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TOPLINE:

Despite increased interest in the potential of cannabis as a substitute for opioids in the treatment of pain, a drop in opioid prescribing for patients with inflammatory bowel disease (IBD) could not be attributed to cannabis legalization.

METHODOLOGY:

• Researchers conducted a retrospective, quasi-experimental study to identify changes in opioid prescribing among patients with IBD in states with and without cannabis legalization before (2009-2012) and after (2012-2016) legalization.
• They identified 6240 patients with IBD in two states that legalized cannabis in 2012 (Colorado and Washington) and 79,272 patients with IBD in 17 states without legalized cannabis using data from IBM MarketScan, which contains claims-based data on millions of people nationwide with commercial insurance.
• They performed a difference-in-difference regression analysis to estimate the change in the rate of opioid prescribing (per 1000 patients with IBD) in the legalized cannabis states relative to the without legalization states.

TAKEAWAY:

• Overall, the rates of opioid prescribing decreased over time in both groups, but the change attributed to cannabis legalization wasn't statistically significant (attributed differential, 0.34).
• In states with legalized cannabis, the mean rates of opioid prescribing decreased from 37.6 per 1000 patients in 2009-2012 to 17.4 per 1000 patients in 2012-2016.
• Similarly, in states without legalized cannabis, the mean rates of opioid prescribing decreased from 36.9 per 1000 patients in 2009-2012 to 16.4 per 1000 patients in 2012-2016.
• Other variables, such as gender, age, and mental health diagnosis, didn't have a significant effect on opioid prescribing trends either.

IN PRACTICE:

"The ongoing opioid crisis in the United States underscores the critical need for more effective and safer alternatives to manage pain, particularly in chronic conditions such as IBD where pain undermines quality of life. While cannabis has the theoretical potential to be a viable analgesic substitute for prescription opioids, an association between decreased opioid prescribing and cannabis legalization was not observed," the authors wrote.

SOURCE:

The study, with first author Mohamed Noureldin, MD, MS, from the Institute of Healthcare Policy and Innovation and Division of Gastroenterology and Hepatology at Michigan Medicine, Ann Arbor, Michigan, was published online in The American Journal of Gastroenterology.

LIMITATIONS:

The study was ecological (rather than interventional), so researchers could not draw conclusions about the impact, efficacy, or safety of cannabis at the individual level. It could not differentiate between change in new vs recurring opioid prescriptions. The results are not necessarily generalizable to all states or patients with governmental insurance coverage because there could be fundamental differences in these populations compared with the commercially insured population evaluated in the study.

DISCLOSURES:

Two authors received training or career development awards from the National Institute of Diabetes and Digestive and Kidney Diseases. Several authors declared consulting fees or research funding from pharmaceutical companies.