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Experts say recreational cannabis can reduce the demand for some prescription opioids. Maria Alejandra Cardona/Getty Images
  • New research conducted by the University of Pittsburgh and Cornell University reveals that U.S. states where recreational cannabis is legal have seen a significant decrease in the dispensing of prescription codeine by pharmacies.
  • The findings suggest that legalizing recreational cannabis use could be a promising strategy for reducing the misuse of prescription opioids, which is responsible for more than 10,000 overdose deaths annually.
  • However, experts argue that although trading one misused drug for another may result in harm reduction on some levels, it will certainly lead to other challenges.

A new study, published in Health Economics, is reporting that there was a substantial decrease in the amount of codeine being dispensed by pharmacies in U.S. states that have legalized recreational cannabis use.

To date, 21 states have passed recreational cannabis laws and legislatures in other states are considering similar measures.

The researchers highlighted the importance of reducing opioid misuse to save lives. Their study, they say, suggests that legalizing recreational cannabis use could be an effective way to achieve this goal.

By analyzing the impact of recreational cannabis laws on shipments of opioids to hospitals, pharmacies, and other endpoint distributors, the researchers say the study sheds light on a potential benefit that has not received much attention before.

This study is one of the first to look at the impact of recreational cannabis laws on dispensing patterns of specific opioids. Previous studies have mostly focused on medical cannabis laws in specific subsets of consumers, such as Medicaid beneficiaries.

The researchers analyzed data from the Drug Enforcement Administration’s Automation of Reports and Consolidation Orders System (ARCOS) to track the flow of controlled substances in the United States.

They reported that states that have legalized recreational cannabis use experienced a significant reduction in the dispensing of codeine in retail pharmacies, with a 26% decrease observed overall and up to 37% after four years of implementation.

However, they observed minimal impact on other opioid prescriptions such as oxycodone, hydrocodone, and morphine in any setting.

Additionally, they found that the impact on codeine dispensing in hospitals was minimal. The researchers suggest this finding was likely due to a lower risk of opioid misuse within hospitals compared to outpatient settings.

Overall, they said these findings suggest that legalizing recreational cannabis use may be an effective strategy for reducing the demand for prescription codeine, which has a high potential for misuse and can result in overdose deaths.

Medical News Today spoke to four independent experts, not involved in this research, for their understanding on this topic.

Dr. Sherry Yafai, an emergency medicine physician at Saint John’s Physician Partners Urgent Care and an adjunct assistant professor at Saint John’s Cancer Institute in California, said, “this is another addition to the fund of knowledge that the scientific world is building to show that the legalization of cannabis results in the improvement of public health, specifically by decreasing the number of opiates being dispensed at the local level.”

Yafai, who is a cannabis specialist, pointed out that although this is an observational study, the research “is consistent with multiple other studies that look at the decrease in prescriptions of opiates, the decrease of mortality from opiate that are occurring with changes in state laws that are associated with cannabis both medical and recreational cannabis legalization.”

However, Yafai said that “notably, hospitals, which represent a placebo-like environment for comparison, are still increasing the number of prescription opiates dispensed during the same timeframe that local pharmacies decrease dispensing opiates.”

Rebecca Abraham RN BSN, founder of Acute on Chronic LLC, told MNT that “this paper also correlates with what we have seen clinically with chronic pain patients and patients with a history of substance abuse, in particular opioid abuse.”

Abraham highlighted the potential benefits for patients, saying, “we’ve had patients with both acute and worsening chronic pain who were recommended to start opiates, but we’re able to treat their pain effectively using only cannabis.”

We’ve also seen a number of patients who had been on opioid pain medications for years who have been able to dramatically reduce the amount of opiates that they use or come off of them altogether. So it isn’t surprising to see reductions at the systemic level as well. It’s also interesting to see this emerge from states with full recreational cannabis laws, as it makes cannabinoids available to a much larger population, not just those who are able to navigate getting a medical card.

Rebecca Abraham RN BSN

Ryan Sheridan, a psychiatric mental health nurse practitioner, told MNT that “the apparent correlation between recreational cannabis laws and a reduction in opioid use suggests a potential step in the right direction in the battle against opioid/opiate abuse.”

However, Sheridan urges caution, highlighting the concerns around cannabis misuse.

Trading one misused drug for another may result in harm reduction on some levels but will certainly uncover other challenges, so it would be helpful to know patterns of use from individuals who have switched from codeine to cannabis. Moreover, are cannabis users receiving direction or prescriptive advice consistent with an evidence based approach to pain management?

Ryan Sheridan, NP

“I see a lot of patients who struggle with cannabis in ways most individuals do not expect given the shift in acceptance toward cannabis,” Sheridan explained.

“While it may be less harmful in some ways compared to opioids, the wide acceptance of cannabis use has elicited concerns about increases in cannabis related diagnoses including psychiatric disorders and cardiovascular diseases,” he said.

My recommendations after reading the article remain the same: cannabis, when used prudently, can be a helpful tool in the treatment of diseases, including chronic pain. It is imperative to note the use of cannabis for medicinal purposes is significantly lower than most recreational doses. Prescribers should be open to cannabis use for patients and should be educated on how to effectively and safely make recommendations for its use.

Ryan Sheridan, NP

Dr. Lewis Jassey, DO, the medical director at Leafwell, notes that there is mixed evidence regarding the effects of cannabis on opioid use and addiction and that addiction is a complex problem that requires multiple approaches to treatment.

Jassey highlights that “the benefits and harms of cannabis legalization need to be fully actualized.”

“At this moment, the evidence is inconsistent to be for or against either position, at least from the government’s perspective,” he told MNT.

Jassey explained that the overall trend in the United States is toward increasing legalization of medical and recreational cannabis, and there is a clear appetite for regulated medical cannabis. However, ethical questions arise regarding the denial of access to cannabis for those who could benefit from it.

In conclusion, Jassey said, “this study alone won’t necessarily change laws overnight, but combined with other positive studies showing that the benefits outweigh the harms, it will contribute to the federal legalization of cannabis (more likely medical cannabis).”