Access to legal cannabis stores has been associated with a reduction in opioid-related deaths in the United States, particularly those associated with synthetic opioids such as fentanyl, according to a study published by The BMJ today.
Opioids are “morphine-type” drugs that relieve short-term (acute) pain and pain at the end of life. There is little evidence that they help with long-term (chronic) pain, but they are often prescribed for this reason.
This has led to widespread abuse and a surge in overdose deaths, especially in the United States. In 2018, there were more than 46,000 fentanyl deaths, representing more than two-thirds of all opioid-related deaths in the US in that year.
Some research has suggested that better access to cannabis stores – legally authorized to sell medical and recreational cannabis – can help reduce opioid-related deaths, but the evidence so far has been mixed.
To investigate this further, researchers examined relationships between medical and recreational cannabis stores (also called dispensaries) and opioid-related deaths between 2014 and 2018.
Their findings are based on data from 812 counties in the 23 US states that allow legal cannabis dispensaries to operate by the end of 2017.
State-level information about cannabis laws was combined with provincial-level data on licensed dispensaries and opioid-related death rates.
After controlling for population characteristics and other potentially influential factors, the researchers found that counties with a greater number of active cannabis dispensaries were associated with reduced opioid-related death rates.
By this estimate, an increase from one to two dispensaries in a province was accompanied by an estimated 17% decrease in all opioid-related death rates.
This association was true for both medical and recreational dispensaries and was especially strong for deaths associated with synthetic opioids other than methadone, with an estimated 21% decrease in death rates associated with an increase from one to two dispensaries.
An increase from two to three dispensaries was associated with a further 8.5% decrease in all opioid-related death rates.
This study is the first to examine the association between active cannabis pharmacy operations and opioid-related death rates at the more fine-grained county level.
However, the results are observational, so the cause cannot be determined, and the researchers emphasize that while cannabis is generally considered less addictive than opioids, it still carries potential harm and that risks to public safety should not be ignored.
But they say their findings suggest “a possible link between increased prevalence of medical and recreational cannabis dispensaries and decreased opioid-related death rates.”
And they call for “a better understanding of the impact of cannabis legalization on opioid abuse and its implications for public health before policymakers can weigh the potential benefits against the drawbacks of promoting cannabis legalization”.
In an accompanying editorial, researchers argue that cannabis liberalization “cannot be seen as a cure for the opioid crisis until a robust scientific basis is available.”
While some may interpret these findings as evidence in support of cannabis liberalization to address the opioid crisis, they point out that “such conclusions are currently premature with no evidence of causation.”
Further experimental studies with individual-level data from those who use prescription opioids and illicit opioids “would provide a more nuanced understanding of the substitution between opioids and cannabis,” they conclude.
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Peer rated? Yes (research); No (linked editorial comment)
Type of evidence: Observational; Opinion
Topics: Legal cannabis stores
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