As more Americans have started using medical marijuana, they’ve actually misused more opioids, not less, a new study reveals.
Prior studies have suggested an encouraging trend: doctors were writing fewer prescriptions for opioid painkillers in states where medical marijuana was legalized.
But Columbia University research suggests that that trend is not what it seems.
They found that people are no less likely to misuse the prescriptions in states where weed is legal, and in fact these states had slightly higher rates of painkiller abuse.
In states where medical marijuana has been legalized, rates of opioid prescribing have fallen, but a new study found that Americans who misuse painkillers aren’t the ones getting fewer pills and using more marijuana
Some have looked to marijuana with the hope that it would be a sort of catch-all fix for everything from staggeringly high incarceration rates to the opioid epidemic.
Marijuana has shown promise in treating some of the same issues that narcotics do, such as sleeplessness and pain.
So some public health policy makers hoped that the legalization of one would drive down the demand for the other.
As time has gone on and more states have made medical marijuana legal (it can now be purchased with a prescription in 33 US states), opioid misuse has only increased at the national level.
The latest estimates suggest that some two million Americans had a diagnosable opioid misuse disorder, as of 2015.
Meanwhile, more people die each year of opioid overdoses than in the previous year.
In 2017, drug overdoses claimed over 70,000 lives.
More people are using marijuana, too, and it does not seem possible to overdose on, at least for healthy adults.
Large epidemiological studies made it appear as though marijuana adoption might be driving down opioid misuse.
Following the legalization of marijuana, states like Colorado, California and Washington saw decreases in the numbers of opioid prescriptions.
OPIOIDS IN AMERICA: BY THE NUMBERS
Opioid prescriptions are going down across the US, but overdoses are not.
Last year, the rate of opioid overdose deaths hit a record high, with around 200 Americans dying every day, according to new figures, published by the DEA earlier this month.
US Health Secretary Alex Azar insists the tide has turned this year.
However, doctors warn the boom in prescriptions flooded the market with unused pills, some of which may have made it onto the black market.
An in-depth analysis of 2016 US drug overdose data shows that America’s overdose epidemic is spreading geographically and increasing across demographic groups.
Drug overdoses killed 63,632 Americans in 2016.
Nearly two-thirds of these deaths involved a prescription or illicit opioid. Overdose deaths increased in all categories of drugs examined for men and women, people ages 15 and older, all races and ethnicities, and across all levels of urbanization.
The Orange County Health Agency found that there has been an 88 percent of drug overdose deaths between 2000 and 2015.
Half of those deaths were due to accidental prescription drug overdoses. Seven out of every 10 overdose deaths between 2011 and 2015 involved opioids.
Source: CDC, Orange County Health Agency
Fewer people were dying from drug overdoses post-medical marijuana legalization.
And hospitals were treating less overdose patients.
It was all very promising.
But those studies took broad data from various states and had no way of telling if the people who were being spared from overdose were the same ones using medical marijuana.
Nor could they give details on whether people who had been misusing opioids recreationally were getting fewer prescriptions for the drugs, or if people in general were simply getting fewer of these prescriptions.
The new Columbia study did, however.
Scientists analyzed data from an annual survey sent out to some 70,000 people 12 and older in the US.
They looked for trends in opioid and marijuana use based on whether and when a state legalized the latter.
Disappointingly, that had been misusing opioids were not the ones to make the switch to marijuana, nor were they less at risk for overdose.
‘Other studies that found an inverse association between medical marijuana enactment and opioid-outcomes did not measure opioid-outcomes for individuals,’ said Dr Silvia Martins, an epidemiologist and lead study author said.
Research on the public health effects of legal marijuana is a hotly contested, if relatively new, area of study.
In recent years, top institutions with backing the National Institutes of Health (NIH), as the Columbia study has, have used highly credible methodology to look at broad trends, and established a connection between legal weed and lower opioid prescription rates.
‘The hypothesis generated from these studies is that after medical marijuana law enactment, health care professionals would be more likely to prescribe medical marijuana instead of opioid medications, this in turn would reduce the chance of individuals to misuse prescription opioids and develop consequences.
‘We tested this relationship and found no evidence that the passage of medical marijuana laws – even in states with dispensaries – was associated with a decrease in individual opioid use of prescription opioids for nonmedical purposes.’
In other words, medical marijuana may be a good alternative to prescription opioids for new chronic pain patients, but those already using opioids aren’t making the switch.
‘Our findings may suggest that medical marijuana policies could be insufficient to reduce individual-level opioid outcomes and that opioid-specific approaches and policy interventions such as prescription drug monitoring programs, and laws on prescribing practices are needed,’ said Dr Martins.
THE PUBLIC HEALTH EFFECTS OF LEGALIZING RECREATIONAL MARIJUANA
Marijuana is now legal for recreational use in 10 states and for medical use in 33 (including those where it is also legal for recreational use).
Research on public health outcomes in states where recreational use is legal has yielded a mixture of positive and negative outcomes.
As they were early adopters, much of this research focuses on Colorado and California.
Colorado saw a six percent drop in opioid overdose deaths in the two years following the legalization of recreational cannabis there, according to a study published in 2017.
Perhaps unsurprisingly, more adolescents use marijuana in any other state in the US.
But, since weed was legalized for recreational use in 2014, teens have actually been drinking less alcohol, using other drugs less and even using cannabis at the lowest rates in a decade.
There has been an uptick in hospitalizations for marijuana exposure in states where the drug is legal for recreational use.
Public health officials have noted a particularly sharp rise among teen ER visits for pot exposure.
So-called ‘drugged-driving’ has climbed sharply in states where marijuana is legal.
In fact, in 2016, half of all people who died in car accidents had marijuana, opioids or both in their systems at the time of death, according to a Governors Highway Association study.