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.
Feds Call For Even More Marijuana Research After Hosting Cannabis Workshop
Federally funded research into marijuana seems to be escalating, with one government agency recently posting a roundup of current “cannabinoid-related funding opportunities” for studies investigating the plant’s therapeutic potential.
On Saturday, the National Center for Complementary and Integrative Health (NCCIH) shared a list of four research grant opportunities for studies on “natural products” like cannabis. One would examine how cannabinoids other than THC affect pain and three others call for more broad clinical trials of natural products involving human participants.
The list appears to have been prepared as part of an NCCIH-hosted workshop last week that explored “how to conduct research within the current regulatory framework”—an event that was explicitly not about “challenging or changing current federal laws, policies or regulations.”
.@NIH, including @NIH_NCCIH, @NIDAnews, @NIMHgov, & @NINDSnews, as well as representatives from other federal agencies, academia, & industry will come together at a workshop this Sat, 12/8 to discuss cannabinoid research. Watch the livestream: https://t.co/pWqZJYBtvf cc: @ACNPorg https://t.co/qubNIzUdwK
— David Shurtleff (@NCCIH_David) December 7, 2018
NCCIH “supports rigorous scientific investigation of natural products such as the cannabis plant and its components (e.g., cannabinoids and terpenes),” the agency wrote.
The goals of the proposed research projects range from identifying the “biological signature” of natural products, which means discovering a replicable biological effect, to determining the best dose and optimal formulation of these products. Researchers interested in taking on the investigations have to submit applications with comprehensive plans for the trials and also obtain clearance from federal agencies charged with regulating controlled substances such as the Drug Enforcement Administration (DEA).
Interestingly, three out of four of the studies highlighted by NCCIH don’t explicitly mention marijuana or cannabinoids; rather, they more broadly cover natural products, which seems to suggest that the agency aims to increase cannabis research through pre-existing funding channels.
While the federal government has historically funded limited studies into marijuana and its components, researchers have struggled to overcome barriers to research that exist for federally banned substances. As more states have legalized cannabis, though, agencies like the NCCIH have started ramping up their calls for research.
At the same time, the DEA has said that it’s streamlining applications for federally-sanctioned marijuana cultivators in order to meet the growing demand for research-grade cannabis products. It authorized 5,400 pounds of cannabis to be grown in 2019—more than five times the amount authorized for this year. The reason for the scaling up is “based solely on increased usage projections for federally approved research projects,” the agency clarified in a Federal Register notice on Monday.
Photo courtesy of Brian Shamblen.
Smoking Marijuana Actually Improves Working Memory, Study Indicates
A new study contains a finding that runs counter to common stereotypes about marijuana and forgetful stoners: smoking cannabis actually seems to improve working memory.
Researchers at the University of Florida acknowledged that their study, which involved rats and was published in the journal Neurobiology of Learning Memory, was unique. Much previous research has concluded that cannabis impairs cognitive performance. But the same time, many of those studies didn’t involve actually inhaling marijuana smoke like this one did.
The team put the 32 rats (split evenly by gender) through a pair of delayed response tasks that involved either finding and pressing a lever a certain amount of times or poking their nose into a feeding trough a certain amount of times—the reward being food pellets, of course. The first few times, the rats were sober; in subsequent experiments, they were exposed to cannabis smoke.
“Cannabis smoke improved working memory accuracy. Placebo smoke did not affect working memory accuracy.”
For male rats, the marijuana didn’t seem to have any effect at all, but for female rats “exposure to cannabis smoke significantly enhanced choice accuracy,” the researchers wrote. That said, baseline performances (prior to exposure) were lower in females compared to males, which “raises the possibility that the enhancing effects in females were due to their relatively worse baseline performance rather than to sex differences in the effects of cannabis per se.”
“The overwhelming majority of research in both animal models and human subjects shows that acute administration of cannabis and cannabinoids induces deficits in tests of cognitive function, including working memory. In contrast, the current experiments show that acute exposure to cannabis smoke enhanced working memory performance in a delayed response task in rats, particularly in females in which baseline levels of task performance were lower than those in males.”
Nearby Marijuana Shops Make Homes And Rentals More Valuable, Studies Show
When a shop selling marijuana opens (or closes), there’s a direct impact on housing and rental prices in the surrounding area, according to a pair of recent studies.
Housing prices for new homes increase by 7.7 percent on average if they’re located within a quarter mile of a new dispensary.
A study published in the journal Contemporary Economic Policy evaluated how the price of new homes in Denver, Colorado, changes when a cannabis dispensary opens up nearby. Researchers compared the prices of homes before and after a dispensary opened within .25 miles, .25-.5 miles and .5-.75 miles.
When new dispensaries opened within .25 miles, housing prices jumped 7.7 percent on average. There was still a 4.7 percent increase for homes located within .5 miles, but the effect “disappears entirely” for houses that are further than .5 miles from a new dispensary. The researchers also found that the effect was slightly more pronounced if the dispensary was the first to the area.
“Our results suggest that despite potential costs, legalization is capitalized as a net benefit in housing prices,” the researchers wrote.
Interestingly, new dispensaries seem to have about the same impact on housing prices as new grocery stores, the study found. But the “mechanisms through which grocery stores affect housing prices are more obvious than dispensaries.”
“If public sentiment surrounding marijuana is positive, homebuyers may also prefer to select into neighborhoods with more dispensaries for convenience. Ultimately however, our data do not allow us to directly determine the underlying mechanisms driving this result, so these potential explanations should be considered speculative.”
Losing a marijuana coffeeshop causes a three percent decrease in Airbnb rental prices.
Amsterdam’s famous cannabis coffeeshops are known tourist attractions, but what happens when one shuts down? For his master’s dissertation, doctoral student Igor Goncalves Koehne de Castro identified at least one collateral effect: Rental costs on Airbnb drop by about three percent on average if the closure was within 250 meters of the lodging.
If the coffeeshop was further than 250 meters, rental prices didn’t change significantly.
There were plenty of examples for de Castro to study, which spanned from 2014 to 2017, because several coffeeshops have closed in response to new laws in recent years, including one in Amsterdam that prohibits the shops from operating within 250 meters of a school.
After controlling for other possible factors, de Castro developed a series of models based on Airbnb data on rental prices over time and their proximity to recently closed coffeeshops. The study revealed that these shops “present a positive impact” on rental prices for lodgings close to the shops—presumably because people who rent through Airbnb are “tourists” who are “sensitive to distances.”
“The findings of this study suggest that, for the city of Amsterdam, the de facto legalization of cannabis actually has a positive externality,” de Castro wrote. “This result puts new evidence to the debate of drug laws and policies, a matter that still lacks data and research.”
Photo courtesy of WeedPornDaily.