United States marijuana legalization and opioid mortality epidemic during 2010–2020 and pandemic implications

Bleyer, Archie; Barnes, Brian J.; Finn, Kenneth

doi:10.1016/j.jnma.2022.03.004

Cited by 3 publications

(10 citation statements)

References 41 publications

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“…Using year of legalization enactment itself instead of the year of implementation of legalization accentuated the difference in overall opioid results and did not significantly alter the fentanyl results. 7 Difference-in-difference methodology was unnecessary to compare subsequent trends since the rates in the two groups were nearly identical for the initial three years of comparison.…”

Section: Jurisdiction Classificationmentioning

confidence: 99%

“…45 Two county-level studies in states that allowed marijuana dispensaries to operate had lower opioid-mortality rates in counties with medical and recreational dispensaries, 46,47 albeit the county-level methodology utilized has been negatively critiqued. 7,48 At the national level, an update of aforementioned studies by other investigators indicates that legal medical marijuana is associated with higher opioid mortality, particularly when available through retail dispensaries, and that recreational marijuana may be correlated with greater death rates relative to the counterfactual of no legal cannabis. 49 Opioid overdose death rates during 2012-2017 in states that legalized medicinal marijuana had a greater increase in opioid mortality than in those that did not (p<0.01).…”

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

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%

“…6 The U.S. also has the world's 2nd highest cannabis-use-disorder prevalence and, by far, the world's highest opioid death rate. 7 To assess whether or not these two grim statistics are related, as considered by others, 8 , 9 we previously compared the opioid death rate in the composite aggregate of legalizing jurisdictions with that in non-legalizing jurisdictions. 7 With then too few evaluable recreational-legalizing jurisdictions, we did not assess them for differences in the impact of recreational versus medicinal legalization.…”

Section: Introductionmentioning

confidence: 99%

“…7 To assess whether or not these two grim statistics are related, as considered by others, 8 , 9 we previously compared the opioid death rate in the composite aggregate of legalizing jurisdictions with that in non-legalizing jurisdictions. 7 With then too few evaluable recreational-legalizing jurisdictions, we did not assess them for differences in the impact of recreational versus medicinal legalization. In this study, we update all 50 states and D.C. during the last decade (2010-2019) by comparing opioid mortality rates in jurisdictions states that had or had not by start of 2019 legalized marijuana for all opioids and the fentanyl group of synthetic opioids.…”

Section: Introductionmentioning

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: Jurisdiction Classificationmentioning

confidence: 99%

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

confidence: 99%

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

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 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

Self Cite

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Comparison of Health Care Providers Attitudes and Beliefs Regarding Medical Marijuana and Cannabidiol in the Management of Pain and Other Symptoms in Cancer Patients

Tanco

Lopez

Koyyalagunta

et al. 2023

Journal of Palliative Medicine

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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

2024

J of Opioid Management

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Background: To determine if marijuana legalization was associated with reduced opioid mortality. Study design: The United States (US) opioid mortality trend during the 2010-2019 decade was compared in states and District of Columbia (jurisdictions) that had implemented marijuana legalization with states that had not. Acceleration of opioid mortality during 2020, the first year of the coronavirus disease 2019 (COVID-19) pandemic, was also compared in recreational and medicinal-only legalizing jurisdictions. Methods: Joinpoint methodology was applied to the Centers for Disease Control and Prevention WONDER data. Trends in legalizing jurisdictions were cumulative aggregates. Results: The overall opioid and fentanyl death rates and the 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 all-opioid and fentanyl death rates were 44 and 50 percent greater in the legalizing than in the nonlegalizing 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 percent confidence interval) 2019-to-2020 increases were 46.5 percent (36.6, 56.3 percent) and 29.1 percent (20.2, 37.9 percent), respectively (p = 0.02). For fentanyl, they were 115.6 percent (80.2, 151.6 percent) and 55.4 percent (31.6, 79.2 percent), respectively (p = 0.01). Conclusions: During the past decade, marijuana legalization in the US was associated at the jurisdiction level with a greater acceleration in opioid death rate. An even greater increase in opioid mortality occurred in recreational-legalizing jurisdictions with the onset of the COVID-19 pandemic. Marijuana legalization is correlated with worsening of the US opioid epidemic.

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United States marijuana legalization and opioid mortality epidemic during 2010–2020 and pandemic implications

Cited by 3 publications

References 41 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

Comparison of Health Care Providers Attitudes and Beliefs Regarding Medical Marijuana and Cannabidiol in the Management of Pain and Other Symptoms in Cancer Patients

United States marijuana legalization and opioid mortality trends before and during the first year of the COVID-19 pandemic

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