Recreational cannabis laws and opioid‐related emergency department visit rates

Abstract

The opioid epidemic in the United States has accelerated during the COVID-19 pandemic. Over 81,000 drug overdose deaths occurred between June 2019 and May 2020-the highest ever recorded in a one-year period (The Centers for Disease Control and Prevention, 2020). Meanwhile, 17 states have legalized recreational cannabis. Over a third of the U.S. population now lives in a state with a recreational cannabis law (RCL) (ProCon.Org, 2021; U.S. Census Bureau, 2021).RCLs were not originally adopted to mitigate the opioid epidemic, though they may have the potential to reduce opioid use. Recent empirical evidence suggests cannabis is a substitute for prescription opioids in pain management (Shi et al., 2019;Wen & Hockenberry, 2018;Wen et al., 2021). In addition, there is some clinical evidence suggesting cannabis may mitigate opioid withdrawal symptoms (Wiese & Wilson-Poe, 2018). These findings are promising because RCLs, unlike medical cannabis laws (MCLs), make cannabis available to the entire population and thus have a larger imspact on cannabis use (Hollingsworth et al., 2020). However, cannabis does not directly treat the symptoms of opioid use disorder, for which medications for opioid use disorder are the only clinically effective treatment.

Association of Recreational Cannabis Legalization With Alcohol Use Among Adults in the US, 2010 to 2019

“…However, cannabis use also has costs and benefits regarding substances that people may use more of or less of when using cannabis (ie, complements and substitutes). An expanding literature suggests, albeit not conclusively, that cannabis legalization may reduce opioid use and associated risks . However, our findings suggest that these gains may need to be considered against the increased costs of alcohol use among young adults and men.…”

“…An expanding literature suggests, albeit not conclusively, that cannabis legalization may reduce opioid use and associated risks. 44,45 However, our findings suggest that these gains may need to be considered against the increased costs of alcohol use among young adults and men. As more data from the postlegalization period becomes available, cost-benefit analyses would be…”

The clouded debate: A systematic review of comparative longitudinal studies examining the impact of recreational cannabis legalization on key public health outcomes

“…Two research studies assessed the effects of RML on opioid-related service use. Drake et al ( 44 ) examined the opioid-related emergency department visit rates per 100,000 population in California, Maine, Massachusetts, and Nevada using the Healthcare Cost and Utilization Project (HCUP) database. While they found initial decreases in opioid-related ED visits in RML states, the effects were abolished by the end of the study period ( 44 ).…”

“…Drake et al ( 44 ) examined the opioid-related emergency department visit rates per 100,000 population in California, Maine, Massachusetts, and Nevada using the Healthcare Cost and Utilization Project (HCUP) database. While they found initial decreases in opioid-related ED visits in RML states, the effects were abolished by the end of the study period ( 44 ). Mennis et al ( 37 ) explored the impact of RML in adolescents and young adults (12–24 years of age) in Washington and Colorado compared to non-RML states regarding opioid-related treatment admission from the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Dataset–Admissions database.…”

The Opioid Crisis, Health, Healthcare, and Crime: A Review of Quasi-Experimental Economic Studies

“…While not specifically an opioid policy, several studies show that legalization of marijuana for medical or recreational purposes may have positive spillovers to opioid use. The rationale or the potential link between marijuana legalization and opioids is that these medications are both used by consumers to treat chronic pain; that is, marijuana and opioids are what economists call “therapeutic substitutes.” Several studies, across various populations, use insurance claims data to show that following marijuana legalization, prescriptions for opioids decline (which is what is expected if two medications are therapeutic substitutes) and proxies for chronic pain improve (Bradford and Bradford 2017; Bradford et al 2018; Wen and Hockenberry 2018; Nicholas and Maclean 2019; Ghimire and Maclean 2020; Wen et al 2021; Drake et al 2021), suggesting that marijuana allows for better symptom management of chronic pain than opioids. Not all studies suggest that legalization leads to reduced reliance on opioids for pain relief (Maclean, Ghimire, and Nicholas 2020; Jayawardhana and Fernandez 2021), and one study (Mathur and Ruhm 2022) links retail marijuana sales to higher opioid death rates.…”