Pubdate: Mon, 02 Apr 2018
Source: Lexington Herald-Leader (KY)
Copyright: 2018 Lexington Herald-Leader
Author: Malcolm Ritter


Can legalizing marijuana fight the problem of opioid addiction and
fatal overdoses? Two new studies in the debate suggest it may.

Pot can relieve chronic pain in adults, so advocates for liberalizing
marijuana laws have proposed it as a lower-risk alternative to
opioids. But some research suggests marijuana may encourage opioid
use, and so might make the epidemic worse.

The new studies don't directly assess the effect of legalizing
marijuana on opioid addiction and overdose deaths. Instead, they find
evidence that legalization may reduce the prescribing of opioids.
Over-prescribing is considered a key factor in the opioid epidemic.

Both studies were released Monday by the journal JAMA Internal

One looked at trends in opioid prescribing under Medicaid, which
covers low-income adults, between 2011 and 2016. It compared the
states where marijuana laws took effect versus states without such
laws. The comparison was done each quarter, so a given state without a
law at one point could join the other category once a law kicked in.

Results showed that laws that let people use marijuana to treat
specific medical conditions were associated with about a 6 percent
lower rate of opioid prescribing for pain. That's about 39 fewer
prescriptions per 1,000 people using Medicaid.

And when states with such a law went on to also allow recreational
marijuana use by adults, there was an additional drop averaging about
6 percent. That suggest the medical marijuana laws didn't reach some
people who could benefit from using marijuana instead of opioids, said
Hefei Wen of the University of Kentucky in Lexington, one of the study

The other study looked at opioid prescribing nationwide for people
using Medicare, which covers people 65 years or older and those with
disabilities. Every year from 2010 through 2015, researchers compared
states with a medical marijuana law in effect to those without one.
Fourteen states plus the District of Columbia had such a law from the
beginning of that time; nine other states joined them during the years
the study covered.

Researchers found that Medicare patients in states with marijuana
dispensaries filled prescriptions for about 14 percent fewer daily
doses of opioids than those in other states. Patients in states that
only allowed them to grow pot at home showed about 7 percent fewer

W. David Bradford, an economist at the University of Georgia in Athens
who's an author of the second study, said the results add to other
findings that suggest to experts that marijuana is a viable
alternative to opioids. The weight of that evidence is "now hard to
ignore," said Bradford, who said he thinks federal regulations should
be changed to allow doctors to prescribe marijuana for pain treatment.

The two studies have some limitations, Dr. Kevin Hill of Harvard
Medical School and Dr. Andrew Saxon of the University of Washington in
Seattle wrote in an accompanying editorial.

For one thing, they don't reveal whether individual patients actually
reduced or avoided using opioids because of the increased access to
marijuana. The findings in Medicaid and Medicare patients may not
apply to other people. And the results may have been skewed by some
characteristics of the state populations studied, they wrote.

They called for states and the federal government to pay for more
studies to clarify the effect of marijuana use on opioid use, saying
such research is needed for science to guide policy-making.
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