The number of people addicted to and dying from opioids has risen to an alarming level, causing healthcare professionals and the media to state America has an opioid crisis. It is estimated that there are 90 overdoses from opioids every day in the U.S., affecting every age, race, and gender.1 Opioids are powerful pain medications that are highly addictive and may be used to treat pain in people who can’t take or don’t get relief from other medications.
Could legalizing marijuana be part of the solution to the opioid crisis?
Two studies recently published in the Journal of the American Medical Association (JAMA) Internal Medicine suggest that the legalization of cannabis – also known as medical marijuana – may have a beneficial role in alleviating the opioid crisis.2
Editor’s note: While individual state laws may differ on the legality of marijuana products, the federal Drug Enforcement Agency considers all marijuana products to be illegal substances.
The first study examined opioid prescribing data from 2010 to 2015 from Medicare, which provides healthcare benefits to individuals aged 65 or older. Researchers found that in states that had legalized medical marijuana, Medicare prescriptions for opioids fell by 2.21 million daily doses a year. There was a noticeable difference in opioid prescriptions based on the type of marijuana laws as well. In states that had more structured laws that allowed medical cannabis dispensaries, the number of opioid prescriptions went down 3.74 million daily doses per year, compared to a reduction of only 1.79 million daily doses per year in states that only allowed individuals to grow their own marijuana for medical use at home.2,3
The second study examined opioid prescribing data from 2010 to 2016 from Medicare, the government assistance program that provides healthcare benefits to individuals with low income and those who qualify for disability. Researchers found that in states that had medical marijuana laws, Medicaid opioid prescriptions decreased by 5.88%, and those states with recreational cannabis laws had a 6.38% reduction in opioid prescriptions.2,4
What are the limitations of this data?
While these two studies provide interesting clues, they do have significant limitations. For example, there is no way to prove causation: it is not known whether the access to marijuana caused patients to ask for fewer opioids or to avoid using them. The states that have legalized marijuana may also have other significant differences from states that have not that influence opioid use and abuse, such as racial makeup of the population, the levels of education obtained, the prevalence of different diseases, the rate of disability within the population, and suicide rates. Two of the states with medical marijuana laws (Connecticut and Maryland) had no change in opioid prescribing. Finally, the data in each of these studies were confined to populations who are on Medicare or Medicaid, and they may not be representative of the population at large.2,4,5
Critics also point out that making marijuana more accessible can also have significant harms, including a higher risk of mood, anxiety, and psychotic disorders, particularly among adolescents.5
Both critics and proponents agree that research on cannabis and medical marijuana is severely lacking compared to the push for marijuana legalization. There is a scarcity of funding, both at the federal and state levels, for cannabis research, and there is not enough rigorous scientific data to understand the benefits and long-term safety risks of medical marijuana.2,5
What’s the difference between cannabis and marijuana?
The plant is called cannabis. Traditionally, the smoking form of cannabis has been called marijuana, although some oral formulations are now also called marijuana.
How does medical marijuana work in the body?
Researchers have discovered that the human body has an endocannabinoid system (ECS). (“Endo” means internal or within the body.) The ECS is distributed throughout the body and plays a part in regulating many functions, including pain, mood, appetite, and the movement of the gastrointestinal system. The ECS is comprised of the cannabinoids the body produces, the receptors on which they act, and the enzymes that are involved. The two most well-known cannabinoids are THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). THC has been associated with a reduction of nausea and pain, increased appetite, and psychological effects like euphoria and altered sensory perception, which can make users feel “high” or intoxicated. CBD does not produce intoxicating effects, but it produces sedative effects that can help reduce convulsions, nausea, and inflammation. THC and CBD have similar shapes to the internal cannabinoids and work on the same receptors.6-8
What are the risks of using medical marijuana?
The long-term negative effects of medical marijuana are not known. Few studies have been conducted on the long-term safety of cannabis, and those that have been completed are conflicting or are of poor quality. The medical field has identified several potential complications, including psychological addiction, a lowering of IQ, impaired immune function, decreased fertility, increased risk of motor vehicle accidents, and psychological issues like anxiety, paranoia, psychosis.6,7
The short-term side effects of cannabis are better understood and include temporary impairment of short-term memory and concentration, increase in anxiety or paranoia, lowered blood pressure, increased heart rate, and impaired motor skills.6
Editor’s note: While marijuana is available in some states, each individual should consult with their doctor and the laws of the state they reside in before considering the possibility of using medical marijuana. Also, federal law still considers the use of cannabis in any form to be illegal.
Rudd RA, Set P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445-1452.
Hill KP, Saxon AJ. The Role of Cannabis Legalization in the Opioid Crisis. JAMA Intern Med. Published online April 02, 2018. doi:10.1001/jamainternmed.2018.0254.
Bradford AC, Bradford WD, Abraham A, Bagwell Adams G. Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population [published online April 2, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.0266.
Wen H, Hockenberry JM. Association of medical and adult-use marijuana laws with opioid prescribing for Medicaid enrollees [published online April 2, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.1007.
Chadi N, Levy S. Easing access to marijuana is not a way to solve the opioid epidemic. Stat. April 12, 2018. Available at https://www.statnews.com/2018/04/12/marijuana-access-opioid-epidemic/. Accessed 4/30/18.
Ahmed W, Katz S. Therapeutic Use of Cannabis in Inflammatory Bowel Disease. Gastroenterology & Hepatology. 2016;12(11):668-679.
R Medical cannabis and IBD. GI Society. Available at https://www.badgut.org/information-centre/a-z-digestive-topics/medical-marijuana-and-ibd/. Accessed 4/30/18.
Esposito G, De Filippis D, Cirillo C, et al. Cannabidiol in inflammatory bowel diseases: a brief overview. Phytother Res. 2012. doi: 10.1002/ptr.4781. Available at https://lirias.kuleuven.be/bitstream/123456789/356043/1/ptr4781.pdf. Accessed 4/30/18