Opioid epidemic is a global problem leading to more than 55% increase of premature death caused by drug abuse. In October 2017 the opioid epidemic was declared ‘National Public Health Emergency’. The number of opioid prescriptions for the period 1993 – 2013 raised from 76 million to 207 million. Since 1996, 29 states and Washington DC legalised cannabis for medical use at state level.
The authors of the research have reviewed available literature studying the relationship between the cannabis legalisation and opioid prescriptions in the states where medical cannabis is legal. They have included data from Medicare and Medicard enrolees. In the United States, Medicare is a federal health insurance program primarily covering senior people aged 65 years or older, and Medicaid is a joint federal and state program primarily covering people with low income or disabilities.
The researches have concluded that cannabis legalization was associated with nearly 30% reduction in Schedule 3 opioids. They were not able to find connection between cannabis legalization and Schedule 2 opioids which account for 95% of all opioid prescriptions. This is due to lack of available data on individual level. In the United States, Schedule III opioids are used typically to treat mild to moderate pain and refillable within 6 months without new prescriptions. In contrast, Schedule II opioids must be refilled with new monthly prescriptions because of their higher potential of dependence and abuse, such that patients prescribed Schedule II opioids are required to receive regular monitoring and evaluations from physicians. Also cannabis has shown mild to moderate pain relief effect which is comparable with codeine which makes cannabis better alternative than Schedule 3 opioids. Due to the concern of cannabis’ lack of efficacy on severe pain symptoms, patients prescribed Schedule II opioids might be less likely to switch to medical cannabis and physicians might be less likely to recommend medical cannabis to these patients.
It was estimated that, if all the states had legalized medical cannabis by 2014, Medicaid annual spending on opioid prescriptions would be reduced by 17.8 million dollars.