Access to legal cannabis stores is associated with a reduction in opioid-related deaths in the United States, especially those related to synthetic opioids, such as fentanyl, a study published by BMJ today.
Opioids are “morphine” drugs that relieve short-term (acute) pain and end-of-life pain. There is little evidence that they are useful for long-term (chronic) pain, but they are often prescribed for this reason.
This has led to widespread misuse and a sharp rise in overdose deaths, especially in the United States. In 2018, there were more than 46,000 fentanyl-related deaths, accounting for more than two-thirds of all opiate-related deaths in the United States that year.
Some studies have suggested that increased access to cannabis stores – legally authorized to sell medical and recreational cannabis – may help reduce opioid-related deaths, but the evidence so far is mixed.
To further explore this, the researchers examined the relationships between medical and recreational cannabis stores (called dispensaries) and opioid-related deaths from 2014 to 2018.
Their findings are based on data for 812 counties in the 23 US states that allowed the operation of legal cannabis dispensaries by the end of 2017.
Information on state cannabis legislation was combined with county-level data on authorized dispensaries and opioid-related mortality rates.
After checking for population characteristics and other potentially influential factors, the researchers found that counties with a higher number of active cannabis dispensaries were associated with lower opioid-related mortality rates.
According to this estimate, an increase from one to two dispensaries in a county was associated with an estimated 17% reduction in all opioid-related mortality rates.
This association owned both medical and leisure dispensaries and appeared particularly strong for deaths associated with synthetic opioids other than methadone, with an estimated 21% reduction in the mortality rate associated with an increase from one to two dispensaries.
An increase from two to three dispensaries was associated with an additional 8.5% reduction in all opioid-related mortality rates.
This study is the first to examine the association between active cannabis dispensary operations and finer-grained opioid-related mortality rates in the county.
However, the results are observational, so they cannot determine the cause, and the researchers point out that while cannabis is generally considered less addictive than opioids, it still carries potential harm and risks to public safety should not be ignore.
But they say their findings suggest “a potential association between the increased prevalence of medical and recreational cannabis dispensaries and low opioid-related mortality rates.”
And it calls for “a better understanding of the impact of cannabis legalization on opioid abuse and public health outcomes before decision-makers can weigh the potential benefits against the harms of promoting cannabis legalization.”
In a related editorial, researchers say that cannabis liberalization “cannot be seen as a cure for the opioid crisis until there is a solid evidence base.”
Although some might interpret these findings as evidence supporting cannabis liberalization to address the opioid crisis, they point out that “such findings are currently premature, with no evidence of causation.”
Other experimental studies, including individual data of those using prescription opioids and illicit opioids, “would inform a more nuanced understanding of opioid-cannabis substitution,” they conclude.
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Evaluated by colleagues? Yes (research); No (editorial linked)
Type of evidence: observational; Opinion
Topics: legal cannabis stores
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