Comparison of hospital claims and poison center data to evaluate health impact of opioids, cannabis and synthetic cannabinoids

Wang, George Sam; Buttorff, Christine; Wilks, Asa; Schwam, Daniel; Tung, Greg; Banerji, Shireen; Dart, Richard C.; Pacula, Rosalie Liccardo

doi:10.1016/j.ajem.2022.01.004

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…52 Another had opioid-related ER visits and admissions to the Colorado Hospital Association increase 51% and 45%, respectively, during the first 4 years after recreational legalization. 54 In Washington and Colorado, hospital admissions for opioid substance abuse did not decrease during the first 2-4 years, during 2013-2017, after recreational legalization. 55 In Washington state, recreational marijuana legalization was not followed by a reduction in opioid compliance rate in patients treated with opioids for chronic pain during the first year after recreational legalization.…”

Section: Discussionmentioning

confidence: 94%

“…In Colorado, three studies have not supported the initial impression of a marijuana legalization benefit on opioid mortality, 52,53,54 one of which not only found that the original analysis did not hold over the longer period, but the association between state medical cannabis laws and opioid overdose mortality reversed direction from −21% to +23% and remained positive after accounting for recreational cannabis laws. 52 Another had opioid-related ER visits and admissions to the Colorado Hospital Association increase 51% and 45%, respectively, during the first 4 years after recreational legalization.…”

Section: Discussionmentioning

confidence: 99%

“…Our study adds two more years of data and D.C., and also differs in that our control group was states that had not legalized marijuana whereas their control group began with all states and excluded those that legalized when they did. Also, we included separate analyses of the T40.4 category of fentanyl and semi-synthetic analogues and we included heroin and opium that were either not assessed in prior studies 13,54,59 or specified. 28,43…”

Section: Discussionmentioning

confidence: 99%

“…50 In Massachusetts, Maine, Nevada and California, per-capita opioid-related emergency department visit rates initially decreased in states that legalized recreational use but began to increase within 6 months after legalization, 51 as of the last year of data in 2017 and before most recreational-legalizing jurisdictions had an acceleration in their opioid mortality. 7 In Colorado, three studies have not supported the initial impression of a marijuana legalization benefit on opioid mortality, 52,53,54 one of which not only found that the original analysis did not hold over the longer period, but the association between state medical cannabis laws and opioid overdose mortality reversed direction from −21% to +23% and remained positive after accounting for recreational cannabis laws. 52 Another had opioid-related ER visits and admissions to the Colorado Hospital Association increase 51% and 45%, respectively, during the first 4 years after recreational legalization.…”

Section: Prior Studies Of Marijuana Legalization's Effect On Opioid M...mentioning

confidence: 99%

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United States Marijuana Legalization and Opioid Mortality Trends Before and During the First Year of the COVID-19 Pandemic

Bleyer,

Barnes,

Finn

2023

Preprint

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To determine if marijuana legalization reduced opioid mortality, the U.S. opioid and fentanyl subset death trends during the 2010-2019 decade were compared in states and District of Columbia (D.C.) (jurisdictions) that had implemented marijuana legalization with states that had not. Acceleration of opioid mortality during 2020, first year of the COVID-19 pandemic, was also compared in recreational and medicinal-only legalizing jurisdictions. Joinpoint methodology was applied to Centers for Disease Control and Prevention WONDER data. Trends in legalizing jurisdictions were cumulative aggregates. The overall opioid and fentanyl death rates and percentage of opioid deaths due to fentanyl increased more during 2010-2019 in jurisdictions that legalized marijuana than in those that did not (pairwise comparison p = 0.007, 0.05, and 0.006, respectively). By 2019, the opioid and fentanyl death rates were 44% and 50% greater in the legalizing than non-legalizing jurisdictions, respectively. When the COVID-19 pandemic hit in 2020, jurisdictions that implemented recreational marijuana legalization before 2019 had significantly greater increases in both overall opioid and fentanyl death rates than jurisdictions with medicinal-only legalization. For all opioids, the mean (95% confidence interval [CI]) 2019-to-2020 increases were 46.5% (95% CI, 36.6% to 56.3%) and 29.1% (95% CI 20.2% to 37.9%), respectively (p = 0.02). For fentanyl, they were 115.6% (95% CI, 80.2% to 151.6%) and 55.4% (95% CI, 31.6% to 79.2%), respectively (p = 0.01). Marijuana legalization is correlated with worsening of the U.S. opioid epidemic, and especially during the COVID-19 pandemic with recreational legalization.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Prior Studies Of Marijuana Legalization's Effect On Opioid M...mentioning

confidence: 99%

See 2 more Smart Citations

United States Marijuana Legalization and Opioid Mortality Trends Before and During the First Year of the COVID-19 Pandemic

Bleyer,

Barnes,

Finn

2023

Preprint

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“…We hypothesized that there are several factors that could explain the increased use of cannabis and SCs, in recent years. First, the legalization of this substance in several countries has contributed to a lower perception of the risk of consumption in the population than the risk perception pre-legalization ( 1 , 29 ). Another reason is the increase in the consumption of cannabinoids for therapeutic or medical purposes, which can lead to misuse and even abuse of these substances ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

Synthetic cannabinoids use in a sample of opioid-use disorder patients

et al. 2022

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Cannabis is the most widely consumed illegal drug in the world and synthetic cannabinoids are increasingly gaining popularity and replacing traditional cannabis. These substances are a type of new psychoactive substance that mimics the cannabis effects but often are more severe. Since, people with opioids use disorder use widely cannabis, they are a population vulnerable to use synthetic cannabinoids. In addition, these substances are not detected by the standard test used in the clinical practice and drug-checking is more common in recreational settings. A cross-sectional study with samples of 301 opioid use disorder individuals was carried out at the addiction care services from Barcelona and Badalona. Urinalysis was performed by high-sensitivity gas chromatography-mass spectrometry (GC-MS) and ultra-high-performance liquid chromatography-high –resolution mass spectrometry (UHPLC-HRMS). Any synthetic cannabinoid was detected in 4.3% of the individuals and in 23% of these samples two or more synthetic cannabinoids were detected. Among the 8 different synthetic cannabinoids detected, most common were JWH-032 and JWH-122. Natural cannabis was detected in the 18.6% of the samples and only in the 0.7% of them THC was identified. Several different synthetic cannabinoids were detected and a non-negligible percentage of natural cannabis was detected among our sample. Our results suggest that the use of synthetic cannabinoids may be related to the avoidance of detection. In the absence of methods for the detection of these substances in clinical practice, there are insufficient data and knowledge making difficult to understand about this phenomenon among opioid use disorder population.

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Cannabis and the overdose crisis among US adolescents

Bleyer,

Barnes,

Stuyt

et al. 2024

American J Addict

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Background and ObjectivesSince 2019, the drug overdose death rate among adolescents 14–18 years of age in the United States more than doubled. That cannabis legalization may have contributed to this tragedy is investigated by comparing the death rate in jurisdictions that have legalized medicinal or both medicinal and recreational use with those that have not.MethodsUnintentional drug overdose death data for each state and District of Columbia (jurisdictions) were obtained from CDC WONDER and separately evaluated according to the jurisdiction legalization implementation of cannabis: recreational legalization, medicinal legalization but not recreational legalization, and nonlegalization.ResultsAfter a decade of similar and decreasing overdose death rates, jurisdictions that implemented cannabis legalization had a statistically significant greater increase in overdose deaths than nonlegalizing states. Those that implemented recreational legalization had the greatest increase, in which the rate was 88%, 479%, and 115% greater in 2019, 2020, and 2021, respectively, than in nonlegalizing jurisdictions. The overdose death rate versus cannabis legalization correlations are apparent in both females and males and in White, Black, and Hispanic individuals, and a statistically significant greater rate increases between recreational cannabis legalization implementation and nonlegalization.Conclusion and Scientific SignificanceLegalization of cannabis is associated with overdose deaths in American adolescents, especially recreational legalization, and regardless of sex or White–Black–Hispanic race/ethnicity. Cause and effect relationships of these previously unreported correlations, if verified, merit investigation of biologic and psychosocial mechanisms, interventions, and prevention strategies.

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Comparison of hospital claims and poison center data to evaluate health impact of opioids, cannabis and synthetic cannabinoids

Cited by 4 publications

References 17 publications

United States Marijuana Legalization and Opioid Mortality Trends Before and During the First Year of the COVID-19 Pandemic

United States Marijuana Legalization and Opioid Mortality Trends Before and During the First Year of the COVID-19 Pandemic

Synthetic cannabinoids use in a sample of opioid-use disorder patients

Cannabis and the overdose crisis among US adolescents

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