Researchers welcome temporary drop in opioid emergency visits associated with cannabis use

A recent study examined emergency department visits associated with marijuana use in Washington State. Currently, Washington is one of nine states (along with the District of Columbia) that have laws allowing for the use of marijuana for medicinal purposes. Investigators looked at emergency department visit rates for 1999-2013. They found that the number of emergency department visits decreased by about 10% from 2013 to 2014, a decrease that was most pronounced among the 30% of people who had no prior emergency department visits related to marijuana use.

We often see increased media coverage of opioid abuse and overdose in the United States. Periods of increased opioid use often coincide with the increased availability of illicitly manufactured heroin, prescription opioids, and other drugs. However, it appears that the increase in illicit drug use may also be associated with a temporary decrease in opioid abuse.

This is not trivial – the drop in opioid-related emergency room visits, even if only for six months, is a welcome development for public health.

In US states where cannabis is legal for recreational use, the number of emergency room visits related to opioids has dropped in the short term, a new study from the University of Pittsburgh shows.

Data from California, Maine, Massachusetts and Nevada show a 7.6 percent drop in opioid-related emergency room visits in the six months after marijuana legalization for adults, compared with states where marijuana is not legalized, the university said in a statement.

And while the drop wasn’t dramatic, the researchers stress that any decrease in opioid use should be encouraged.

This is not trivial – a decrease in opioid-related emergency room visits, even if it’s only six months, is a welcome development for public health, says Coleman Drake, PhD, lead author of the study and associate professor of health policy and management.

The findings, published this week in the journal Health Economics, were made after analyzing data on opioid-related visits in 29 states between 2011 and 2017. The four states listed above have legalized cannabis for recreational use, while the others have served as witnesses.

Even after the temporary decrease in effect, the researchers found that legalizing marijuana for adults was not associated with an increase in opioid-related emergency room visits. This suggests that recreational marijuana is not a gateway to opioids, according to a statement from the university.

However, Drake warns that while liberalization of cannabis may help in the fight against the opioid epidemic, it is unlikely to be a panacea.

Coleman Drake, PhD, is assistant professor of health policy and management at the Graduate School of Public Health at the University of Pittsburgh. / PHOTO: UNIVERSITY OF PITTSBURGH

Recent evidence suggests that recreational cannabis laws may be a harm reduction tool in the fight against the opioid epidemic. People can use cannabis to relieve pain and withdrawal symptoms from opioids, although it does not directly treat opioid-related illnesses, the study’s abstract says.

Based on our results, we cannot draw a definitive conclusion about why these laws are associated with a temporary decrease in opioid-related emergency room visits, but based on our results and previous literature, we suspect that people who use opioids for pain management are replacing them with cannabis, at least temporarily, Drake suggests.

States can combat the opioid epidemic by expanding access to treatment for opioid-related conditions and reducing opioid use through recreational cannabis laws, he suggests. These measures are not mutually exclusive; on the contrary, they are both a step in the right direction.

Data from the U.S. Centers for Disease Control and Prevention shows that there were more than 81,000 drug overdose deaths between June 2019 and May 2020 – an unenviable record. According to the researchers, almost half of the country’s population now lives under the rule of law.

Research findings on the effects of cannabis use on opioid use are mixed. For example, a Canadian study published last year found that cannabis use was associated with less exposure to potentially lethal fentanyl in people treated with opioid agonists for opioid use disorder.

But a study published last month found that patients who tried smoking marijuana as part of a risk reduction strategy to prevent a return to opioid use were unsuccessful.

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