Does Medical Marijuana Prevent Prescription Drug Abuse and Overdose?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Twenty-three states and the District of Columbia have now passed medical marijuana laws, and four more have pending legislation to legalize medical marijuana. Meanwhile, the use of prescription opioid medications (hydrocodone, oxycodone) has increased as the number of Americans with chronic non-cancer pain has increased. With that, we have seen in the United States the disturbing rise in prescription opioid abuse and overdose deaths. A recent study addressed whether the use of nonopioid treatments, specifically medical marijuana, affects overdose rates.

Ten things we’ve learned about medical marijuana laws and opioid deaths:

  1. Medical marijuana laws are associated with increased marijuana use among adults (seems obvious but let’s start there). This increased access may reduce the use of prescription pain medications in patients with chronic pain, and therefore reduce opioid overdoses.
  1. If the above is true, then states with medical cannabis laws should have lower opioid analgesic overdose deaths (this was the question addressed in the study).
  1. Guess what, they do. From 1999 to 2010, states with medical cannabis laws had lower rates of death from opioid overdose compared with states without such laws.
  1. Lower opioid mortality rates in those states persisted even when including all deaths related to heroin—indicating that lower rates of prescription drug overdose were not offset by higher rates of heroin overdose.
  1. Approximately 60% of all opioid analgesic overdoses occur among patients who have legitimate prescriptions from a single provider. This we would love to prevent.
  1. It appears that when patients already receiving opioid analgesics start medical marijuana, they decrease their opioid use, which decreases their risk of overdose.
  1. Medical marijuana laws may lead to decreases in polypharmacy (patients taking a mixture of meds along with their opiates like Ativan, Xanax, or Valium), meaning overdose risk would be decreased.
  1. Marijuana use is associated with modest reductions in opioid withdrawal symptoms for some people which may also help reduce opioid use.
  1. Medical marijuana may lessen the drive to use opiates at lethal levels in people with non-pain psychiatric conditions.
  1. If more and more patients with chronic non-cancer pain choose medical cannabis instead of opioids, rates of use/overuse and overdose may drop.

Interested in the study? You can find more information here.

Thoughts?

Dr O.

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