National cannabis laws associated with reduction of opioid prescriptions by orthopedic surgeons
The misuse of opioids and the large number of prescriptions given remain an important national problem, explains this survey, published this month in theAmerican Academy of Orthopedic Surgeons. The study is specific to prescriptions given by orthopedic surgeons, who are among the doctors who prescribe the most opioids in the United States.
Orthopedic surgeons are among the largest prescribers of opioids, which underscores the importance of providing alternatives to non-opioid pain relievers as part of efforts to reduce opioid use in the patient cohort. This is the first study to examine the association between the implementation of state cannabis laws and the opioid prescribing habits of orthopedic surgeons in Part D patients.
Cannabinoids offer a potentially attractive non-opioid analgesic option for orthopedic patients, and 32 U.S. states have passed medical cannabis laws, legalizing patient access to cannabinoids. We examine the association between the implementation of state cannabis laws and the prescription habits of opiates by orthopedic surgeons in patients between 2013 and 2017.
Using the database Medicare Part D Prescription Drug Event, we measured the annual global daily doses of all opioid drugs (except buprenorphine) prescribed by orthopedic surgeons in each U.S. state, in addition to the total daily doses of opioid drugs by generic name (hydrocodone, oxycodone, fentanyl, morphine, methadone and "other opioids"). We used adjusted linear regression models to examine the associations between state-specific cannabis regulations (dispensary, home growing, recreational legalization) and total annual daily doses of opioid drugs (all opioids and types of opioids, separately)
The researchers not only examined each state's cannabis laws on paper, but also their actual application. They found that in states that have approved the legislation but have not yet opened stores, there has been no significant change in the number of opioid prescriptions. The drop in opioid prescriptions has only been seen in countries where patients can buy medical cannabis in stores, 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 prescription of opioids by 144000 daily doses (19,7% reduction) per year. States that allow access to public dispensaries recorded a statistically significant reduction in total opioid prescriptions of 96000 daily doses (or 13,1%) per year. More specifically, a statistically significant reduction of 72000 daily doses of hydrocodone per year. No significant association between legalization for recreational purposes and prescription of opioids was found. Compared to a drop of only 1,7% in the American 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.