National Cannabis Laws Associated With Reduced Opioid Prescriptions By Orthopedic Surgeons
The misuse of opioids and the large number of prescriptions given remain a significant national problem, explains this survey, published this month in theAmerican Academy of Orthopedic Surgeons. The study looks specifically at prescriptions given by orthopedic surgeons, who are among the most prescription opioid physicians in the United States.
Orthopedic surgeons are among the largest prescribers of opioids, underscoring the importance of providing alternatives to non-opioid pain relievers as part of efforts to reduce opioid use in the patient cohort. This study is the first to examine the association between the implementation of state cannabis laws and opioid prescribing patterns by orthopedic surgeons in Medicare Part D patients.
Cannabinoids offer a potentially interesting non-opioid pain reliever option for orthopedic patients, and 32 states in the US have passed medical cannabis laws, legalizing patient access to cannabinoids. We examine the association between the implementation of state cannabis laws and opioid prescribing patterns by orthopedic surgeons in patients between 2013 and 2017.
Using the database Medicare Part D Prescription Drug Event, we measured the annual aggregate daily doses of all opioid drugs (except buprenorphine) prescribed by orthopedic surgeons in each US state, in addition to the total daily doses of opioid drugs by generic name (hydrocodone, oxycodone, fentanyl, morphine, methadone and “other opioids”). We used fitted linear regression models to examine associations between state-specific cannabis regulations (dispensary, home cultivation, recreational legalization) and annual total daily doses of opioid drugs (all opioids and types of drugs). opioids, separately)
The researchers not only looked at each state's cannabis laws on paper, but also their actual application. They found that in states that have approved the legislation but have yet to open stores, there has been no significant change in the number of opioid prescriptions. The decline in opioid prescriptions was only seen in countries where patients could buy medical cannabis in stores, and not just grow it themselves at home.
From 2013 to 2017, states that have legalized were associated with a statistically significant reduction in the overall opioid prescription of 144000 daily doses (19,7% reduction) per year. States that allow access to public dispensaries reported a statistically significant reduction in total opioid prescriptions of 96000 daily doses (or 13,1%) per year. Specifically, a statistically significant reduction of 72000 daily doses of hydrocodone per year. No significant association between recreational legalization and opioid prescribing was found. Compared to a decrease of only 1,7% in US states where medical cannabis was banned.
Similar results have already been obtained in a survey from the University of Alabama published earlier this year in the Journal of Health Economics, as well as in published studies in the Journal of the American Medical Association (JAMA) in 2018.