Opioid overdose deaths occur less often in areas with more cannabis retail storefronts, study shows

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The more legal cannabis dispensaries a region has the fewer opioid deaths they suffered, according to a detailed new study published in a top-tier medical journal. Most sharply reduced were deaths from fentanyl overdoses.

In areas with one legal storefront cannabis dispensary, opioid death rates were an estimated 17 per cent lower than average. In areas with two dispensaries, there was an estimated 21 per cent reduction in mortality rates, the study found.

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The results — based on U.S. data — suggest marijuana use as an alternative to opioids in pain management could improve health prospects.

What the study doesn’t do, however, is specifically declare a direct cause of lower opioid death rates.

“Our findings suggest that higher storefront cannabis dispensary counts are associated with reduced opioid-related mortality rates at the county level,” the authors write. “While the associations documented cannot be assumed to be causal, they suggest a potential association between increased prevalence of medical and recreational cannabis dispensaries and reduced opioid-related mortality rates.”

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The study by Greta Hsu, at the University of California, Davis, and Balázs Kovács, at Yale University, was published this week in The BMJ, a respected medical journal previous known as the British Medical Journal.

It follows a Canadian study published this week that found legalizing cannabis led to a “marked decline” in the volume of opioids prescribed across Canada.

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The Canadian study, published in Applied Health Economics and Health Policy journal, concludes that “easier access to cannabis for pain may reduce opioid use for both public and private drug plans.”

Another Canadian study, published last month and based on a large prospective examination of Canadian medical cannabis patients, found cannabis use significantly reduced the use of prescription opioids.

Published in the journal Pain Medicine, the Canadian academics concluded: “The high rate of cannabis use for chronic pain and the subsequent reductions in opioid use suggest that cannabis may play a harm reduction role in the opioid overdose crisis, potentially improving the quality of life of patients and overall public health.”

The BMJ study focusses on the extreme outcomes of opioid use.

“This association holds for both medical and recreational dispensaries, and appears particularly strong for deaths associated with synthetic (non-methadone) opioids, which include the highly potent synthetic opioid fentanyl and its analogs,” the study says.

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“This study highlights the importance of considering the complex supply side of related drug markets and how this shapes opioid use and misuse.”

Canada legalized cannabis use in 2018 and since then, licensed cannabis retail outlets, called dispensaries, have been popping up with regularity. Although cannabis remains illegal under U.S. federal law, an increasing number of U.S. states have legalized its use and sale, some for recreational use but more frequently for medical use.

Deaths from overdoses of opioids — a class of drugs that include heroin, prescription pain relievers such as oxycodone, and synthetic opioids such as fentanyl, a particularly powerful pain killer — have risen sharply in many countries, including Canada. Fentanyl, in particular, has caused wide alarm.

The researchers, using U.S. data, said highly addictive opioids represent more than two thirds of all U.S. drug overdose deaths in 2018. According to Canadian government data, there were 17,602 apparent opioid-related overdose deaths in Canada between January 2016 and June 2020.

Researchers have looked at what impact cannabis dispensaries have on the use, abuse and impact of other drugs in the past, and have returned with mixed results.

In response, the two U.S. researchers drilled down to a more local level to compare data in U.S. counties that actually have dispensaries, rather than look at statewide or nation-wide data.

Their study also took into account how many dispensaries were operating in each county, probing how the count of cannabis dispensaries relates to opioid deaths.

Their data set spanned from 2014 to 2018, the first year that structured data on dispensaries was available, and ending with the most recent period for detailed health statistics.

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