Legalizing medical cannabis appears to significantly lessen monetary payments from opioid manufacturers to doctors who specialize in pain, according to recently published research, with authors finding “evidence that this decrease is due to medical marijuana becoming available as a substitute” for prescription painkillers.
“We find MML [medical marijuana legalization] leads opioid manufacturers to decrease direct payments to physicians prescribing opioids,” wrote authors, from the University of Florida, University of Southern California and the State University of New York (SUNY) at Buffalo. “Our analyses suggest this shift is due to increased adoption of marijuana for pain management, indicating that opioid manufacturers perceive marijuana as a superior substitute and respond by reducing these payments.”
The study was published late last year in the Journal of the American Statistical Association and was partially funded through a grant from the National Science Foundation. It looked at various financial incentives that opioid drugmakers provide to prescribing doctors—such as consulting fees and travel to conferences—and used a novel method of analysis meant to estimate causal effects from observational data.
“Our analysis finds a significant decrease in direct payments from opioid manufacturers to pain medication physicians as an effect of MML passage,” the report says.
Wreetabrata Kar, an assistant professor of marketing in the SUNY Buffalo’s school of management, co-authored the new study.
“Our findings indicate that medical marijuana is increasingly viewed as a substitute for opioids in chronic pain treatment, with the potential to transform pain management practices and help mitigate the opioid crisis that has profoundly affected communities across the U.S.,” the researcher explained in a press release. “The availability of new pain management options can change the financial dynamics between drug companies and health care providers.”
The team’s analysis found that decreases in direct payments from opioid makers to physicians was higher among physicians “practicing in localities with higher white populations, lower affluence, and a larger proportion of working-age residents.”
“Lower income regions tend to have higher rates of chronic pain and opioid misuse, making them key areas for potential substitution with medical marijuana,” Kar said. “Black patients are also less likely to be prescribed opioids for pain, and younger populations may be more open to alternative treatments, which could explain the different impacts of marijuana legalization in these communities.”
The study emphasizes that while its focus is the relationship between opioid manufacturers and doctors, “it’s crucial to consider how MML affects patient pain management,” noting that annual prescription data shows a decrease in opioid prescriptions among states that legalized medical cannabis.
“From 2015 to 2017, in the states not passing an MML, 30 days’ fill of opioid versus non-opioid remained flat,” the paper says. “However, in the states passing an MML, from 2015 to 2017, 30 days’ fill as well as the number of days of prescription of opioid versus non-opioid decreased from a 1.57:1 ratio to a 1.52:1 ratio. In particular, the pattern of opioid versus non-opioid prescriptions did not change in the control states, while there was a relative decrease in opioid prescriptions in the MML states from 2015 to 2017.”
Separate research published late last year also showed a decline in fatal opioid overdoses in jurisdictions where marijuana was legalized for adults. That study found a “consistent negative relationship” between legalization and fatal overdoses, with more significant effects in states that legalized cannabis earlier in the opioid crisis. Authors estimated that recreational marijuana legalization “is associated with a decrease of approximately 3.5 deaths per 100,000 individuals.”
“Our findings suggest that broadening recreational marijuana access could help address the opioid epidemic,” that report said. “Previous research largely indicates that marijuana (primarily for medical use) can reduce opioid prescriptions, and we find it may also successfully reduce overdose deaths.”
“Further, this effect increases with earlier implementation of [recreational marijuana legalization],” it added, “indicating this relationship is relatively consistent over time.”
Another recently published report into prescription opioid use in Utah following the state’s legalization of medical marijuana found that the availability of legal cannabis both reduced opioid use by patients with chronic pain and helped drive down prescription overdose deaths statewide. Overall, results of the study indicated that “cannabis has a substantial role to play in pain management and the reduction of opioid use,” it said.
Yet another study, published in 2023, linked medical marijuana use to lower pain levels and reduced dependence on opioids and other prescription medications. And another, published by the American Medical Association (AMA) last February, found that chronic pain patients who received medical marijuana for longer than a month saw significant reductions in prescribed opioids.
About one in three chronic pain patients reported using cannabis as a treatment option, according to a 2023 AMA-published report. Most of that group said they used cannabis as a substitute for other pain medications, including opioids.
Other research published that year found that letting people buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 percent to 8.1 percent fewer opioid prescriptions.
A 2022 research paper that analyzed Medicaid data on prescription drugs, meanwhile, found that legalizing marijuana for adult use was associated with “significant reductions” in the use of prescription drugs for the treatment of multiple conditions.
A 2023 report linked state-level medical marijuana legalization to reduced opioid payouts to doctors—another datapoint suggesting that patients use cannabis as an alternative to prescription drugs when given legal access.
Researchers in another study, published last year, looked at opioid prescription and mortality rates in Oregon, finding that nearby access to retail marijuana moderately reduced opioid prescriptions, though they observed no corresponding drop in opioid-related deaths.
Other recent research also indicates that cannabis may be an effective substitute for opioids in terms of pain management.
A report published recently in the journal BMJ Open, for instance, compared medical marijuana and opioids for chronic non-cancer pain and found that cannabis “may be similarly effective and result in fewer discontinuations than opioids,” potentially offering comparable relief with a lower likelihood of adverse effects.
Separate research published found that more than half (57 percent) of patients with chronic musculoskeletal pain said cannabis was more effective than other analgesic medications, while 40 percent reported reducing their use of other painkillers since they began using marijuana.
A related report published late last year examined the effects of adding medical marijuana to state prescription drug monitoring programs, concluding that the additional tracking had mixed effects, both reducing the prescription of medications that could cause complications with cannabis and also exposing a possible bias against medical marijuana patients among healthcare providers.
Photo courtesy of Philip Steffan.
Legalizing medical cannabis appears to significantly lessen monetary payments from opioid manufacturers to doctors who specialize in pain, according to recently published research, with authors finding “evidence that this decrease is due to medical marijuana becoming available as a substitute” for prescription painkillers. “We find MML [medical marijuana legalization] leads opioid manufacturers to decrease direct Read More
