Cannabis: Legal stores linked to fewer opioid deaths in the United States

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  • A correlation shows that the presence of legal cannabis shops is associated with fewer opioid-induced deaths in the United States. The results may have implications for controlling opioid abuse.

    A correlation shows that the presence of legal cannabis shops is associated with fewer opioid-induced deaths in the United States. The results may have implications for controlling opioid abuse.

    Access to legal cannabis stores is associated with a reduction in opioid-related deaths in the United States, particularly those related to synthetic opiates such as fentanyl, finds a study released today by the BMJ. Opiates are “morphine-like” drugs that provide short-term (acute) pain relief and pain at the end of life. There is little evidence that they are helpful for long-term (chronic) pain, but they are often prescribed for this reason.

    An explosion of deaths linked to opiates in the United States

    This has led to widespread abuse and a sharp increase in overdose deaths, especially in the United States. In 2018, there were over 46,000 fentanyl-related deaths, representing more than two-thirds of all opioid-related deaths in the United States that year.

    Some studies have suggested that increased access to cannabis stores, legally licensed to sell medical and recreational cannabis, could help reduce opioid-related deaths, but the evidence to date is mixed. To explore this question further, researchers looked at the relationships between medical and recreational cannabis stores (called dispensaries) and opioid-related deaths from 2014 to 2018.

    Their findings are based on data from 812 counties in the 23 US states that have allowed legal cannabis dispensaries to operate by the end of 2017. Information on national cannabis law has been combined with data at the counties level on licensed dispensaries and opioid-related death rates.

    Presence of legal cannabis stores lowers mortality

    After controlling for population characteristics and other potentially influencing factors, the researchers found that counties with a higher number of active cannabis dispensaries were associated with reduced opioid-related death rates.

    According to this estimate, an increase from one to two dispensaries in a county was associated with an estimated 17% reduction in all opioid-related death rates. This association applied to both medical and recreational clinics and appeared particularly strong for deaths associated with synthetic opiates other than methadone, with an estimated 21% reduction in death rates associated with an increase from one to two clinics.

    An increase from two to three dispensaries was associated with a further 8.5% reduction in all opioid-related death rates.

    This study is the first to examine the association between active cannabis dispensary operations and county-level opioid-related death rates. However, the results are observational and therefore cannot establish the cause, and the researchers point out that while cannabis is generally considered less addictive than opiates, it still carries potential harm and risks to public safety that should not be ignored.

    The study remains observational

    But they say their findings suggest “a potential association between the increased prevalence of medical and recreational cannabis dispensaries and reduced opioid-related death rates.” And they call for “a better understanding of the impact of cannabis legalization on opioid abuse and public health outcomes before policymakers can weigh the potential benefits against the harms of promoting legalization of cannabis”.

    In a linked editorial, the researchers say that legalizing cannabis “cannot be seen as a cure for the opioid crisis until a solid database is available.” While some may interpret these findings as evidence to support the liberalization of cannabis to address the opioid crisis, they point out that “such conclusions are currently premature without evidence of causation.”

    Further experimental studies including data at the individual level of those who use prescription opiates and illicit opiates “would shed light on a more nuanced understanding of substitution between opiates and cannabis,” they conclude.

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