Legal cannabis dispensaries tied to lower opioid-related mortalities
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Access to medical and recreational cannabis dispensaries was associated with reductions in opioid-related mortality in counties where cannabis is legal in the United States, according to research published in BMJ.
“Our findings suggest that higher storefront cannabis dispensary counts are associated with reduced opioid-related mortality rates at the county level,” Greta Hsu, PhD, professor of management at the Graduate School of Management at University of California, Davis, and colleagues wrote. “This association holds for both medical and recreational dispensaries, and appears particularly strong for deaths associated with synthetic (non-methadone) opioids, which include the highly potent synthetic opioid fentanyl and its analogs.”
Hsu and colleagues used secondary data on cannabis dispensary storefront locations and opioid-related mortalities from 2014 through 2018. They collected data on dispensaries using the U.S. cannabis website Weedmaps, which the researchers noted was used in previous studies. They used the CDC’s multiple cause of death database to collect years data on prescription opioid-related mortality.
The researchers specifically evaluated 812 counties from the 23 states that had legalized cannabis dispensaries by the end of 2017.
Hsu and colleagues determined that the number of dispensaries in each county was negatively related to the log-transformed, age-adjusted mortality rate for all types of opioids (beta = 0.17; 95% CI, 0.23 to 0.11).
Based on this finding, the researchers said, an increase from one to two dispensaries in a county was associated with a 17% drop in opioid-related mortality rates for all types of opioids.
They also identified a negative association between dispensary count and deaths caused by synthetic opioids other than methadone (beta = 0.21; 95% CI, 0.27 to 0.14), which indicates an estimated reduction of 21% in opioid-related mortalities with an increase from one to two dispensaries in a county.
Hsu and colleagues identified similar associations between both medical and recreational cannabis dispensaries and reductions in synthetic opioid-related deaths other than methadone.
“Given the alarming rise in the fentanyl-based market in the U.S., and the increase in deaths involving fentanyl and its analogs in recent years, the question of how legal cannabis availability relates to opioid-related deaths is particularly pressing,” Hsu and colleagues wrote. “Overall, our study contributes to understanding the supply side of related drug markets and how it shapes opioid use and misuse.”
References:
Eurekalert. Legal cannabis stores linked to fewer opioid deaths in the United States. https://eurekalert.org/pub_releases/2021-01/b-lcs012621.php. Accessed February 10, 2021.
Hsu G, et al. BMJ. 2021;doi:10.1136/bmj.m4957.
Perspective
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Ellie Grossman, MD
These study findings are provocative and make one think harder about the potential upsides of cannabis use and legalization — but it is impossible to show causality from a cross-sectional study like this one. It is certainly possible that there is some unmeasured confounder in the ‘milieu’ of a county that allows cannabis dispensaries that also promotes a reduction in deaths from opioids (e.g. other harm-reduction policies like naloxone distribution, addiction treatment). But the idea that there may be some people who get pain/symptom relief from cannabis and hence avoid risky opioid use is interesting. It would be really nice to see federal funding for research directly studying the use of cannabis for pain and comparing it with other pain treatments (including opioids) — with long-term follow-up and careful assessments of risks as well as benefits.
Previous studies about the relationship between cannabis legalization and opioid overdose mortality have had mixed results. This study adds strong weight to one side of this dispute since their use of data on actual dispensaries (instead of just legalization status) is more methodologically rigorous and hence compelling.
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