The misuse of opioids and the large number of prescriptions given remains a significant national problem, explains the study, published last month in the American Academy of Orthopedic Surgeons. The study focuses specifically on prescriptions given by orthopedic surgeons, who are among the top prescribers of opioids in the United States.
Orthopedic surgeons are among the largest prescribers of opioids, underscoring the importance of providing alternatives to non-opioid analgesics as part of efforts to reduce opioid use in the patient cohort. This study is the first to examine the association between the implementation of state cannabis laws and opioid prescribing patterns by orthopedic surgeons in Part D patients.
Cannabinoids offer a potentially attractive non-opioid analgesic option for orthopedic patients, and 32 U.S. states have passed medical cannabis laws, legalizing patient access to cannabinoids. We examine the association between the implementation of state cannabis laws and orthopedic surgeons’ opioid prescribing patterns in patients between 2013 and 2017.
Using the Medicare Part D Prescription Drug Event database, we measured the annual aggregate daily doses of all opioid drugs (excluding buprenorphine) prescribed by orthopedic surgeons in each U.S. state, in addition to total daily doses of opioid drugs by generic name (hydrocodone, oxycodone, fentanyl, morphine, methadone, and “other opioids”). Adjusted linear regression models were used to examine associations between state-specific cannabis regulations (dispensary, home cultivation, recreational legalization) and total annual daily doses of opioid drugs (all opioids and opioid types, separately).
The researchers not only examined each state’s cannabis laws on paper but also their actual enforcement. They found that in states that have approved legislation but have not yet opened shops, there has been no significant change in the number of opioid prescriptions. The decline in opioid prescriptions has been observed only in countries where patients could buy medical cannabis in shops, not just grow it themselves at home.
From 2013 to 2017, legalized States were associated with a statistically significant reduction in the overall opioid prescription of 144,000 daily doses (a reduction of 19.7 percent) per year. States that provide access to public health clinics experienced a statistically significant reduction in total opioid prescriptions of 96,000 daily doses (a reduction of 13.1 percent) per year. Specifically, there was a statistically significant reduction of 72,000 daily doses of hydrocodone per year. No significant association between recreational legalization and the opioid prescription was found. This compares to a reduction of only 1.7% in US states where medical cannabis was banned.
Similar results have already been obtained in a University of Alabama study published earlier this year in the Journal of Health Economics, as well as in studies published in the Journal of the American Medical Association (JAMA) in 2018.