FROM JAMA INTERNAL MEDICINE

Laws covering medical or recreational use of marijuana are associated with reduced rates of opioid prescribing among federal health care program enrollees, results of two recently published investigations show.

In one study, researchers investigated whether medical cannabis access affected opioid prescribing in Medicare Part D, the federal program that subsidizes cost of prescription drugs and drug insurance premiums.

Opioid prescribing in Part D was lower in states that permitted access to medical cannabis, according to investigator Ashley C. Bradford of the department of public administration and policy the University of Georgia, Athens, and her colleagues.

“Medical cannabis policies may be one mechanism that can encourage lower prescription opioid use and serve as a harm abatement tool in the opioid crisis,” Ms. Bradford and her coauthors wrote in JAMA Internal Medicine.

Medical marijuana laws were associated with a decrease of 2.11 million daily opioid doses yearly from an average of 23.08 million doses yearly in the Medicare Part D population, according to results of the longitudinal analysis daily opioids doses filled in Medicare Part D from 2010 through 2015.

In a second study, medical marijuana laws were associated with lower opioid prescribing rates among Medicaid enrollees.

That finding was consistent with earlier studies looking more broadly at pain prescriptions covered by Medicaid that also showed a reduction, researchers Hefei Wen, PhD, and Jason M. Hockenberry, PhD, wrote in their JAMA Internal Medicine article.

However, adult-use marijuana laws were associated with “even-lower” opioid prescribing rates, something that had not been investigated previously, according to Dr. Wen, who is with the University of Kentucky, Lexington, and Dr. Hockenberry of Emory University, Atlanta.

“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,” Dr. Wen and Dr. Hockenberry wrote in their report on the study, a cross-sectional analysis including all Medicaid fee-for-service and managed care enrollees during 2011-2016.

The rate of opioid prescribing in the study was –5.88% lower (95% confidence interval, –11.55% to approximately –0.21%) in association with medical marijuana laws, and –6.38% lower (95% CI, –12.20% to approximately –0.56%) for adult-use laws, they reported.

Based on those findings, policy discussions about the opioid epidemic should include the potential for liberalization of marijuana policies to reduce prescription opioid use and consequences in Medicaid enrollees, Dr. Wen and Dr. Hockenberry concluded.

However, legal marijuana alone won’t solve the opioid epidemic, they cautioned.

“As with other policies evaluated in the previous literature, marijuana liberalization is but one potential aspect of a comprehensive package to tackle the epidemic,” they said in the article.

None of the study authors reported conflicts of interest.

imnews@mdedge.com

SOURCES: Bradford AC et al. JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.0266; Wen H, Hockenberry JM. JAMA Intern Med. 2018 Apr 2. doi: 10.1001/jamainternmed.2018.1007.

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