The Role of Cannabis Legalization in the Opioid Crisis

Hill, Kevin P.; Saxon, Andrew J.

doi:10.1001/jamainternmed.2018.0254

Cited by 18 publications

(8 citation statements)

References 6 publications

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“…Students should be cognizant of the changing national and state roles of the pharmacist in laws governing cannabis cultivation, sales, and employment. 52,53 Curricula should also include time to discuss the legal challenges around access to and use of novel, emerging, and/or synthetic psychoactive substances and "designer drugs" (eg, psychedelics, cathinones, synthetic cannabinoids (ie, K2), kratom, illicitly manufactured fentanyl). [54][55][56][57][58] Content related to contemporary statutes and regulations regarding access to, control, and administration of controlled substances, harm reduction equipment, drug paraphernalia, medications for opioid use disorder (ie, buprenorphine, methadone, naltrexone), and opioid antagonists (eg, naloxone access laws) should be included as part of law course curricula.…”

Section: Legal and Ethical Issuesmentioning

confidence: 99%

Report of the 2020 Special Committee on Substance Use and Pharmacy Education

Tran

Ball

Bratberg

et al. 2020

American Journal of Pharmaceutical Education

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Education Report (SAPER) specifically with recommendations on core curricular content and delivery processes on substance misuse and substance use disorder (SUD). This report provides information on the committee's process to address the charges, background information and resources pertaining to the charges, and rationale for SUD being a critical topic for curriculum at colleges and schools of pharmacy. This committee offers several recommendations to the Association of Colleges of Pharmacy (AACP) pertaining to the committee charges.

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Section: Legal and Ethical Issuesmentioning

confidence: 99%

Report of the 2020 Special Committee on Substance Use and Pharmacy Education

Tran

Ball

Bratberg

et al. 2020

American Journal of Pharmaceutical Education

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“…One policy considered to impact opioid overdose deaths is increasingly permissive Cannabis legislation [11]. Currently, more than 33 states permit Cannabis use for medical purposes, and 11 states permit recreational Cannabis use [12].…”

Section: Introductionmentioning

confidence: 99%

Is Cannabis being used as a substitute for non‐medical opioids by adults with problem substance use in the United States? A within‐person analysis

et al. 2020

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Background and Aims Ecological studies have suggested that Cannabis legalization might have led to a decrease in opioid overdose deaths. Such studies do not provide information about whether individuals are substituting Cannabis for opioids at different points in time. The current study assessed the magnitude of the daily association between Cannabis and opioid use in individual adults with and without pain who use non‐medical opioids. Design Prospective cohort study. Setting The greater New York area and a suburban inpatient addiction program. Participants Adults with problem substance use who use non‐medical opioids, recruited from May 2016–June 2019. The analytical sample included 13 271 days of observation among 211 participants (64% male, 41% white, 78% unmarried, 80% unemployed, mean age 43 years). Measurements Participants completed interviewer‐ and self‐administered computerized surveys, and then responded to an interactive voice response (IVR) system daily for the following 90 days. The main exposures, Cannabis use and pain, were defined as responding affirmatively to the IVR question: ‘Did you use Cannabis yesterday?’ and endorsing moderate or severe pain at baseline, respectively. The main outcome, non‐medical or illicit opioid use during 90‐day follow‐up, was defined as responding affirmatively to IVR question: ‘Did you use heroin yesterday?’ or ‘Did you use prescription opioids more than prescribed or without a prescription yesterday?’. Findings The mean IVR completion rate was 70%. The unadjusted odds ratio (aOR) indicating same‐day use of Cannabis and opioids was 2.00 [95% confidence interval (CI) = 1.54–2.59]. Controlling for demographic characteristics, recruitment method, opioid types at baseline and pain, the aOR was 1.86 (95% CI = 1.44–2.41). A test of interaction between pain and Cannabis use to determine if the association of Cannabis with opioid use differed between people with moderate‐to‐severe pain and less‐than‐moderate pain was inconclusive. Conclusions Among US adults with problem substance use who use non‐medical opioids, the odds of opioid use appear to be approximately doubled on days when Cannabis is used. This relationship does not appear to differ between people with moderate or more severe pain versus less than moderate pain, suggesting that Cannabis is not being used as a substitute for illegal opioids.

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“…Recent evidence suggests that approximately 16% of CNCP patients co-use cannabis and prescription opioids (Degenhardt et al, 2015; Sohler et al, 2018). In addition, population health research has found associations between the legalization of medical cannabis and decreases in opioid-related deaths, hospitalizations, and overdoses, as well as reductions in expenditures related to prescription opioid overdose and misuse (Bachhuber, Saloner, Cunningham, & Barry, 2014; Bradford, Bradford, Abraham, & Adams, 2018; Hill & Saxon, 2018; Vyas, LeBaron, & Gilson, 2017). Adverse effects of both short and long-term cannabis use have been documented including, memory impairment, impaired motor coordination, paranoia, psychosis, cognitive impairment and increased risk for anxiety and depression (Volkow, Baler, Compton, & Weiss, 2014).…”

Section: Introductionmentioning

confidence: 99%

Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care

Cooke

Knight

Miaskowski

2019

International Journal of Drug Policy

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Background: The prevalence of opioid-associated morbidity and mortality underscores the need for research on non-opioid treatments for chronic non-cancer pain (CNCP). Pain is the most common medical condition for which patients request medical cannabis. Limited research indicates that patients are interested in cannabis as a potential addition to or replacement for opioid medication. This analysis reports on CNCP patient and clinician perceptions about the co-use of cannabis and opioids for CNCP management. Methods: We interviewed 23 clinicians and 46 CNCP patients, using semi-structured interview guides, from six safety-net clinics across the San Francisco Bay Area, and 5 key stakeholders involved in CNCP management. We used a modified grounded theory approach to code and analyze transcripts. Results: CNCP patients described potential benefits of co-use of cannabis and opioids for pain management and concerns about dosing and addictive potential. Patients reported seeking cannabis when unable to obtain prescription opioids. Clinicians stated that their patients reported cannabis being helpful in managing pain symptoms. Clinicians expressed concerns about the potential exacerbation of mental health issues resulting from cannabis use. Conclusion: Clinicians are hampered by a lack of clinically relevant information about cannabis use, efficacy and side-effects. Currently no guidelines exist for clinicians to address opioid and cannabis co-use, or to discuss the risk and benefits of cannabis for CNCP management, including side effects. Cannabis and opioid co-use was commonly reported by patients in our sample, yet rarely addressed during clinical CNCP care. Further research is needed on the risks and benefits of cannabis and opioid co-use.

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The Role of Cannabis Legalization in the Opioid Crisis

Abstract: The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu

Cited by 18 publications

References 6 publications

Report of the 2020 Special Committee on Substance Use and Pharmacy Education

Report of the 2020 Special Committee on Substance Use and Pharmacy Education

Is Cannabis being used as a substitute for non‐medical opioids by adults with problem substance use in the United States? A within‐person analysis

Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care

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