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Marijuana Legalization Causes ‘Significant Decline’ In Opioid Overdoses, New Research Finds

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Two new studies find that opioid-related deaths decline when states legalize access to marijuana. In fact, when adult-use cannabis laws are in place, the rate of opioid overdoses declines by at least 20 percent.

Both papers, published in the journal Economic Inquiry, not only show the impact of passing such laws, but also how dispensaries play a role in helping to quell these deaths.

The first study, helmed by researchers in Massachusetts and Colorado, claims to be the first to show the causal effects of access to recreational cannabis on opioid mortality.

“We find that marijuana legalization causes a significant decline in opioid mortality— especially deaths from synthetic opioids—with particularly pronounced benefits in states that have legalized recreational usage,” the study’s authors write. “Yet it is not legalization, per se, that produces these gains; rather, states that have legal access via dispensaries see the largest reductions in mortality.”

“We estimate that [recreational marijuana laws] reduce annual opioid mortality in the range of 20%–35%, with particularly pronounced effects for synthetic opioids.”

The study used three main sources of data: death rates involving all opiates, prescription opioids and synthetic opioids from January 1999 through the end of 2017; the history of marijuana legalization in each state (including when legislation was passed and when dispensaries opened for business) and state-level demographic information. During the study period, 29 states had approved medical cannabis, while recreational marijuana was legalized in eight states plus the District of Columbia. According to the Centers for Disease Control and Prevention, the number of opioid-related deaths has increased six times over between 1999 and 2017. Additionally, 36 percent of the 47,600 opioid overdoes in 2017 involved prescription opioids.

After running several statistical and mathematical models that included checks to ensure their results were consistent, the study’s authors found that broader adult-use laws reduce a state’s opioid death rate between 20 percent (for all opiates and prescription opioids) to 35 percent (for synthetic opioids).

“Recreational marijuana laws affect a much larger population than medical marijuana laws, yet we know relatively little about their effects,” study co-author Nathan W. Chan, PhD said in a press release. “Focusing on the recent wave of recreational marijuana laws in the U.S., we find that opioid mortality rates drop when recreational marijuana becomes widely available via dispensaries.”

“Our estimates are sizable,” the study itself states. “For reference, the average never-legalizer state has 4.82 fatalities per 100,000 people from All Opiates (Synthetic Opioids) annually, while for the average [medical marijuana law] state, these are 6.067 and 0.856 per 100,000 people. Thus, our estimates imply annual reductions in All Opioid mortality between 1.01 and 1.27 deaths per 100,000 people for non-[recreational marijuana law] states, on average. For a state with a population of 5 million (near the nationwide median), this would save on the order of 50 lives per year, or roughly 10 averted deaths from Synthetic Opioids alone.”

Those are conservative estimates, the authors add.

Additionally, models showed that white people and women saw the highest reductions in synthetic opioid deaths in states that legalized recreational cannabis: Whites experienced a 32 percent decrease, while the statistical effect for women was larger and “highly statistically significant” compared to what they found for men.

The authors did not identify what mechanism is responsible for this reduction in mortality rates, though past research suggests people who can legally access marijuana may substitute it for opioids. A recent study, for example, found the majority of people who shopped at cannabis retail shops reported using marijuana to help with pain and sleep.

The new study’s authors do stress, however, that the causal effect they identified is “highly robust.”

“Our bedrock findings remain unmoved by variations in modeling assumptions and selections of control variables, and our findings are further corroborated through placebo tests,” they write. “Our results show that there are substantial ancillary benefits to marijuana legalization, especially [recreational marijuana laws], and they offer important food for thought as many states continue to contemplate expansions to both medical and recreational marijuana access.”

Their findings support a growing body of research that has linked the availability of medical marijuana dispensaries with a drop in the rate of local opioid-related deaths.

In fact, that was the focus of the second cannabis-related study published recently in Economic Inquiry. According to its findings, after a medical cannabis dispensary opened in a county, prescription opioid deaths fell locally by approximately 11 percent. These results, the author writes, suggest “a substitutability between marijuana and opioids.”

“Furthermore,” the study concludes, “the unintended beneficial effects of allowing for marijuana dispensary operations should be considered by policymakers as they aim to curtail narcotic abuse and limit the impact of the opioid epidemic.”

New Analysis Explores Relationship Between Medical Marijuana And Opioid Overdoses

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.

Kimberly Lawson is a former altweekly newspaper editor turned freelance writer based in Georgia. Her writing has been featured in the New York Times, O magazine, Broadly, Rewire.News, The Week and more.

Politics

Federally Funded Journal Exposes How Marijuana Prohibition Puts Consumers At Risk

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Federal dollars are supporting the publication of a recent report that highlights how marijuana prohibition puts cannabis consumers at risk due to the resulting lack of guidance on safety standards from regulators.

The article was published this week in Environmental Health Perspectives, an “an open-access journal published with support from” the National Institutes of Health (NIH). It looked at issues related to regulating cannabis quality, which includes ensuring that the products don’t contain dangerous contaminants such as metals, pesticides and microbes.

“At the federal level in the United States, cannabis is still considered an illegal drug,” the piece notes. “As a result, neither the Food and Drug Administration (FDA) nor the Environmental Protection Agency (EPA) has provided any guidance on how to regulate contaminants or on which cannabis-related exposures can be considered safe.”

“States have had to determine on their own how to protect millions of cannabis users, and they have come up with widely varying responses,” the report states. “The result is an uncertain and occasionally incoherent regulatory landscape.”

The use of butane to extract marijuana concentrates, the prevalence of microbial contamination and high concentrations of metals are all concerns that federal agencies like the FDA and EPA would presumably address—if cannabis wasn’t a federally banned substance.

There’s at least one recent, relevant example on the issue: EPA announced on Wednesday that it will be approving pesticide applications for hemp, which was federally legalized through the Farm Bill late last year, but such tools will not be approved for marijuana because of its status under federal law.

But as it stands, such regulations are made and enforced at the state-level, meaning there’s a lack of consistency across legal marijuana programs.

“States have become experts at taxing and controlling this industry, and public health and safety has generally been a secondary or even-later-down-the-line consideration,” Ben Gelt, board chair of the Cannabis Certification Council, was quoted as saying in the report. “I think that is shifting, to some degree. I think that these issues are going to inevitably bubble up.”

Considering that instances of contamination have been reported in legalized states, it’s within reason to assume that cannabis consumers in non-legal states face an even greater set of risks given the complete lack of quality control standards.

“No state has it right, and there’s still a long way to go, and there’s still a lot of research that needs to be done,” Gelt said. “All of the states have significant gaps in their policies when it comes to testing and ensuring product quality and quality assurance. It just depends on what state you’re in where the gap is.”

While Environmental Health Perspectives receives support from federal government sources, an article’s appearance in the publication “does not indicate that the National Institute of Environmental Health Sciences condones, endorses, approves, or recommends the use of any products, services, materials, methodology, or policies stated therein,” according to a disclaimer on the journal’s website.

“Conclusions and opinions are those of the individual authors and advertisers only and do not necessarily reflect the policies or views of Environmental Health Perspectives or the National Institute of Environmental Health Sciences,” the notice states.

Nonetheless, the irony of federal dollars being spent to circulate a report hosted on a dot gov website that highlights the public health harms of ongoing federal marijuana prohibition was not lost on NORML Political Director Justin Strekal.

“The flat Earth mentality of continuing to deny the fact that a sizable percentage of the public consumes cannabis is hurting our ability to derive evidence-based best practices that put people’s health first,” he said. “It is the height of absurdity that public resources were used to compile a report that essentially states that the government is helpless because they have chained their hands to their sides as a result of prohibition. We demand regulation, not incarceration.”

“When the Congress chooses to get serious about putting public safety ahead of political expediency, they will move one of the various proposals to remove marijuana from the Controlled Substances Act to a vote,” Strekal said.

Marijuana Flower Offers More Pain Relief Than Other Cannabis Products, Study Finds

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Marijuana Flower Offers More Pain Relief Than Other Cannabis Products, Study Finds

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Among the overwhelming variety of cannabis products available on the market today, the most effective for pain relief appears to be whole dried marijuana flower and products high in THC, a new study finds.

“Whole cannabis flower was associated with greater pain relief than were other types of products, and higher tetrahydrocannabinol (THC) levels were the strongest predictors of analgesia and side effects prevalence across the five pain categories,” researchers from the University of New Mexico wrote. “In contrast, cannabidiol (CBD) levels generally were not associated with pain relief except for a negative association between CBD and relief from gastrointestinal and non-specified pain.”

Using data from a mobile app that aims to educate users about cannabis products and help them track their experiences, the researchers found that most people who reported self-medicating with marijuana have short-term, yet significant, relief from pain. “In our sample,” they write, “we observed an average pain reduction of roughly 3 points on a standard 0 to 10 visual analogue pain scale, consistent with its application as a mid-level analgesic.”

The findings, published in Complementary Therapies in Medicine in late July, are the latest in a robust body of scientific literature that shows marijuana can help people with different kinds of pain.

The study’s goal was to gauge how the severity of pain changed and what side effects were experienced after cannabis consumption, and whether these effects differed by product. Researchers used information gleaned from Releaf App, a mobile software program developed by three of the study’s authors and released in 2016. The app allows users to monitor their symptoms before, during and after consuming cannabis, thus helping them to understand the differences between products and delivery methods.

The study—which calls the Releaf data set “the largest database of real-time cannabis administration sessions in the U.S”—analyzed 20,513 cannabis sessions recorded in the app by 2,987 people between June 6, 2016 and October 24, 2018.

“Perhaps the most surprising result,” lead author Xiaoxue Li said in a statement, “is just how widespread relief was with symptom relief reported in about 95 percent of cannabis administration sessions and across a wide variety of different types of pain.”

“The results suggest that cannabis flower with moderate to high levels of tetrahydrocannabinol is an effective mid-level analgesic.”

On average, users reported their starting pain to be 5.87 on a scale of 1 to 10. After consuming marijuana, that number fell to 2.77—a decrease of 3.1 points.

“Among the limited number of product characteristics that are typically made available to consumers, we found that consumption of whole, natural Cannabis flower was associated with greater anesthetic potential than were most other types of products,” the authors wrote.

The study also found:

  • Patients whose cannabis sessions involved flower reported similar pain relief as those using concentrates and topicals. Edibles, pills and tinctures, however, offered less relief than flower.
  • Concentrates were found to be associated with more negative side effects, which the researchers reasoned could be because of solvents and other additives, as well as the removal of most terpenoids, terpenes and flavonoids.
  • Products labeled as hybrid strains were more effective at relieving pain than those labeled indica or sativa.
  • Combustion method didn’t affect pain.
  • Higher THC levels offered more pain relief, while higher CBD levels did not.
  • Patients with back, joint or muscle pain, headache or migraine and non-specified pain saw more relief with high-THC products.
  • Patients with gastrointestinal/abdominal-related pain found more relief with lower levels of THC.

As for other reactions, patients were more likely to report positive effects than negative effects: they cited dry mouth and feeling foggy as the most common negative ones, while feeling relaxed and peaceful were frequently reported as the most positive ones. Additionally, while CBD levels didn’t impact pain much, the cannabinoid did appear to decrease the likelihood of having negative side effects.

“The current findings,” the study concludes, “show that self-directed medical cannabis treatment, especially among users of higher THC products, is associated with significant improvements in at least short-term pain relief, perhaps a major reason why cannabis has become one of the most widely used medications in the United States.”

In a statement, Jacob Vigil, another study author and UNM associate professor of psychology, said the reason why dried cannabis flower may be more effective for pain is because of its “numerous constituents that possess analgesic properties beyond THC, including terpenes and flavonoids.” These compounds probably work together to increase cannabis’ therapeutic effects, he said.

“Our results confirm that cannabis use is a relatively safe and effective medication for alleviating pain, and that is the most important message to learn from our results,” Vigil continued. “It can only benefit the public for people to be able to responsibly weigh the true risks and benefits of their pain medication choices.”

Study Reveals How Marijuana Components THC And CBD Affect Chronic Pain

Photo courtesy of WeedPornDaily.

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Science & Health

Federal Data Shows Youth Marijuana Use Isn’t Increasing Under Legalization

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Despite prohibitionists’ often-expressed fears that legalization would lead more young people to use marijuana, new federal data released on Tuesday shows no such trend.

Reports of past-month cannabis use among those 12-17 remained stable from 2017 to 2018—and they’re significantly lower than in the years prior to when the first states began legalizing for adult use.

That’s according to the 2018 National Survey on Drug Use and Health (NSDUH), an annual report produced by the Substance Abuse and Mental Health Services Administration (SAMHSA).

“The percentage of adolescents in 2018 who used marijuana in the past year was lower than the percentages in 2002 to 2004 and in 2009 to 2013, but it was similar to the percentages in 2005 to 2008 and in 2014 to 2017,” SAMHSA said.

Via SAMHSA.

Recent studies that have used NSDUH data and other sources also demonstrate that youth marijuana use is not increasing post-legalization. In fact, research published in JAMA Pediatrics in July found that states with recreational cannabis experience a decline in underage marijuana use, with the study authors stating that regulated markets appear to deter illicit use.

Indeed, on a national scale, the percentage of adolescents who reported using marijuana began declining at a greater rate in the years after states started implementing legal cannabis systems. In 2018, 12.5 percent of those 12-17 said they used cannabis in the last month, compared to 13.5 percent in 2012, according to the NSDUH results.

Colorado and Washington State became the first U.S. states to vote to legalize marijuana for recreational use in late 2012, with legal sales commencing in 2014.

Between 2002 and 2018, the highest rate of adolescent marijuana use took place in 2002, when 15.8 percent reported past-month consumption.

“The survey results suggest that marijuana use among youth has remained stable and low in recent years, even as more states legalize medical and adult use,” Sheila Vakharia, PhD, deputy director of the Drug Policy Alliance’s Department of Research and Academic Engagement, told Marijuana Moment. “Rather than encouraging increased use, it is possible that legalization has limited access and deterred youth use. We find that these results strengthen the case for legalization in the interest of public health and protecting our nation’s young people.”

What’s more, the report found that cases of cannabis use disorder declined again for the 12-17 group in 2018, marking the seventh year in a row that fewer young people seem to be misusing the substance.

Via SAMHSA.

Interestingly, these trends are developing even as people’s perceptions of the risks of casual marijuana consumption are dropping. That seems to contradict an argument from reform opponents who claimed that legalizing cannabis would normalize it in such a way that underage individuals would feel more emboldened to experiment with marijuana.

Via SAMHSA.

Overall, marijuana consumption increased across age groups by about one percentage point over the past year, the survey found, with the bulk of that rise being attributable to those over 26. Past-month cannabis use for that demographic increased from 12.2 percent in 2017 to 13.3 percent in 2018.

Marijuana Taxes Differ In Legalized States, Complicating Projections

This story was updated to include comment from the Drug Policy Alliance.

Photo courtesy of Philip Steffan.

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.
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