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Legal Marijuana States Have Lower Opioid Use, New Studies Show

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Letting people legally access marijuana appears to reduce reliance on addictive opioids, two new studies published by the American Medical Association find.

“Medical cannabis laws are associated with significant reductions in opioid prescribing in the Medicare Part D population,” concludes one paper from researchers at the University of Georgia, Athens. “This finding was particularly strong in states that permit dispensaries, and for reductions in hydrocodone and morphine prescriptions.”

The second study, from scientists at the University of Kentucky and Emory University, noted that “marijuana is one of the potential nonopioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose.” It found that laws allowing medical cannabis or recreational marijuana “have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose.”

“Marijuana liberalization may serve as a component of a comprehensive package to tackle the opioid epidemic,” the researchers conclude.

The two papers, released Monday by JAMA Internal Medicine, a publication of the AMA, looked at use of opioids such as fentanyl by people enrolled in Medicare and Medicaid, with both examinations finding that states with legal marijuana access saw lower reliance on the pharmaceutical drugs.

And the easier the access to legal marijuana, the lower the rate of opioid prescribing.

“States with active dispensaries saw 3.742 million fewer daily doses filled; states with home cultivation only [laws] saw 1.792 million fewer filled daily doses,” one of the studies, which focused on medical cannabis laws, found.

The other new paper shows that while medical marijuana is associated with reduced opioid prescriptions, recreational laws have an even greater effect.

“State implementation of medical marijuana laws was associated with a 5.88% lower rate of opioid prescribing,” the authors wrote. “Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38% lower rate of opioid prescribing.”

U.S. Sen. Kirsten Gillibrand (D-NY) recently suggested that pharmaceutical companies oppose marijuana legalization for selfish reasons.

“To them it’s competition for chronic pain, and that’s outrageous because we don’t have the crisis in people who take marijuana for chronic pain having overdose issues,” she said. “It’s not the same thing. It’s not as highly addictive as opioids are.”

The results of the new studies add to a growing body of research indicating that legal marijuana access is associated with reduced opioid issues.

In 2014, for example, a previous JAMA study showed that states with medical cannabis laws have roughly 25 percent lower opioid overdose rates.

A separate analysis published in February concluded that “legally protected and operating medical marijuana dispensaries reduce opioid-related harms,” suggesting that “some individuals may be substituting towards marijuana, reducing the quantity of opioids they consume or forgoing initiation of opiates altogether.”

And previous work by Ashley and David Bradford of the University of Georgia, who authored one of the new studies released on Monday, showed broad reductions in Medicare and Medicaid pain prescriptions when state medical cannabis laws went into effect. Their new paper builds on that by zeroing in on opioid painkillers and showing that the type of state marijuana law has an effect on the reduction in prescriptions.

“The type of [medical cannabis law] matters,” David Bradford said in an email. “Dispensaries have the biggest effect.”

The other paper, by the Kentucky and Emory researchers, tabulated reductions in opioid prescriptions associated with changes in laws, finding that medical cannabis policies lead to 39.41 fewer opioid prescriptions per 1,000 enrollees annually and that the effect for recreational legalization was even larger.

“Furthermore, the implementation of adult-use marijuana laws was associated with a 9.78% lower Medicaid spending on prescription opioids, equivalent to an annual saving of $1,815 Medicaid spending per 1,000 enrollees,” the study found. “The implementation of medical and adult-use marijuana laws was also associated with a lower rate of Medicaid-covered prescriptions for nonopioid pain medications of 8.36% and 8.69%, respectively.”

The research teams behind both new studies said that medical cannabis shows promise as a partial solution to opioid issues.

“Combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids,” the Bradfords’ Georgia team wrote. “Furthermore, a growing consensus suggests that cannabis can be used to effectively manage pain in some patients. If initial licit prescriptions for opioids can be reduced, then there is a plausible theoretical pathway to anticipate that opioid misuse and abuse could also fall.”

When legal marijuana is available, some patients appear to be more likely to choose it instead of prescription pain pills that can lead to addiction or overdose.

“Most opioid use disorder and overdose cases occurred in patients with legitimate prescriptions from health care professionals for pain management. Marijuana liberalization, therefore, may have benefited these patients by providing them with legal protection and access to marijuana as an alternative relief from their pain conditions,” the Kentucky and Emory team wrote. “The widespread public support will bring medical marijuana laws to more and more states for years to come, which may help decrease the use of prescription opioids in pain management and the adverse consequences, such as opioid use disorder and overdose.”

Those researchers also noted that “marijuana may help ease opioid withdrawal symptoms.”

“Thus, marijuana liberalization potentially reduced prescription opioid use on 2 fronts, serving as a substitute for opioid pain medications, and as a complement to opioid use disorder treatment,” the wrote. “The potential of adult-use marijuana laws to reduce the use and consequences of addictive opioids deserves consideration, especially in states that have been hit hard by the opioid epidemic.

This piece was first published by Forbes.

Marijuana Moment is made possible with support from readers. If you rely on our cannabis advocacy journalism to stay informed, please consider a monthly Patreon pledge.

Tom Angell is the editor of Marijuana Moment. A 15-year veteran in the cannabis law reform movement, he covers the policy and politics of marijuana. Separately, he founded the nonprofit Marijuana Majority. Previously he reported for Marijuana.com and MassRoots, and handled media relations and campaigns for Law Enforcement Against Prohibition and Students for Sensible Drug Policy. (Organization citations are for identification only and do not constitute an endorsement or partnership.)

Culture

Marijuana Tourism From China To Amsterdam: Study Sheds Light On Motivations

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Marijuana use in China is strictly forbidden. In fact, when Canada legalized cannabis last year, the Chinese government sternly reminded its citizens living in or visiting the country to “please avoid contact or using marijuana.”

Yet, despite their nation’s strict views on marijuana, research shows that significant numbers of Chinese tourists are heading to Amsterdam to take part in its prolific cannabis culture. A new study published in the journal Current Issues in Tourism sheds light on some of the motivations for the cross-continental cannatourism.

The punishment for drug use of any kind in China, including marijuana, is up to 15 days in detention and mandatory rehabilitation, the study’s authors write. But the Chinese government has been known to enforce harsher sentences for other cannabis-related charges. For example, Jaycee Chan, the son of actor Jackie Chan, spent six months in a Beijing jail after police discovered more than 100 grams in his apartment.

Because Chinese citizens are “widely educated to stay away from any kind of drugs,” the study states, researchers were curious to know more about who these tourists heading to the Netherlands for cannabis really were. Between February 2014 and October 2016, they randomly approached Chinese tourists in or exiting Amsterdam coffee shops where marijuana is sold over the counter and invited them to complete a confidential questionnaire. A total of 654 surveys were collected and analyzed.

About 80 percent of respondents said they’d never tried marijuana prior to their trip to Amsterdam.

Participants were divided into three segments based on their responses: cannabis enthusiasts, diversionists/recreationists (people who were seeking pleasure or a diversion from their daily lives) and people who were simply curious about cannabis culture.

Survey responses from the first and third groups “demonstrate that Chinese drug tourists desire to ‘experience all’ and seek authenticity out of their normal daily life and society during the overseas travel,” the study authors wrote.

The largest number of tourists surveyed (almost 44 percent) fell into the category of diversionist/recreationist. In other words, they used cannabis as a way to enjoy their vacation—not unlike tourists from other countries.

“They travelled and consumed cannabis mostly for the sake of experiencing/experimenting with the local cannabis culture in Amsterdam as well as relaxation, pleasure, and to escape from stressful social environments,” the authors write.

Cannabis enthusiasts were the smallest segment of the sample. In terms of demographics, almost half of the survey respondents were women. Overall, a majority of participants reported being college-educated, under 35 years old and not married.

In a recent interview, lead study author Jun Wen discussed why Chinese tourists are especially attracted to the Netherlands.

“You can do a lot of things there that are illegal in China – gambling, paying for sexual services, and buying cannabis for recreational use,” he said. “So Chinese tourists want to go there to find a different way to relax that’s not traditional.”

World Health Organization Recommends Reclassifying Marijuana Under International Treaties

Photo by Sharon McCutcheon on Unsplash.

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This Is The Best Way To Store Marijuana For The Apocalypse, According To Science

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You may want to rethink how you’re storing your marijuana stash long-term.

Many enthusiasts will tell you the best place to keep cannabis is in an air-tight container stowed somewhere cool and dark. But according to the results of a new four-year study, the freezer may actually be a better place—especially if you’re concerned about maintaining that all-important THC content.

Researchers in Italy were interested in understanding how time and various storage conditions (involving light, oxygen and temperature) affected the chemical composition of high-potency cannabis products. Past studies have also investigated this topic, but the authors of new research published in Forensic Science International last week noted that the potency of cannabis in today’s market is “extremely different” from years past.

Using six cannabis products of herbal and resin materials (which were seized by law enforcement and given to researchers to analyze), the study’s authors created 24 primary samples.

After collecting information about how much THC, CBD and CBN (that is, cannabinol, another non-intoxicating component in cannabis that occurs when THC degrades over time) each sample contained, the researchers stored the samples in four controlled conditions for a period of four years.

The testing conditions differed by light exposure (whether it was light or dark 24 hours) and storage temperature (including at room temperature, refrigerated at 4 degrees Celsius or frozen at -20 degrees Celsius). Over the span of the study period, the samples were tested 14 times.

In a finding that will likely be unsurprising to anyone who has stumbled upon an old stash of cannabis stored in a sock drawer, the study determined that the amount of THC decreased—thus increasing the amount of CBN—in the samples stored at room temperature. In the first 100 days of data gathering, the THC in the marijuana stored in both light and dark spaces at room temperature had degraded by 13 percent and 11 percent, respectively.

Meanwhile, the refrigerated cannabis did show some decline in THC and increase in CBN over time, though not nearly as pronounced as the samples kept at room temperature.

The THC content in the samples stored in below-freezing conditions, however, did not significantly change.

This finding indicates, as the authors write, “that freezing is the best storage condition to avoid the reduction of the cannabinoids content over time.”

As for CBD, the study found that the compound remained “relatively constant over time in all the considered samples.”

The authors point out that their findings could be important for forensic purposes. With their methods, they write, law enforcement may be able to figure out what the THC concentration might initially have been in degraded marijuana.

On a more basic level, the research could also help consumers better plan how to store their cannabis.

That said, with marijuana not exactly that hard to find—it’s not as if prohibition is very effective, and more states are legalizing cannabis stores in any case—most people probably won’t be seeking to intentionally store their supply for multi-year periods.

Unless, that is, you’re a prepper planning for hard times. In that case, just know that, according to this research, stuffing your stash in the freezer is best.

Study Reveals How Marijuana Components THC And CBD Affect Chronic Pain

Photo courtesy of WeedPornDaily.

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Legal Marijuana Sales Don’t Increase Use, But Allowing Possession Does, Study Finds

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When penalties for marijuana possession are lifted, usage rates seem to increase—but that’s not the case when retail sales of cannabis are permitted. Those are the findings of a new study that seems to run contrary to a key talking point of groups that oppose legalization.

To learn how different reform policies impact consumption trends, researchers at Colorado Mesa University analyzed survey data from more than 1,400 people over the course of 17 months in Colorado, Washington and Australia. Their findings were recently published in the journal Substance Abuse: Research and Treatment.

While some prohibitionist groups have proposed simply removing penalties for possession as a preferred alternative to full commercial marijuana legalization—which they believe will create an industry incentivized to increase heavy cannabis consumption—the new study appears to undermine that position.

After Washington State instituted voter-approved legalization of cannabis consumption and possession, but before retail sales were allowed, there was a 12-22 percent spike in use among college undergraduates in the state.

However, the researchers “found no evidence” that the subsequent implementation of legal sales of recreational cannabis “influenced the number of marijuana users in Washington.”

A similar trend was observed when they looked at data from Australia. The country doesn’t allow legal cannabis sales, but after decriminalizing the plant, there was a 16 percent increase in consumption.

Because the researchers started collecting data from Colorado just three months before retail cannabis sales started, they didn’t reach a conclusion about how removing penalties for possession alone influenced consumption patterns. But the data did show that, in the year after retail sales launched, “rates of marijuana use did not significantly increase.”

The researchers said that the seemingly counterintuitive finding could interpreted a couple ways.

First, it’s possible that “the social and legal implications of legalizing recreational marijuana are stronger than accessibility and price,” they wrote. In other words, ending criminal penalties for cannabis and normalizing its consumption in a social context might lead to an increase in usage “even before it is sold to the public through legal means.”

“It is important to note, however, that it is reasonable to assume that people would be more truthful and more likely to report marijuana use after its legalization,” they wrote, referring to common study methodology that relies on consumers’ own self reports to track usage levels. “Thus, some of the increase in rates of marijuana use may be an artifact of a greater willingness to report such use, since social and legal barriers were removed by legalization.”

The other inference that can be drawn from the study is that “marijuana is easily accessed even when it is not sold in stores recreationally.” It may be easy to access prior to removal of penalties for possession, too, but legal and social barriers associated with prohibition could suppress its use—or at least lead people not to report about their consumption truthfully when asked in a survey.

All that said, the study authors emphasized that “the conclusions drawn in this commentary are based on observable patterns from correlational research, limiting conclusions of cause and effect.”

States With Legal Medical Marijuana Have Lower Teen Use Rates, Large-Scale Study Finds

Photo courtesy of Chris Wallis // Side Pocket Images.

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