Access to legal cannabis stores is linked to a decrease in opioid-related deaths in the United States, especially those related to synthetic opioids such as fentanyl, a study published by The BMJ today.
Opioids are ‘morphine’ drugs that relieve short-term (acute) pain and pain at the end of life. There is little evidence that it is useful for long-term (chronic) pain, but it is often prescribed for this reason.
This has led to widespread abuse and a sharp increase in overdose deaths, particularly in the United States. In 2018, there were more than 46,000 fentanyl-related deaths, representing more than two-thirds of U.S. opioid-related deaths in 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 has been mixed.
To further investigate this, researchers cited relationships between medical and recreational cannabis stores (pharmacies) and opioid-related deaths from 2014 to 2018.
Their findings are based on data for 812 counties in the 23 U.S. states that allowed legal cannabis pharmacies by the end of 2017.
State-level cannabis legislation information was combined with provincial-level data on licensed pharmacies and opioid-related mortality rates.
After examining the population characteristics and other potentially influential factors, the researchers found that provinces with a higher number of active cannabis pharmacies were associated with a lower mortality rate associated with opioids.
According to this estimate, an increase of one to two pharmacies in a country has been associated with a 17% decrease in all opioid-related mortality rates.
This association held for medical and recreational wards and was 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 pharmacies.
An increase from two to three pharmacies is associated with a further 8.5% decrease in all opioid-related mortality rates.
This study is the first to investigate the link between active cannabis pharmacies and mortality rates associated with opioids at the finer grain level.
However, the results are observational, and therefore cannot be causal, and the researchers emphasize that although cannabis is generally less addictive than opioids, it still causes potential harm, and that public safety risks should not be ignored.
According to them, however, they find a possible link between increased incidence of medical and recreational drugs for cannabis and reduced mortality rates with opioids. ‘
And they call for a greater understanding of the impact of cannabis legalization on opioid abuse and public health outcomes before policymakers can weigh the potential benefits against the harm that cannabis legalization promotes. ‘
In a linked editorial, researchers argue that cannabis liberalization “cannot be considered a solution to the opioid crisis until a robust evidence base is available.”
Although some may interpret these findings as evidence supporting cannabis liberalization to address the opioid crisis, they point out that “such conclusions are currently premature without evidence of causation.”
Further experimental studies, including data at the individual level of those using prescribed opioids and illegal opioids, would provide a more nuanced understanding of the substitution between opioids and cannabis.
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Peer review? Yes (research); No (linked main article)
Form of evidence: Observation; Opinion
Topics: Legal marijuana stores
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