Last week, the Alabama Legislature took some of the first steps on SB165—a bill that would ultimately legalize medical cannabis in Alabama. This bill would move Alabama from the minority of states that continue to prohibit the prescribing of medical marijuana to the majority of states that do. While advocates and proponents of this bill have offered a number of arguments for and against the legalization of medical cannabis, a common thread has come to dominate much of the public debate over this bill. And that thread concerns the impact legalization of medical cannabis would have on the opioid crisis.
As the defining public health crisis of this generation, the opioid crisis has rightly been placed at the forefront of the medical cannabis conversation. In 2017, one American died of an opioid overdose every 11 minutes, and some estimates place the cost of the opioid crisis at over $500 billion. Alabama has not been immune from this crisis, and Blue Cross Blue Shield estimates that its Alabama members were more likely than others across the country to be on a long-duration opioid regime. Given the high stakes involved, the question of how medical cannabis legalization will affect the opioid crisis is obviously an important one.
In a study recently published in the Journal of Health Economics, two co-authors and I investigated the impact of medical cannabis access laws on opioid prescriptions across the country. In that study, we found strong and consistent evidence that enacting medical cannabis access laws reduces opioid prescriptions. In general, these laws decrease opioid prescriptions by 4.2 percent. While this may not, by itself, be enough to reverse the opioid crisis, reducing opioid prescriptions is an important step in addressing this crisis.
Our study was not the first to examine the impact of medical cannabis access laws on opioid prescriptions. However, the strength of our study lies not in its novelty, but in the data it analyzes. Instead of examining counts of opioid prescriptions among Medicare or Medicaid beneficiaries, we analyzed a dataset of over 1.5 billion individual opioid prescriptions across the country. This dataset included approximately 90 percent of all opioid prescriptions written in the United States between 2011 and 2018. And our data came from prescriptions paid for by commercial insurance, Medicaid, Medicare, other government assistance, and even cash.
With such rich data available in our study, we were able to obtain a clearer picture of the effect of medical cannabis access laws than has previously been possible. While we found that these laws reduced opioid prescriptions in general by 4.2 percent, they had larger impacts on certain groups. For example, medical cannabis access laws reduced opioid prescriptions to those with commercial insurance by 4.4 percent and to those with Medicaid by 5.2 percent.
These laws may reduce opioid prescriptions in various ways, and our study found suggestive evidence that one important way may be facilitating the substitution of cannabis for opioids in the treatment of pain. In addition to reducing the use of prescription opioids, our study revealed evidence that medical cannabis access laws also reduce NSAID prescriptions. NSAIDS are often found in common, over-the-counter pain medications. This reduction in another type of medication used in the treatment of pain suggests that the reduction in prescription opioids may be driven by a decreased need for pain treatment once individuals can access medical cannabis. And our results are consistent with the conclusion of the National Academies of Sciences, Engineering, and Medicine which found “conclusive. . . evidence that cannabis. . . [is] effective. . . [f]or the treatment of chronic pain in adults.”
As the Alabama Legislature completes its task of debating whether to join the majority of states that allow access to medical cannabis, understanding the role of this law in the opioid crisis will be critically important.