Opioids And Marijuana

Is Legal Marijuana Making the Opioid Epidemic Worse?
2022, April 8

Is marijuana REALLY a safer alternative to prescription painkillers and the solution to the opioid epidemic? From the beginning, supporters of expanded cannabis legalization have promised that marijuana could save lives by replacing other, more dangerous drugs.

But like so many other claims about marijuana’s supposed benefits, that assertion doesn’t quite hold up. Despite that promise, legal medical and recreational marijuana play a significant role in the still-worsening opioid overdose crisis in America…

United States marijuana legalization and opioid mortality epidemic during 2010–2020 and pandemic implications
Science Direct 2022, March 9

In a national epidemiologic survey of the U.S., nonmedical prescription opioid use increased 5.8-fold (95%CI=4.2–7.9) and opioid use disorder increased 7.9-fold (95%CI=5.0–12.3) within 3 years of using cannabis.

Instead of supporting the marijuana protection hypothesis, ecologic associations at the national level suggest that marijuana legalization has contributed to the U.S.’s opioid epidemic in all major races/ethnicities, and especially in blacks. If so, the increased use of marijuana during the 2020–2022 pandemic may thereby worsen the country’s opioid crisis….

Naturalistic cannabis use reported in online opioid and opioid recovery community discussion forums
PLOS ONE 2022, February 8

The opioid epidemic in North America is characterized by dramatic increases in opioid-related overdoses and unmet treatment need for opioid use disorder (OUD). As Canada and most U.S. states enact decriminalization and legalization of cannabis for medical and recreational adult use, there is considerable interest in determining whether cannabis and cannabinoid products are viable alternatives to opioids for pain management or a potential adjunctive therapy for OUD. Recent interest is spurred in part by several studies that found relationships between cannabis legalization at the state level and reductions in opioid-related deaths, though the ecological association between state-level medical cannabis legislation and reduced opioid overdose mortality reported previously was not replicated in a study examining additional years. Additionally, several studies have found that medical cannabis patients report pain management as one of the most common reasons for cannabis use and that cannabis use was associated with lower opioid use among people who use illicit drugs. However, there are also ongoing concerns about cannabis use increasing the risk for non-medical opioid use and opioid and cannabis use disorders, especially among adolescents and young adults, and that cannabis use may lead to return to opioid use by people with a history of OUD…

Legal weed was supposed to help ease the opioid crisis. What happened?
NBC News 2021, July 16

Yet during the pandemic, overdose deaths from opioid use rose by more than a third to 69,000 in 2020, according to provisional data released this week by the Centers for Disease Control and Prevention. Drug overdose deaths overall reached a record 93,000 last year.

Study author Coleman Drake, an assistant professor of health policy and management at the University of Pittsburgh, said some people may have turned to marijuana instead of opioids for pain relief, at least initially. Others may have tried to use marijuana to wean off of opioids but found it didn’t work…

Legal marijuana either eases opioid crisis or makes it worse. The evidence is split
NBC News 2021, July 16

The researchers concluded that while recreational cannabis laws may offer some help in fighting the opioid crisis, they are “likely not a panacea.” They noted that about a third of Americans now live in a state with a recreational cannabis law. Yet during the pandemic, overdose deaths from opioid use rose by more than a third to 69,000 in 2020, according to provisional data released this week by the Centers for Disease Control and Prevention. Drug overdose deaths overall reached a record 93,000 last year…

Recreational cannabis laws and opioid-related emergency department visit rates
Wiley Online Library 2021, July 12

As of 2021, roughly a third of Americans now live in a state with a recreational cannabis law (RCL). Recent evidence indicates RCLs could be a harm reduction tool to address the opioid epidemic. Individuals may use cannabis to manage pain, as well as to relieve opioid withdrawal symptoms, though it does not directly treat opioid use disorder. It is thus unclear whether RCLs are an effective policy tool to reduce adverse opioid-related health outcomes…

Case Reports on the Failure of Smoking Marijuana to Prevent Relapse to Use of Opiates in Adolescents/Young Adults With Opiate Use Disorder
Science Direct 2021, May 26

Twenty-six adolescent/young adult patients with opioid use disorder smoked marijuana in an attempt to avoid relapse to opiate use. In each case, smoking marijuana increased cravings and urges for opiates and promoted opiate relapse. These clinical case reports show that smoking marijuana was not helpful as a harm reduction strategy to prevent return to opioids in young people with OUD…

Is Cannabis being used as a substitute for non-medical opioids by adults with problem substance use in the United States? A within-person analysis Wiley Online Library 2020, October 8

Among US adults with problem substance use who use non-medical opioids, the odds of opioid use appear to be approximately doubled on days when Cannabis is used. This relationship does not appear to differ between people with moderate or more severe pain versus less than moderate pain, suggesting that Cannabis is not being used as a substitute for illegal opioids…

Understanding Opioid Use Disorder (OUD) using tree-based classifiers
Science Direct 2020, March 1

We developed a method to identify adults likely to develop Opioid Use Disorder.•

Early initiation of marijuana is a dominant predictor of Opioid Use Disorder.•

The method considers demographic, socioeconomic, and health related features.•

Mining public domain datasets can aid in understanding addiction disorders…

Association between medical cannabis laws and opioid overdose mortality has reversed over time PNAS 2019, June 10

Medical cannabis has been touted as a solution to the US opioid overdose crisis since Bachhuber et al. [M. A. Bachhuber, B. Saloner, C. O. Cunningham, C. L. Barry, JAMA Intern. Med. 174, 1668–1673] found that from 1999 to 2010 states with medical cannabis laws experienced slower increases in opioid analgesic overdose mortality. That research received substantial attention in the scientific literature and popular press and served as a talking point for the cannabis industry and its advocates, despite caveats from the authors and others to exercise caution when using ecological correlations to draw causal, individual-level conclusions. In this study, we used the same methods to extend Bachhuber et al.’s analysis through 2017. Not only did findings from the original analysis not hold over the longer period, but the association between state medical cannabis laws and opioid overdose mortality reversed direction from −21% to +23% and remained positive after accounting for recreational cannabis laws…

Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically National Center for Biotechnology Information  2018, August 12

Results: Medical marijuana users were significantly more likely (RR 1.62, 95% confidence interval [CI] 1.50-1.74) to report medical use of prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug (RR 2.12, 95% CI 1.67-2.62), with elevated risks for pain relievers (RR 1.95, 95% CI 1.41-2.62), stimulants (RR 1.86, 95% CI 1.09-3.02), and tranquilizers (RR 2.18, 95% CI 1.45-3.16).

Conclusions: Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use…

People who use medical marijuana more likely to use and misuse other prescription drugs
Science Daily 2018, April 17

Rather than being at lower risk, people who use medical marijuana may be at higher risk for non-medical prescription drug use, suggests the study by Theodore L. Caputi, BS of University College Cork’s School of Public Health and Keith Humphreys, PhD, of Stanford University. However, an accompanying commentary questions whether medical cannabis is the cause of higher prescription drug use, or whether other factors explain the association…

Marijuana use is associated with an increased risk of prescription opioid misuse and use disorders National Institute on Drug Abuse 2017, September 26

New research suggests that marijuana users may be more likely than nonusers to misuse prescription opioids and develop prescription opioid use disorder. The study was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and Columbia University…

Teens who smoke and drink may be more likely to abuse prescription opioids later
Yale News 2012, August 21

Their findings included:

  • 12% of the survey population of 18- to 25-year-olds reported current abuse of prescription opioids.
  • For this population, prevalence of previous substance use was 57% for alcohol, 56% for cigarettes, and 34% for marijuana.
  • In young men, previous abuse of all three substances was associated with an increased likelihood of subsequent opioid abuse during young adulthood, but only previous marijuana use carried this association among young women…

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