuse decreased from 4.7% to 3.7%. Both appropriate users (OR=1.99) and misusers (OR=1.94) of prescription pain relievers were significantly more likely to use medical marijuana than non-users. Medical marijuana users also had higher rates of serious mental illness (14.0% vs 4.4%) and non-marijuana substance dependence (5.3% vs 1.2%).
Why it matters
The relationship between medical marijuana and prescription opioids is central to cannabis policy debates. This population-level data shows the trends are moving in promising directions, but the association between painkiller use/misuse and medical marijuana use suggests these populations have complex, overlapping needs.
The numbers in context
- Medical marijuana use: 1.6% (2015) to 2.4% (2019)
- Appropriate pain reliever use: 33.4% to 27.5%
- Pain reliever misuse: 4.7% to 3.7%
- Appropriate users OR for medical marijuana: 1.99 (p<.001)
- Misusers OR: 1.94 (p<.001)
- 15.1% of marijuana users in non-medical states
- Serious mental illness: 14.0% vs 4.4%
How the study worked
Retrospective secondary analysis of NSDUH data (2015-2019). Multivariable logistic regression adjusting for substance use, psychiatric, and demographic factors.
Who was studied
US adult population from the National Survey on Drug Use and Health (2015-2019)
What this study cannot tell us
Cross-sectional survey data cannot establish causation or directionality. Self-reported substance use may be inaccurate. NSDUH categories may not capture all medical marijuana use patterns. The observed trends could reflect broader societal changes beyond cannabis policy.
How to read the evidence
Large national survey data with multivariable adjustment. Strong population representativeness but limited by cross-sectional design.
When this study was published
Published in 2023 using 2015-2019 NSDUH data. Captures a critical period of expanding medical marijuana access.
The bigger picture
The parallel trends of rising medical marijuana and declining prescription painkiller use are often cited as evidence that cannabis can substitute for opioids. This study adds nuance: the two populations overlap significantly, and medical marijuana users have higher rates of mental illness and other substance issues.
Questions still open
- Are people switching from prescription painkillers to medical marijuana, or using both?
- Does medical marijuana access reduce opioid overdose deaths at the population level?
- Why do medical marijuana users have such elevated rates of serious mental illness?
Read the original research
The relationship between medical marijuana use and prescription pain reliever use among U.S. adults: A retrospective analysis utilizing the 2015-2019 National Survey on Drug Use and Health (NSDUH).
Exploratory research in clinical and social pharmacy, 12, 100368
Citation
Dunn, Tyler J; Holmes, Erin; Yang, Yi; Bentley, John P; Kashmiri, Saim; Ramachandran, Sujith. (2023). The relationship between medical marijuana use and prescription pain reliever use among U.S. adults: A retrospective analysis utilizing the 2015-2019 National Survey on Drug Use and Health (NSDUH).. Exploratory research in clinical and social pharmacy, 12, 100368. https://doi.org/10.1016/j.rcsop.2023.100368