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Impact of medical marijuana legalization on opioid use, chronic opioid use, and high-risk opioid use
Objective
To determine the association of medical marijuana legalization with prescription opioid utilization.
Methods
A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006-2014. Adults with pharmacy and medical benefits for the entire calendar year were included in the population for that year. Multilevel logistic regression analysis, controlling for patient, person-year, and state-level factors, were used to determine the impact of medical marijuana legalization on the three opioid use measures. Sub-group analysis among cancer-free adults and cancer-free adults with at least one chronic non-cancer pain condition in the particular year were conducted. Alternate regression models were used to test the robustness of our results including a fixed effects model, an alternate definition for start date for medical marijuana legalization, a person-level analysis, and a falsification test.
Results
The final sample included a total of 4,840,562 persons translating into 15,705,562 person years. Medical marijuana legalization was found to be associated with a lower odds of any opioid use: OR?=?0.95 (0.94-0.96), chronic opioid use: OR?=?0.93 (0.91-0.95), and high-risk opioid use: OR?=?0.96 (0.94-0.98). The findings were similar in both the sub-group analyses and all the sensitivity analyses. The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR?=?1.00; CI 0.99-1.01) or antihypertensives (OR?=?1.00; CI 0.99-1.01).
Conclusions
In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use. However, further research assessing risk versus benefits of medical marijuana legalization and head to head comparisons of marijuana versus opioids for pain management is required.
Authors
A Shah, C J Hayes, M Lakkad, B C Martin
Journal
Journal of General Internal Medicine
Therapeutic Area
Neurology
Center of Excellence
Real-world Evidence & Data Analytics
Year
2019
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