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As more states legalize medical and recreational marijuana, doctors may be replacing opioid prescriptions with suggestions to visit a local marijuana dispensary. Two papers published Monday in JAMA Internal Medicine analyzing more than five years of Medicare Part D and Medicaid prescription data found that after states legalized weed, the number of opioid prescriptions and the daily dose of opioids went way down.

That indicates that some people may be shifting away from prescription drugs to cannabis, though the studies can’t say whether this substitution is actually happening or if patients or doctors are the driving force.


“In this time when we are so concerned — rightly so — about opiate misuse and abuse and the mortality that’s occurring, we need to be clear-eyed and use evidence to drive our policies,” said W. David Bradford, an economist at the University of Georgia and an author of one of the studies. “If you’re interested in giving people options for pain management that don’t bring the particular risks that opiates do, states should contemplate turning on dispensary-based cannabis policies.”

Previous research has pointed to a similar correlation. A 2014 paper found that states with medical marijuana laws had nearly 25 percent fewer deaths from opioid overdoses.

But the new research is the first to connect marijuana legalization to prescription painkillers with such large data sets.


One of the two new studies found that people on Medicare filled 14 percent fewer prescriptions for opioids after medical marijuana laws were passed in their states. The second study found that Medicaid enrollees filled nearly 40 fewer opioid prescriptions per 1,000 people each year after their state passed any law making cannabis accessible — with greater drops seen in states that legalized both medical and recreational marijuana.

Those findings are somewhat positive from a public health angle. Opioids, in addition to an addictive potential much greater than that of marijuana, have other unappealing side effects. “The effect of opioids chronically — they wreak havoc on your GI tract,” said Marie Hayes, a psychologist at the University of Maine. Of course, medical cannabis is a drug with side effects, too. Obviously people can get high, though that does depend on the concentration of the psychoactive compound, tetrahydrocannabinol, in the strain or formulation that someone is using.

Marijuana’s safety profile isn’t really at issue. “People are convinced of its safety,” Hayes said. But there’s just not a lot of evidence supporting marijuana as a chronic pain treatment in its own right. “I would say the evidence has been very modest up until about 10 years ago, because nobody would fund the research,” she said. Still, opioids as a chronic pain treatment have a checkered reputation as well: One recent study found opioids didn’t provide any more relief for chronic arthritis pain than over-the-counter painkillers.

Americans seem more willing than ever to accept marijuana. A recent Pew survey found that 61 percent of Americans favor legalizing pot. Nine states and the District of Columbia allow adults to use it for whatever reason they want, while more than 20 other U.S. states permit residents to use marijuana for medicinal purposes. But not all states with medical marijuana laws are created equal, the studies found. States with dispensaries that are open for business saw the greatest decrease in opioid prescriptions, while states without active dispensaries saw a far less dramatic decline — about 7 percent instead of about 14.

That makes sense, Bradford noted. There’s a big difference between telling someone they can pick up a prescription at a local pharmacy and telling someone they should go pick up some plants and grow them at home for a few months, often with little help or support.

Neither Medicaid nor Medicare will reimburse people for money they spend on marijuana. While the amount of money spent on opioids in states with a medical marijuana law fell by about 8 percent, the costs of both treatments might be comparable. “I did a back-of-the-envelope calculation that suggested that a daily pain management dose of hydrocodone would be about $10 out of pocket in the U.S,” Bradford said, though Medicare Part D plans cover much of that.

A daily pain management dose of cannabis likely cost about $6 last year — and that number should be lower by now, Bradford said. “It’s becoming relatively comparable in cost.”

But while Americans may accept marijuana, the federal government does not. Attorney General Jeff Sessions has promised to crack down on marijuana cases, with some exceptions. “I know policymakers are often skeptical of cannabis. But we need to be terrified of things like fentanyl, and we need to be willing to use evidence-based approaches to help address that,” Bradford said. “Cannabis looks like it could be one.”

  • I have back pain it’s hurt so much when I been over to any kind any kind of work. When I get up in the morning I can’t hardly walk around until it get better. What I am saving is I got Hydrocodon for my pain from the doctor and I hardly ever take it’s because it’s make feel like I am in another world. I don’t like the feeling when I take it . You feel so weird when you are on it. So I hardly ever touch it and their are so many side effects it’s scared when you read them. So my point is marijuana has know side effects to it’s and it’s from the earth which God put it there for reason wherner you want to believe that or not it’s up to you but it’s true. Marijuana is helping people with all kind of illnesses why wouldn’t anyone want that for their self or of your love ones that sick or when somebody in your family will get sick because in time we all are going get sick that everybody sooner or later I don’t care who are you will get sick and you will say I wish I had
    some of that marijuana to help me . It’s is helping people that is sick trying to help make their love one well. We all want that don’t we you may want it’s for family. I have a grandson that is keeping him alive I can’t be against that and neither you if it’s was your grandson. I hope some day everyone that need it will get it’s. You will give people drugs through the doctors that got so ma y side effects and that stuff can kill
    you with all of the side effects think about it very hard. Thanks

  • I am a pain management patient and opiate user for over 20 yrs. I hate being addicted and going through withdrawals repeatedly when I run out.I would never purchase a street drug but I would be inclined to sell my home and go to Las Vegas or California to purchase edibles. Please legalize weed products in Texas

    • I’m in Greeley (CO). I go to ‘Garden City’ for my cannabis needs. Before this, I stayed a while in Pennsylvania (2015-2016). They were busting people with just dirty pot paraphernalia. No weed! Front page news. Moved to Colorado. I really don’t see a negative to this in the community. I’d be more alarmed if yet another liquor store sprang up than a marijuana dispensary. Tell your hubby hello, and congrats for not letting opiates take a hold on him. Seriously hard to walk away. Onward through the fog.

  • I’m disabled; lower back_other injuries. Am 56 years old. Worked hard all my life. Wear and tear damage. For two years I listened to the doctor(s) and took my hydrocodone as recommended. I may have been in less pain, but the side effects were killing me. I have been smoking weed since the Nixon administration. Never in the past to replace meds. Cannabis doesn’t kill my pain but makes my quality of life better. Is a great distraction. A high count THC indica (flower) does the trick. It also works to help me sleep, and it makes for a wonderful decongestant. Again, I suffer from chronic pain (includes nerve damage). Nine out of ten tokes, I do so seeking comfort. The ten percent; recreational. Beats booze. A hell of a lot safer. My Mom died an alcoholic when I was seven. I’ve seen that picture too. Went through the DT’s at age 24. FYI: I take two meds’ nowadays; high blood pressure_cronic nerve pain. If I lose a tad more weight I can drop the Lisinopril. Coffee and wake n’ bake … onward through the fog.

  • The U.S. needs to quit the madness of managing others’ pain from an outsider’s perspective. And educate about marijuana: it has been used medicinally for centuries and never killed anyone. As is typical of a capitalist economy, it was prohibited for purely market share purposes, starting with a campaign of falsehoods and argumentative fallacies.

  • I have never used marijuana nor any illigal drugs but l buy a lot of prescripton for my wife she has chronic pain from her problem ,sarcoid istis actually i am antimarijuana but ther seems to be an over whelming evidence that certain compounds help her so I am slowly changing my mind and as usual I fear the govenrment will stop this remember we will be going against big pharma

    • You should look into CBD. It is cannabidiol, a non-psychoactive cannabinoid. It does wonders for pain and anxiety but it doesn’t get you high. Research any company you buy from. There are a lot of bootleg ones. I would suggest getting it from a place who uses American grown hemp.

  • It is amazing how the very people who condem marijuana and opioides have absolutely nothing to say about alcohol use. I am 99 % sure if a study was done to compare all three we would find out the alcohol is far more damaging than opioids or marijuana could ever be. So maybe we should limit the amount of alcohol that someone can drink in a day. I wonder how that sounds to all of our great decision making people in government.😁

    • Was just wondering if anyone using CBD oil might know the answer my question. Have heard that the oil that comes from states with legal marijuana is of a much higher quality than the stuff you can by online ?

    • Kathleen, excellent points that I completely agree with though I’d also like to add kratom to your list of substances that are much less harmful than alcohol. I’ve also noticed that most – if not all – of those who condemn the use of mmj, opioid-based medication and kratom, particularly for those in chronic pain, have never experienced ongoing, unrelenting pain that will plague them every second of their day for the rest of their lives, much less an acute, severe pain episode. We are all just a second away from becoming the victim of a car accident which renders us completely disabled and in severe pain that can’t be “cured” through any type of medical intervention. Perhaps when it’s the “do-gooders” who experience this and are left in severe pain because their government bureaucrats – most of which do not have a license to practice medicine, let alone no medical education, now dictate who deserves relief and who doesn’t, they’ll understand how necessary these pain-relieving and pain-reducing substances (opioid-based medication, mmj, and/or kratom) are. These are the ones who will wish they could eat the words of their past.

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