TOPLINE:

A national claims analysis found that opening medical or recreational cannabis dispensaries was associated with fewer opioid prescriptions and shorter opioid supplies among commercially insured adults with cancer. Medical cannabis dispensary openings were associated with a reduction of 41.07 patients with opioid prescriptions per 10,000, whereas recreational dispensaries were associated with a smaller but significant decrease of 20.63 patients per 10,000, suggesting cannabis may serve as an alternative for managing cancer-related pain.

METHODOLOGY:

• Pain affects more than 65% of patients with advanced cancer, and opioids remain the standard therapy. However, cannabis is increasingly available and may offer analgesic or opioid-sparing effects. Currently, 39 states and Washington, DC, have adopted medical cannabis laws, and 24 states and Washington, DC, have legalized recreational use; however, prior studies have not evaluated the effects of recreational cannabis laws on opioid use in patients with cancer or examined cannabis availability across historically undertreated subgroups.
• To bridge this gap, researchers conducted a cross-sectional analysis of Optum’s deidentified claims database from January 2007 to December 2020, employing a synthetic control method to examine the association between cannabis dispensary openings and opioid dispensing among commercially insured adults (age, 18-64 years) with cancer who had at least 6 months of continuous enrollment.
• Overall, the study population included a mean of 3.05 million patients per year (mean age, 43.7 years; 59.0% women); 3.7% were Asian, 8.0% Black, 9.1% Hispanic, and 74.2% White.
• The outcome measures were the number of patients with opioid prescriptions per 10,000 enrollees with cancer, the quarterly mean days’ supply per prescription, and the quarterly mean number of prescriptions per patient.

TAKEAWAY:

• Medical cannabis dispensary openings were associated with significant reductions in opioid prescriptions, with the rate of patients with cancer receiving opioid prescriptions decreasing by 41.07 per 10,000 (95% CI, -54.78 to -27.36; P < .001).
• Following medical dispensary openings, the quarterly mean days’ supply of opioids decreased by 2.54 days (95% CI, -3.16 to -1.92; P < .001), and the mean number of prescriptions per patient reduced by 0.099 (95% CI, -0.121 to -0.077; P < .001).
• Opening recreational dispensaries was associated with smaller but significant reductions, with prescription rates decreasing by 20.63 per 10,000 (95% CI, -35.35 to -5.91; P = .049), mean daily supply decreasing by 1.09 days (95% CI, -1.72 to -0.46; P = .04), and the mean number of prescriptions per patient decreasing by 0.097 (95% CI, -0.134 to -0.060; P = .01).
• State-level analyses showed that most treated states experienced reductions relative to synthetic controls, and no increases in opioid prescribing were detected after dispensary openings. No consistent heterogeneity in policy effects was observed by age, sex, or race and ethnicity.

IN PRACTICE:

The findings of “this study suggest that cannabis may serve as a substitute for opioids in managing cancer-related pain, underscoring the potential of cannabis policies to impact opioid use,” the authors wrote, emphasizing that “[f]urther research should explore individual-level impacts, the mechanisms underlying these changes, and the long-term effects of cannabis policies on cancer pain management.”

SOURCE:

This study, led by Felipe Lozano-Rojas, PhD, University of Georgia in Athens, Georgia, was published online in JAMA Health Forum.

LIMITATIONS:

Concurrent state policies could have confounded findings. The study was limited to only commercially insured patients, potentially affecting generalizability of findings. Additionally, the analysis of recreational cannabis dispensary openings was restricted to only four states.

DISCLOSURES:

This study was funded by a grant from the National Institute on Drug Abuse. One author reported receiving grants from the National Institute on Drug Abuse during the conduct of the study. Another author disclosed receiving grants from the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Center for Advancing Translational Sciences during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.