Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees

• Type of Material: Article
• Authors: Hefei Wen, University of Kentucky; Jason Michael Hockenberry, Emory University
• Language: English
• Date: 2018-05-01
• Publisher: American Medical Association (AMA)
• Publication Version: Final Published Version
• Copyright Statement: © 2018 American Medical Association. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1001/jamainternmed.2018.1007
• Title of Journal or Parent Work: JAMA Internal Medicine
• ISSN: 2168-6106
• Volume: 178
• Issue: 5
• Start Page: 673
• End Page: 679
• Keywords: ABUSE; EPIDEMIC; CHRONIC NONCANCER PAIN; UNITED-STATES; Medicine, General & Internal; LEGALIZATION; Science & Technology; REDUCE; CANNABIS; DEATHS; General & Internal Medicine; PUBLIC-HEALTH; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Public Health

Abstract

IMPORTANCE: Overprescribing of opioids is considered a major driving force behind the opioid epidemic in the United States. 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. Marijuana liberalization, including medical and adult-use marijuana laws, has made marijuana available to more Americans. OBJECTIVE: To examine the association of state implementation of medical and adult-use marijuana laws with opioid prescribing rates and spending among Medicaid enrollees. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a quasi-experimental difference-in-differences design comparing opioid prescribing trends between states that started to implement medical and adult-use marijuana laws between 2011 and 2016 and the remaining states. This population-based study across the United States included all Medicaid fee-for-service and managed care enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose. EXPOSURES: State implementation of medical and adult-use marijuana laws from 2011 to 2016. MAIN OUTCOMES AND MEASURES: Opioid prescribing rate, measured as the number of opioid prescriptions covered by Medicaid on a quarterly, per-1000-Medicaid-enrollee basis. RESULTS State implementation of medical marijuana laws was associated with a 5.88%lower rate of opioid prescribing (95%CI,-11.55% to approximately-0.21%). 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 (95% CI,-12.20% to approximately-0.56%). CONCLUSIONS AND RELEVANCE:The potential of marijuana liberalization to reduce the use and consequences of prescription opioids among Medicaid enrollees deserves consideration during the policy discussions about marijuana reform and the opioid epidemic.