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Original Investigation
Health Care Policy and Law
May 2018

Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees

Author Affiliations
  • 1Department of Health Management & Policy, University of Kentucky College of Public Health, Lexington
  • 2Department of Health Policy & Management, Emory University Rollins School of Public Health, Atlanta, Georgia
  • 3National Bureau of Economic Research (NBER), Cambridge, Massachusetts
JAMA Intern Med. 2018;178(5):673-679. doi:10.1001/jamainternmed.2018.1007
Key Points

Question  Are medical and adult-use marijuana laws passed after 2010 associated with lower rates of opioid prescribing for Medicaid enrollees?

Findings  In this population-based, cross-sectional study using the all-capture Medicaid prescription data for 2011 to 2016, medical marijuana laws and adult-use marijuana laws were associated with lower opioid prescribing rates (5.88% and 6.38% lower, respectively).

Meaning  Medical and adult-use marijuana laws have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose, and marijuana liberalization may serve as a component of a comprehensive package to tackle the opioid epidemic.

Abstract

Importance  Overprescribing of opioids is considered a major driving force behind the opioid epidemic in the United States. Marijuana is one of the potential nonopioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose. Marijuana liberalization, including medical and adult-use marijuana laws, has made marijuana available to more Americans.

Objective  To examine the association of state implementation of medical and adult-use marijuana laws with opioid prescribing rates and spending among Medicaid enrollees.

Design, Setting, and Participants  This cross-sectional study used a quasi-experimental difference-in-differences design comparing opioid prescribing trends between states that started to implement medical and adult-use marijuana laws between 2011 and 2016 and the remaining states. This population-based study across the United States included all Medicaid fee-for-service and managed care enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose.

Exposures  State implementation of medical and adult-use marijuana laws from 2011 to 2016.

Main Outcomes and Measures  Opioid prescribing rate, measured as the number of opioid prescriptions covered by Medicaid on a quarterly, per-1000-Medicaid-enrollee basis.

Results  State implementation of medical marijuana laws was associated with a 5.88% lower rate of opioid prescribing (95% CI, −11.55% to approximately −0.21%). Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38% lower rate of opioid prescribing (95% CI, −12.20% to approximately −0.56%).

Conclusions and Relevance  The potential of marijuana liberalization to reduce the use and consequences of prescription opioids among Medicaid enrollees deserves consideration during the policy discussions about marijuana reform and the opioid epidemic.

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    1 Comment for this article
    EXPAND ALL
    Should marijuana be co-prescribed with opioids, when the latter are needed for pain?
    DAVID KELLER, M.D., M.S. | Retired internal medicine physician.
    These results imply that the liberalized prescribing of marijuana may result in decreased use of opioids, and hence, fewer subsequent opioid-related overdose events.

    Marijuana has demonstrated some mild analgesic effects, when compared with placebo in clinical studies, but has not been proven to relieve pain as effectively as opioids.

    Dangerous effects of opioid abuse, including fatal respiratory depression, result when patients exceed safe dosages in an attempt to get high, or experience the opioid "rush".

    Could this study's results be explained by the possibility that abuse-prone patients are satisfied with the less-dangerous marijuana "high", and therefore
    demand less opioid medication when legal marijuana is available?

    If so, perhaps marijuana could be co-prescribed with opioids, as prophylaxis to opioid abuse, when opioids are required to treat appropriate pain syndromes, after appropriate studies have been conducted.
    CONFLICT OF INTEREST: None Reported
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