Legalizing Marijuana Could Stem Opioid Abuse, Pitt Study Suggests

By: Natasha Lindstrom, Trib Live

Legalizing marijuana for recreational use could lead to fewer opioid-spurred health emergencies and overdose deaths, a University of Pittsburgh study has found.

Opioid-related emergency department visits dropped by 7.6% within a year of cannabis legalization for adult residents in four states — California, Nevada, Maine and Massachusetts — according to the analysis led by Pitt’s Graduate School of Public Health.

Lead study author Coleman Drake said the research does not point to cannabis legalization as “the silver bullet” to stemming the opioid epidemic, but it could be “another arrow in the quivers” of policymakers to combat the broader crisis.

“It suggests that recreational cannabis legalization could be an effective tool to help not only reduce opioid use but also to reduce the health implications that stem from opioid use, one of them being overdoses,” said Drake, assistant professor in Pitt’s Department of Health Policy and Management. “That’s potentially exciting and promising.”

The study did not examine data from Pennsylvania, where only medical marijuana has been available since 2016, although legislative efforts are brewing to change that. Nineteen states and the District of Columbia now allow recreational marijuana use, with New York, New Mexico, Virginia and Connecticut among the latest to do so this year.

“I would hope that policymakers in states that have not yet legalized recreational cannabis would take a look at this closely,” Drake said.

Not a ‘gateway drug’

The study’s findings add to mounting peer-reviewed evidence that marijuana, at least once legalized, does not pose the threat of a so-called “gateway drug” that leads to harder drug use — an argument lodged by Pennsylvania GOP leaders opposed to broad legalization.

“Our state is in the midst of an opioid epidemic. Gov. Wolf signed a disaster declaration over the crisis and renewed the declaration six separate times since January 2018,” House Speaker Bryan Cutler, R-Lancaster, said in a statement criticizing Wolf’s declaration in 2019 that he’d sign any cannabis legalization that reached his desk. “We do not believe easing regulations on illegal drugs is the right move in helping the thousands of Pennsylvanians who are battling drug addiction.”

The Pitt study, which has been in the works for more than a year and was backed by the National Institute on Drug Abuse, was published this week in the journal Health Economics. Pitt researchers collaborated with authors at the Harvard Pilgrim Health Care Institute and RTI International.

They analyzed data on hospital visits involving opioids from 2011 through 2017 in 29 states, including the four that legalized cannabis and 25 other states to serve as controls. The study took into account local economic conditions, Medicaid availability, prescription drug monitoring programs and other state-specific factors and policies.

Drake noted that, generally speaking, “it wasn’t the intent of policymakers originally when they were legalizing cannabis to use it as a tool against the opioid epidemic,” but it’s been a welcome effect.

Though the positive impact on emergency rooms began to wane after six months, the new Pitt study suggests marijuana use, at the minimum, does not lead to an increase in opioid use. At best, decriminalizing cannabis might lead to less opioid use, through the likes of helping some addicts recover and preventing other chronic pain patients from becoming addicted.

The study found reductions in opioid emergencies were especially prominent among men ages 25 to 44.

”That’s not really surprising, because we know those are the populations that tend to use cannabis more than the rest of the population proportionally,” Drake said.

Drake said more research is needed to explore why the reductions in opioid emergencies appear to have waned after the first year of cannabis legalization, as well as to examine what happens in subsequent years. The study also had data limitations, including not being able to distinguish specific types of opioids, such as heroin, fentanyl or prescription opioids.

Opioid addiction treatment and using cannabis for chronic pain as an alternative to opioids are among Pennsylvania’s medical marijuana program’s qualifying conditions.

Proposals for broad legalization have not made it far in the GOP-controlled Legislature in recent years, though Lt. Gov. John Fetterman, D-Braddock, has made legalizing cannabis a priority and secured the governor’s backing in 2018, a switch from Wolf previously refusing to do so publicly.

Will Pennsylvania legalize cannabis?

In coming weeks, state Sen. Dan Laughlin of Erie is set to become the first Republican in Pennsylvania history to introduce a recreational cannabis bill, along with Democratic co-sponsor state Sen. Sharif Street of Philadelphia.

“We are in the very final stages of tweaking the legislation,” Laughlin told the Tribune-Review.

Five years ago, Laughlin would’ve balked at the idea. When taking his oath of office in 2016, “I was probably the most anti-cannabis one there,” Laughlin said. “I had a pretty bad opinion in my mind about cannabis, but once I got past my emotions and looked at the logic, it’s the smartest thing we can do.”

Details for the legislation released thus far include allowing adults 21 and older to buy and possess up to 30 grams of cannabis flower and for medical marijuana cardholders to grow up to five marijuana plants at home. The bill also looks to release those serving time for nonviolent marijuana offenses and expunge convictions for low-level marijuana offenses. Gun owners also would be able to lawfully possess marijuana — something that’s not permissible under the state’s current medical marijuana program nor under federal law.

“I’m proud to join my Republican colleague and introduce this historic, bipartisan bill to legalize marijuana,” Sen. Street said in a statement. “I look forward to working with my colleagues in the Legislature and with the Administration to build support for this critical legislation that aims to make Pennsylvania’s cannabis market the most diverse and inclusive in the country.”

The state Capitol in Harrisburg has been buzzing about the bill since the bipartisan pair announced plans to team up on the legislation in February.

But observers question whether the GOP has the political will to take it up.

“Right now we are still running into a solid red wall of opposition. Even though Sen. Laughlin has come out in full support of the legislation and has joined with Sen. Street, we are not seeing any public comments from Republican leadership that would give us any reason to suspect or anticipate that any such bill would even get a committee hearing,” said Patrick Nightingale, a criminal defense attorney and director of cannabis advocacy group Pittsburgh NORML. “It’s critically important that they pay attention to the facts and the science. To say in 2021 that cannabis is a gateway drug is reprehensible and disgusting, and yet they still do it.”

Laughlin is more optimistic. He thinks the legislation may get divided into two pieces and go through separate committees — one for the cannabis program itself, the other for the justice-related changes and expungements.

“It has obviously been an issue that most of my (Republican) counterparts are approaching cautiously — but most of them are not a hard no when you’re just talking to them privately,” Laughlin said. “In fact, the majority of them at least realize this is not a big or as divisive a deal as it was five, 10 years ago. They are aware that there’s been a pretty big shift in public opinion on this in the last few years.”

Nearly 6 in 10 Pennsylvania registered voters are in favor of cannabis legalization, a Franklin & Marshall College poll found in March.

“The few that I’ve talked to that are definitely a no, I think, are mostly just misinformed,” Drake said. “A lot of them say they think it’s a gateway drug, and research study after study like this one prove that’s not true.

“We shouldn’t be legislating based on how we feel about things, we should look at the actual data and make informed decisions.”

Lindstrom, N. (2021). Legalizing marijuana could stem opioid abuse, Pitt study suggests. Trib Live. https://triblive.com/news/health-now/legalizing-marijuana-could-stem-opioid-abuse-pitt-study-suggests/