Medical Cannabis Laws Were Linked to Fewer Opioid Deaths and Lower Healthcare Costs | Research

The takeaway

A systematic review of 10 studies found that medical cannabis laws were associated with decreased prescription opioid use, fewer opioid-related hospitalizations, lower overdose death rates, and reduced healthcare expenditures.

Public health officials, policy makers, pain management providers.

All four outcome categories improved in states with medical cannabis laws: lower opioid use, fewer hospitalizations, fewer overdose deaths, and reduced healthcare costs.

What the researchers found

The 10 included studies collectively suggest medical cannabis laws could be associated with decreased prescription opioid use, fewer POM-related hospitalizations, lower rates of opioid overdose, and reduced national healthcare expenditures related to opioid overdose and misuse. Four studies examined individual-level cannabis-for-opioid substitution; six examined state-level opioid outcomes.

Why it matters

The opioid crisis kills tens of thousands of Americans annually. This review presents converging evidence from multiple study designs that medical cannabis access may reduce opioid-related harms, suggesting cannabis policy could be one component of addressing the epidemic.

The numbers in context

11,513 records identified, 10 met criteria. Four cross-sectional surveys on individual substitution. Six secondary analyses on state-level outcomes (overdose fatalities, hospitalizations, Medicare/Medicaid costs).

How the study worked

Systematic literature review of Medline, PubMed, CINAHL, and Cochrane databases for peer-reviewed articles published 2010-2017. 11,513 records identified, 789 abstracts reviewed, 134 full-text screened, 10 met inclusion criteria.

What this study cannot tell us

Sparse literature with notable limitations across studies. Ecological studies cannot prove individual-level causation. Cross-sectional surveys rely on self-report. Federal policy restrictions constrain cannabis research. Confounding by other state-level changes possible.

How to read the evidence

Moderate - systematic review methodology is rigorous, but the evidence base is sparse with significant limitations in individual studies.

When this study was published

Published in 2018. The opioid-cannabis substitution evidence has continued to evolve.

The bigger picture

While no single study is conclusive, the convergence of individual-level and state-level evidence from multiple research groups strengthens the case that medical cannabis access may reduce opioid harms. This has significant policy implications.

Questions still open

Does recreational cannabis legalization have the same opioid-reduction effect as medical cannabis? Which components of medical cannabis programs are most important for reducing opioid harms? Could expanding medical cannabis access be more effective than restricting opioid prescribing?

Common questions

Does medical cannabis reduce opioid deaths?

This systematic review found that states with medical cannabis laws had lower rates of opioid overdose deaths, fewer opioid-related hospitalizations, and reduced opioid prescribing. However, the evidence is still limited and cannot prove causation.

Can cannabis replace opioids for pain?

Individual-level studies in this review found many patients reported substituting cannabis for prescription opioids. State-level data showed corresponding decreases in opioid prescriptions and related harms in states with medical cannabis access.

Read the original research

The use of cannabis in response to the opioid crisis: A review of the literature.

Nursing outlook, 66(1), 56-65

View on PubMed ↗Publisher’s paper ↗

Citation

Vyas, Marianne Beare; LeBaron, Virginia T; Gilson, Aaron M. (2018). The use of cannabis in response to the opioid crisis: A review of the literature.. Nursing outlook, 66(1), 56-65. https://doi.org/10.1016/j.outlook.2017.08.012