Steuart Shelby R, Lozano-Rojas Felipe, Bethel Victoria, Shone Hailemichael Bekele, Abraham Amanda J
Crown Family School of Social Work, Policy, and Practice, The University of Chicago.
Department of Public Administration and Policy, University of Georgia.
Cannabis. 2025 Feb 1;8(1):121-138. doi: 10.26828/cannabis/2024/000268. eCollection 2025.
Almost half of U.S. states have passed recreational cannabis laws as of May 2024. While considerable evidence to date indicates cannabis may be a substitute for prescription opioids in the treatment of pain, it remains unclear if patients are treating pain with cannabis alone or concomitantly with other medications.
Using data from a national sample of commercially insured adults, we examine the effect of recreational cannabis legalization (through two sequential policies) on prescribing of opioids, NSAIDS, and other pain medications by implementing synthetic control estimations and constructing case-study level counterfactuals for the years 2007-2020.
Overall, we find recreational cannabis legalization is associated with a decrease in opioid fills among commercially insured adults in the U.S., and we find evidence of a compositional change in prescriptions of pain medications more broadly. Specifically, we find marginally significant increases in prescribing of non-opioid pain medications after recreational cannabis becomes legal in some states. Once recreational cannabis dispensaries open, we find statistically significant decreases in the rate of opioid prescriptions (13% reduction from baseline, < .05) and marginally significant decreases in the average daily supply of opioids (6.3% decrease, < .10) and number of opioid prescriptions per patient (3.5% decrease, < .10).
These results suggest that substitution of cannabis for traditional pain medications increases as the availability of recreational cannabis increases. There appears to be a small shift once recreational cannabis becomes legal, but we see stronger results once users can purchase cannabis at recreational dispensaries. The decrease in opioids and marginal increase in non-opioid pain medication may reflect patients substituting opioids with cannabis and non-opioid pain medications, either separately or concomitantly. Reductions in opioid prescription fills stemming from recreational cannabis legalization may prevent exposure to opioids in patients with pain and lead to decreases in the number of new opioid users, rates of opioid use disorder, and related harms.
截至2024年5月，美国近一半的州已通过休闲大麻法律。虽然迄今为止有大量证据表明大麻在治疗疼痛方面可能是处方阿片类药物的替代品，但尚不清楚患者是单独使用大麻治疗疼痛还是与其他药物同时使用。
利用全国商业保险成年人样本的数据，我们通过实施合成控制估计并构建2007 - 2020年案例研究水平的反事实，研究休闲大麻合法化（通过两项相继政策）对阿片类药物、非甾体抗炎药和其他止痛药处方的影响。
总体而言，我们发现休闲大麻合法化与美国商业保险成年人中阿片类药物配药减少有关，并且我们更广泛地发现了止痛药处方构成变化的证据。具体而言，我们发现在一些州休闲大麻合法化后，非阿片类止痛药的处方略有显著增加。一旦休闲大麻药房开业，我们发现阿片类药物处方率有统计学显著下降（较基线降低13%，P <.05），阿片类药物平均每日供应量略有显著下降（降低6.3%，P <.10），每位患者的阿片类药物处方数量略有显著下降（降低3.5%，P <.10）。
这些结果表明，随着休闲大麻可得性的增加，大麻替代传统止痛药的情况增多。休闲大麻合法化后似乎有一个小的转变，但当用户可以在休闲药房购买大麻时，我们看到了更强的结果。阿片类药物的减少和非阿片类止痛药的略有增加可能反映患者单独或同时用大麻和非阿片类止痛药替代阿片类药物。休闲大麻合法化导致的阿片类药物处方配药减少可能会防止疼痛患者接触阿片类药物，并导致新阿片类药物使用者数量、阿片类药物使用障碍发生率及相关危害的降低。
