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Invited Commentary
May 2018

The Role of Cannabis Legalization in the Opioid Crisis

Author Affiliations
  • 1Division of Addiction Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 2Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Healthcare System, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
JAMA Intern Med. 2018;178(5):679-680. doi:10.1001/jamainternmed.2018.0254

The United States remains gripped by the opioid crisis. Each day, 90 Americans die from opioid overdoses.1 Owing to the incredible reach of the opioid crisis—it has affected people of every race, sex, and age across our country—many stakeholders are trying to combat the crisis using multipronged approaches emphasizing prevention, treatment, and law enforcement.

In this issue of JAMA Internal Medicine, Bradford et al2 and Wen and Hockenberry3 report results suggesting that cannabis legalization may play a beneficial role in the opioid crisis. To examine the association between prescribing patterns for opioids in Medicare Part D and the implementation of state medical cannabis laws (MCLs), Bradford et al2 performed a longitudinal analysis of the number of prescriptions filled under Medicare Part D for all opioids as a group and for the categories of opioids by state and state-level MCLs from 2010 through 2015. Medicare Part D prescriptions for opioids fell by 2.21 million daily doses filled per year (95% CI, −4.15 to −0.27) when MCLs went into effect in a given state. The type of MCL implemented in these states was important as well, with greater reductions in opioid prescriptions observed in states with more structured MCLs that increased access to medical cannabis. Prescriptions for opioids fell by 3.74 million daily doses per year (95% CI, −5.95 to −1.54) when medical cannabis dispensaries opened, but only by 1.79 million daily doses per year (95% CI, −3.36 to −0.22) when states only offered allowances for home cultivation. Similarly, Wen and Hockenberry3 analyzed Medicaid prescription data from 2011 to 2016 and found that both medical and recreational cannabis laws were associated with annual reductions in opioid prescribing rates of 5.88% and 6.38%, respectively.

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