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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.”

  • Whatever study claims over the counter pain meds do the same as opioids is liar. Some of us live everyday in a torture chamber. No cannabis is going to help that. This world has gone insane. I should walk around stoned all day and not be able to function. Pain will be exactly the same because cannabis is not a painkiller. The government would rather I be stoned all day, not be able to work or care for any of my responsibilities. I function on opiates, I not get stoned on opiates, I am normal. I can work, care for kids and live a life. Never OD’d or took more than prescribed. I was cutoff and told to take cannabis. Now I am a bed vegetable on disability. Cannabis and over the counter junk did not help. Good job government. You ruined my life and destroyed my family.

    • I am a stage four cancer patient with growths in my 40% of my liver, pancreas, right kidney, 80% of my bones and my lungs. I am on heavy opiates and have been for years. My tolerance raised over the years and I felt I was running out of options. I was very skeptical of marijuana as I smoked a ton as a younger man and didn’t notice any pain relieving feelings in the past. However once I started using the medical cannabis I found that I could make it almost twice as long before re-dosing with the opiates. So it does work for pain relief. It in my eyes does not adequately remove 100% of the pain but then again nothing does.

  • The main reason for the drop is a Doctor will cut off prescriptions for pain medicine if their patient tests positive for Cannabis in their monthly drug test.

  • I am gratified this is finally happening. We are undertreating pain, especially in the older population, because of toxicities or inefficacy of current pain management options available.Cannabis compounds are safe and it’s efficacy for pain has been known and used extensively by different cultures, but we needed the studies. Funding for more studies and more access and education based on present data should be the logical path. Lowering opioids morbidity and mortalityits also worth the effort.

  • if CBD oil is legal federally then why do i get piss tested for it at my pain management clinic ? that is not right. i would love to use medical marijuana for my chronic pain but it doesn’t work for my pain now, it did before my 3 level lumbar fusion, i thought i had pain before the fusion but i just had a tickle, now i know what pain is, please never have a back fusion, they told me i had 11% chance of having more pain after the fusion, they should have told me you have 11% chance of never using marijuana again, then i would have never even considered the fusion. now i have to be on all kinds of pharmaceutical drugs that i hate taking just to get through the day , anyone know of a dr that would give both pain meds and recommend medical marijuana i would move anywhere in the usa if i could get both i live in ohio now please help. thanks for your time.

    • There is a HUGE difference between CBD from hemp and CBD from MJ
      You are tested because if you are using CBD from MJ then you are also getting THC. From hemp, there is all but no THC in the plant
      The federal Gov made it federally legal for anything that contains hemp to be allowed and transported around the USA NOT so for MJ of course
      Dr Dave

  • We have ROUTINELY recommended the limited sister product CBD oil for now almost 8 years with EXCEPTIONAL results in our cancer patients
    We have easily reduced opioid use by 30% or more and breakthrough pain is all but gone with CBD oil use
    The issue is that CBD like any cannabidiols need time to build up in the system in order to be effective
    Patients are used to popping a pill and instantly feeling the results. this is more like taking vitamins then like taking pills
    The body has an entire system that is directed to the class of compounds called Canabinodiols and it NORMALLY is in mute mode or shut down mode. It takes quite a bit of build up in order for it to realize that from that point forward it will be needed
    Once activated it is very excellent for reducing pain reducing nausea and reducing seizure activities
    Anyone who is looking to MJ CBD THC or the like to treat or cure anything is out of luck since there is absolutely NO evidence that it can or will do that
    With all that in mind though CBD is OFTEN derived from HEMP not Marijuana and therefore legal in ALL states and even legal FEDERALLY based on a law from the early to mid-1900’s
    NO concern about the DEA pushing in your door or worrying about losing some Federal benefit by using the hemp-based product since hemp is a stable legal plant for all uses from dietary supplementation to making shirts and handbags belts and rope
    The CBD system is just coming into its own with some research being started here in the USA. The world’s largest treasure trove of CBD research, however, is in Israel at the Technion and they have been researching this since the 1960’s with amazing quantities of data and experience
    There is NO doubt that adding CBD or if you must MJ will help us to get past the opioid crisis in terms of taking patients OFF opioids and not being concerned about addiction or compliance concerns or regulation BUT the one issue still is not addressed
    A bottle of CBD oil from REPUTABLE manufacturers is close to $200 for 100ml and that is about 45 or 50 days so budgets are an issue
    Off the street, pot is much cheaper if not even free in states that allow personal growth BUT the side effects of the THC is definitely an issue and I sure don’t want my family using anything with THC in it then heading out to drive or use heavy or dangerous equipment
    I am sure once the evidence is created the future is very promising for Cannabidiol based treatments for pain and seizures and the prices will come WAY down
    Dr. Dave

  • Well duh!! I’d much rather be smoking a joint , than taking pain meds.Some of those pills have bad side effects.I use them bc I’m afraid of having back and neck surgery..It could always help with my seizures,that medication makes you feel like you’re walking thru wet cement.

    • Well duh, smoking pot has far more tar & nicotine than a normal choke, but you want to “entertain yourself to death” have at it dumbo.
      Its already a scientific fact that there is a canyon wide difference between those of us who use pain killers for acute pain vs. the SUD crowd. My withdrawal fm cigarettes 40+ yrs ago was horrible, but go ahead and smoke your pot.
      When you can no lo ger breath or have to use a hole in your throat, you’ll have wished you took the pill way back when, if you have acute pain. Sry, but pot, cbd oil doesnt work for the vast amount of folks who contend with acute pain on a daily basis.

    • Cannabis and cigarettes are two different things. No nicotine (addictive) in marijuana. Whose the ‘dumbo’ now (TommyThis)? It’s people like U who spread misinformation, that drags down the cannabis/hemp movement; legalization and decriminalization.

    • Yo TommyNumbNuts, One more thing. Cannabis DOES help people COPE with chronic pain. I believe your IQ to be so LOW that it would be a total waste of time explaining it fully to you.

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