a., JOHNS HOPKINS BLOOMBERG SCHOOL ofPUBLIC HEALTH
Testimony for Pennsylvania Senate State Government Committee’s
Public Hearing on Senate Bill 3
February 25, 2015
Colleen L. Barry, PhD. MPP, Associate Professor and Associate Chair for Research and Practice,
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public
Health. 624 N. Broadway, Room 403, Baltimore, MD 21205
Good morning, Committee Members. My name is Colleen Barry. and I am an Associate
Professor and Associate Chair for Research and Practice in the Department of Health Policy and
Management at the Johns Hopkins Bloomberg School of Public Health. The opinions expressed here are my own and do not necessarily reflect the views of The Johns Hopkins University. My research focuses on how health policies affect a range of critical outcomes for persons with substance use disorders and mental illness, including access to health care and social services, care quality, health care spending, financial protection and mortality. I am here today to summarize the flndings from my research study published in JAMAJnternal Medicine in 2014 that examined states with medical marijuana laws and opioid painkiller overdose deaths. This research was conducted in collaboration with my colleagues Marcus Bachhuber at the University of Pennsylvania, Brendan Saloner at Johns Hopkins University and Chinazo Cunningham at
Montefiore Medical Center. I am submitting a copy of this published paper with my written hearing testimony along with a New YorkTimescommentary on this topic we published in
August 2014. the prolonged expected study overdose Meanwhile, scrutiny that hypothesized pain Prescription the certificate alternative states painkiller In law in controversial, laws. 2011—more our average leading had the is period and .JAMA by rate about in based deaths overdose far the data use. to recent cause rate as of opioid from Internal the prescription that District our 1,700 this prescription compiled than on Opioid in because most of years the study 1999 trends states committee painkillers, deaths injury quadruple fewer passage Medicine of common overdoses because to indicates Columbia without medical by before narcotics 2010. in death opioid painkiller the states of knows, the like study, Centers condition of the medical in these However, marijuana an were painkiller the number have with the Percocet, for laws
important JOHNS overdose access we drastic laws. pain United responsible BLOOMBERG for medical legalized were marijuana of studied reported for PUBLIC we Disease does overdose management—affected In to Vicodin
rise n States, passed. 1999. unintended ‘fly deaths found
absolute HOPKINS medical marijuana not HEALTH how in its SCHOOL among for laws Control overdose Deaths lead broad that deaths killing and increased the nearly While marijuana terms, in to the people OxyContin, availability benefit medical laws states and from fatal overall more average medical 17,000 deaths states in Prevention was overdoses. could using drug of adults overdose has all use—and in state about deaths associated with states yearly of marijuana have been 2010 overdose medical lead medical than medical a 25 (CDC). expanding—23 medical come over in alone death to Using rate chronic car percent the a with marijuana. have reduction laws our of marijuana—an crashes. under than rates. marijuana United death we opioid marijuana their 12 become or have lower would found year We intense severe States in been than be I’‘fl, JOHNS HOPKINS BLO0MBERG SCHOOL cfPUBUC HEALTH
It is important to note that isolating the effects of laws on health is challenging. For one thing, we would expect that states that have already passed medical marijuana laws are likely to be different in important ways from states that have not passed such laws with regard to, for example, social attitudes about drug use and overall health trends that might affect rates of opioid painkiller deaths. In addition, states have implemented various measures in response to the threat ofopioid painkiller overdoses, including central registries of controlled substance prescriptions, laws allowing pharmacists to request identification before filling a prescription, and laws increasing oversight of pain management clinics. These measures, too, might affect rates of opioid painkiller deaths, regardless of the legality of medical marijuana. Our study was designed to compare state-level rates of opioid painkiller overdose deaths before and after the passage of medical marijuana laws, while controlling for these and other concurrent state and national trends.
If medical marijuana laws are having the unintended benefit of reducing opioid overdose deaths,
it is important figure out how and why. There may be multiple, overlapping reasons. One possibility is that that people are replacing opioid painkillers in part or entirely with medical marijuana for chronic pain treatment. Another possibility is that the availability of medical
marijuana has changed the behavior of people who are addicted to and abuse or misuse opioids.
Our analysis is based on aggregate CDC data, so we cannot track the effect of state medical
marijuana laws on particular individuals or say anything about which subgroups may be most
affected by medical marijuana laws. This is an important priority for future research. In addition, Thank quality-of-life more Colleen I appreciate research you Barry for the trajectories 624 is your opportunity needed North time http:llwww.jhsph.edulfacultv/directorvforofllef5O73/Barrv/Colleen%20L. Broadway. to and of identify to individuals Department consideration. speak Hampton who
to JOHNS of House, this BLOOMBERG can with Health of PUBLIC Committee benefit room
chronic n Policy
In, HOPKINS HEALTH 403 SCHOOL most and Baltimore, pain about Management from who our MD these use 21205 research. medical laws 410-955-3679 and marijuana. on the health and Research
Original Investigation Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010
MarcusA.Bachhuber,MD;BrendanSaloner,PhD:Chinazo0. Cunningham.MD.MS;ColleenL.Bany,PhD,MPP
InvitedCommentary IMPORTANCEOpioidanalgesicoverdosemortalitycontinuesto riseinthe UnitedStates. driven by Increasesinprescribingforchronicpain.Becausechronicpainisa majorindication formedicalcannabis,lawsthat establish access to medicalcannabis maychange overdose mortalityrelated to opioidanalgesicsinstates that haveenacted them.
OBJECTIVETodeterminethe associationbetweenthe presenceof state medicalcannabis lawsandopioidanalgesicoverdosemortality.
DESIGN,SaTING. ANDPARTICIPANTSAtime-seriesanalysiswasconductedofmedical cannabislawsandstate-leveldeath certificatedata inthe UnitedStatesfrom1999to 2010; all50 states wereincluded.
EXPOSURESPresenceofa lawestablishinga medicalcannabisprograminthestate.
MAINOUTCOMESANDMEASURESAge-adjustedOØOid analgesicoverdosedeath rate per 100 000 populationineach state. Regressionmodelsweredevelopedindudingstate and yearfixedeffects,the presenceof3 differentpoliciesregardingopioidanalgesics,and the state-specificunemploymentrata
RESULTSThreestates (California.Oregon.andWashington)hadmedicalcannabislaws effectiveprior to1999.Tenstates (Alaska.Colorado.Hawaii.Maine,Michigan,Montana. Nevada,NewMexico.RhodeIsland.andVermont)enacted medicalcannabislawsbetween 1999and2010.Stateswithmedicalcannabislawshada 24.8%lowermeanannualopioid overdosemortalityrate (95% Cl.—37.5%to —9.5%:p = .003) comparedwithstates without medicalcannabislaws.Examinationofthe associationbetweenmedicalcannabislawsand opioidanalgesicoverdosemortalityineachyearafter implementationofthe lawshowedthat suchlawswereassociatedwitha lowerrate ofoverdosemortalitythat generally
strengthenedovertime:yearI (‘-19,9%:95% Cl.—30-6%to —72%; P = .002). year2 (—252%; 95%CI,—40.6%to—5.9%:P= .01).year3(—23.6%;95%CI.—41.1%to—1.0%;P=.04).year4 (—20.2%;95%CI, —33.6%to—4.O%;P= .02).year5(—33.7%;95%Cl.—50.9%to—10.4%; P = .008). andyear6 (—33.3%;95%CI.—44.7%to —19.6%;Pc .001). Insecondaryanalyses, the findingsremainedsimilar.
CONCLUSIONSANDRELEVANCEMedicalcannabislawsareassociatedwithsignificantlylower state-levelopioidoverdosemortalityrates. Furtherinvestigationisrequiredto determine howmedicalcannabislawsmayinteractwithpoliciesaimedat preventingopioidanalgesic overdose.
AuthorAffiliations:Author affiliationsarelistedat the end of this article.
correspondingAuthor: MarcusA. Bachhuber.MD.center forHealth EquityResearchandPromotion. PhiladelphiaVeteransAffairsMedical center,423GuardianDr.1303-A .14M4InternMed.doi:10iOO1/jamaintemmed.2014.4005 Blo&leyHall.Philadelphia,PA19104 PublishedcnilneAugust25.2014. ([email protected]).
El
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Figure1.Mean Age-AdjustedOpioidAnalgesicOverdose Death Rate
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Table.AssociationBetween MedicalCarmabisLawsand State-LevelOploidAnalgesicOverdose MortalityRates Inthe UnitedStates. 1999-2010
PercentageDifferenceinAye-AdjustedOpioldAnalgesicOverdoseMortality InStatesWithvsWithouta Law PrimaryAnalysis SecondaryAnalyses (1)b IndependentVariable Estimate(95% Estimate(95%CO’ Estimate(95%CO Medicalcannabislaw —24.8(—37,5to —9.5)’ —31.0(—42.2to —17.6)’ —23.1(—37.1to—5.9)’ Prescriptiondrugmonitoringprogram 3.7 (—12.7to 23.3) 3.5 (—13,4to 23.7) 7.7 (—11.0to 30.3) Lawrequiringorallowingpharmacists 5.0 (—10.4to 23.1) 4,1 (—11,4to 22.5) 2.3 (—15.4to 23,7) to requestpatientIdentification Increasedstateoversightofpainmanagementclinics —7,6(—19.1to 5.6) —11.7(—20.7to —1.7)’ —3.9(—21.7to 18.0)
Annualstate unemploymentrate’ 4.4 (—0.3to 9.3) 5.2 (0.1 to 10.6)’ 2.5 (—2.3to 7.5)
‘ Allmodelsadjustedforstate andyear(fixedeffects), involved.Allcovariateswerethe sameasintheprimaryanalysis.ft3 0.842. bft2 0.876. • Ps .05. ‘Allintentional(suicide)overdosedeathswereexcludedfromthe dependent ‘Ps .001. opioid is are variable: analgesicoverdosemortality thereforedeathsthat •#n associationwascalculatedfora 1-percentage-pointIncreaseInthe state unintentionalorofundeterminedintent,Allcovariateswerethe sameas inthe unemploymentrate primaryanalysis;ft = 0.873. d Findingsincludeallheroinoverdosedeaths,evenifnoopioidanalgesicwas
predated the implementation ofmedical cannabis laws by in In the adjusted model, medical cannabis laws were asso cluding indicator variables in a separate regression model for ciated with a mean 24.8% lower annual rate of opioid analge the 2 years before the passage of the law,24Finally,to test the sicoverdosedeaths (95%Cl,—375%to —95%;P = .003)(Table), specificity of any association found between medical canna compared with states without laws. In 2010, this translated to bis laws and opioid analgesic overdose mortality, we exam an estimated 1729 (95% Cl, 549 to 3151) fewerdeaths than ex ined the association between state medical cannabis laws and pected. Medicalcannabis lawswereassociatedwith lowerrates age-adjusted death rates of other medical conditions without of opioid analgesic overdose mortality, which generally strong links to cannabis use: heart disease (lCD-b codes 100- strengthened in the years after passage (Figure 2): year 1 109, In, 113,and I2ol51)25 and septicemia (A4o-A41).Allanaly (—19.9%; 95% CI, —30.6% to —7.7%:P = .002), year 2 (—25.2%; ses were performed using SAS,version 93 (SAS Institute lnc). 95% CI, —40.6%to —5.9%; P = .01), year 3 (—23.6%; 95% CI, —41.1%to —L0%; P = .04), year 4 (—2a2%; 95%CI, —33.6%to —4.0%; P = .02), year 5 (—33.7%;95% CI, —50.9% to —10.4%; P = .008), and year 6 95% Cl, —447%to —19.6%; Results (—33.3%; P < .001).The other opioid analgesic policies, as well as state The mean age-adjusted opioid analgesic overdose mortality unemployment rates, were not significantly associated with rate increasedinstates with andwithout medicalcannabislaws opioid analgesic mortality rates. during the study period (Figure 1). Throughout the study pe In additional analyses, the association between medical dod, states with medical cannabis lawshad ahigher oploidan cannabis laws and opioid analgesic mortality rates was simi algesic overdose mortality rate and the rates rose for both lar after excluding intentional deaths (ie, suicide) and when groups;however,between 2009 and 2010 the rate instates with including all heroin overdose deaths, even if an opioid anal medical cannabis laws appeared to plateau. gesic was not involved (Table),Including state-specific linear
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provide analgesia for some individuals.”’8 In addition, Figure2. AssociationBetween MedicalCannabisLawsand Oplold already AnalgesicOverdose MortalityinEachYearAfter Implementation patients receiving opioid analgesics who start medi of laws Inthe UnitedStates, 1999201O cal cannabis treatment may experience improved analgesia and decrease their opioid dose,’°”° thus potentially 0 decreasing their dose-dependent risk of overdose.313’ at Finally, if medical cannabis laws lead to decreases in -20 polypharmacy—particularly with benzodiazepines—in people taking opioid analgesics, overdose risk would be • -40 decreased. Further analyses examining the association e between medical cannabis laws and patterns of opioid anal -60 gesic use and polypharmacy in the population as a whole and across different groups are needed. I 2 3 4 5 6 YearsAfterLawiticlementation,Nc Aconnection between medical cannabis laws and opi oid analgesic overdose mortality among individuals who Fnt estnate ofthe meandiftereexeintha opioldaialgesk overdose misuse or abuse opioids is less clear. Previous laboratory mortalityrate instates wth medicalcamabis lawscoenparedwithgates work has shown that cannabinoids act at least in part wittnststxh laws;wliskwl indicate95%C&. through an opioid receptor mechanism’3”4 and that they increase dopamine concentrations in the nucleus accum time trends in the model resulted in a borderline significant bens in a fashion similar to that of heroin and several other association between lawsand opioid analgesicoverdose mor drugs with abuse potential.””5 Clinically, cannabis use is tality (—17.9%;95%Cl,—32.7%to 0.3%; P = .054). When exam associated with modest reductions in opioid withdrawal ining the years prior to law implementation, we did not find symptoms for some people,’°” and therefore may reduce an association between medicalcannabis laws and opioid an opioid use. In contrast, cannabis use has been linked with algesic overdose mortality 2 years prior to law implementa increased use of other drugs, induding opioids’”8°; how tion (—13.1%;95%Cl, —45.5%to 38.6%;P = .56)or lyear prior ever, a causal relationship has not been established)4’4’ (1.2%; 95%Cl, —41.2% to 74.0%; P = .97).Finally, we did not Increased access to cannabis through medical cannabis laws find significant associations between medical cannabis laws could influence opioid misuse in either direction, and fur and mortality associated with heart disease (1.4%; 95% CI, ther study is required. —0.2%to 2.9%; P a .09) or septicemia (—1.8%;95%Cl, —7.6% Although the mean annual opioid analgesic overdose t04.3%;P= .55). mortality rate was lower in states with medical cannabis laws compared with states without such laws, the findings of our secondary analyses deserve further consideration. State-specific characteristics, such as trends or Discussion in attitudes health behaviors, may explain variation in medical cannabis In an analysis of death certificate data from 1999 to 2010, we laws and opioid analgesic overdose mortality, and we found found that states with medical cannabis laws had lower some evidence that differences in these characteristics con mean opioid analgesic overdose mortality rates compared tributed to our findings. When including state-specific lin with states without such laws. This finding persisted when ear time trends in regression models, which are used to excluding intentional overdose deaths (le, suicide), suggest adjust for hard-to-measure confounders that change over ing that medical cannabis laws are associated with lower time, the association between laws and opioid analgesic opioid analgesic overdose mortality among individuals overdose mortality weakened. In contrast, we did not find using opioid analgesics for medical indications. Similarly, evidence that states that passed medical cannabis laws had the association between medical cannabis laws and lower different overdose mortality rates in years prior to law pas opioid analgesic overdose mortality rates persisted when sage, providing a temporal link between laws and changes including all deaths related to heroin, even if no opioid in opioid analgesic overdose mortality. In addition, we did analgesic was present, indicating that lower rates of opicid not find evidence that laws were associated with differences analgesic overdose mortality were not offset by higher in mortality rates for unrelated conditions (heart disease rates of heroin overdose mortality. Although the exact and septicemia), suggesting that differences in opioid anal mechanism is unclear, our results suggest a link between gesic overdose mortality cannot be explained by broader medical cannabis laws and lower opioid analgesic overdose changes in health. In summary, although we found a lower mortality. mean annual rate of opioid analgesic mortality in states Approximately 60% of all opicid analgesic overdose with medical cannabis laws, a direct causal link cannot be deaths occur among patients who have legitimate prescrip established. tions from a single provider.’6 This group may be sensitive This study has several limitations. First, this analysis is to medical cannabis laws; patients with chronic noncancer ecologicand cannot adjust for characteristics of individuals pain who would have otherwise initiated opioid analgesics within the states, such as socioeconomic status, race? may choose medical cannabis instead. Although evidence ethnicity, or medical and psychiatric diagnoses. Although for the analgesic properties of cannabis is limited, it may we found that the association between medical cannabis
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laws and lower opioid overdose mortality strengthened in the years after implementation, this could represent hetero Conclusions geneity between states that passed laws earlier in the study period vs those that passed the laws later. Second, death Although the present study provides evidence that medical certificate data may not correctly classify cases of opioid cannabis laws are associated with reductions in opioid anal analgesic overdose deaths, and reporting of opioid analge gesic overdose mortality on a population level, proposed sics on death certificates may differ among states; misclassi mechanisms forthis association are speculative and relyon in fication could bias our results in either direction. Third, direct evidence. Further rigorous evaluation of medical can although fixed-effects models can adjust for time-invariant nabis policies,includingprovisionsthat varyamongstates,’4-42 characteristics of each state and state-invariant time effects, is required before their wide adoption can be recommended. there may be important time- and state-varying confound lithe relationship between medical cannabis lawsand opiold ers not included in our models. Finally, our findings apply analgesic overdose mortality is substantiated in further work, to states that passed medical cannabis laws during the enactment of laws to allow for use of medical cannabis may study period and the association between future laws and be advocated as part of a comprehensive package of policies opioid analgesic overdose mortality may differ. to reduce the population risk of opioid analgesics.
ARTIcLEINFORMATION Roleof the SponsonThesponsorshadnorolein ‘4’1&4416S8j.pdf.PublishedDecember4.2013. of AcceptedforPublication:May2,2014. the designandconduct the study:collection, AccessedJanuary31,2014. management,analysis,andinterpretationofthe 9. OregonPublicHealthAuthority.OregonMedical PublishedOnline August25,2014. data:preparation,review,orapprovalofthe doilO.1001/jamalntemmed.2O14.4005. MarijuanaProgramstatistics.https://public.health manuscript:anddecisionto submitthe manuscript .oregon.gov/diseasesconditionsl&ronlcdisease AuthorAffiliatIons:center forHealthEquity forpublication. Imedicalmarijuanaprogramlpagesfdata.aspx. ResearchandPromotion,PhiladelphiaVeterans Disclaimer:Thefindingsandconclusionsofthis PublishedJanuary1.2014.AccessedJanuary31. AffairsMedicalcenter,Philadelphia,Pennsylvania artide arethoseofthe authorsanddo not 2014. (Bachhuber);RobertWoodJohnsonFoundation necessarilyreflectthe positionorpolicyofthe clinicalScholarsProgram,universityof 10. MontanaDepartmentofPublicHealthand DepartmentofVeteransAffairsorthe us HumanServices.MontanaMarijuanaProgram Pennsylvania,Philadelphia(Bathhuber);Leonard government. DavisInstituteofHealthEconomics,Universityof Registryinformation.http:llwww.dphhs.mt.gov /marijuanaprogramimmpreglstryinformation.pdf. Pennsylvania,Philadelphia(Bathhuber,Saloner, REFERENCES Published 1,2014.Accessed 31, Barry):RobertWoodJohnsonHealthandSociety January January ScholarsProgram,UniversityofPennsylvania, 1. GaskinDJ,RichardP.Theeconomiccostsofpain 2014. inthe unitedStates.J 2012:13(B):715’724. Philadelphia(Saloner):DivisionofGeneralInternal io. II. cerda M,WallM.KeyesKM.Galea5,HasinD. Medicine,MontefioreMedicalcenter/Albert 2. 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Prevention.Menuol painmanagementdAt 26. Centersforoisease Contd and Prevention. foropiatedependenceaid with&wv.. tt,osderie. regulation.hJfv.w.cdcgovfpip/docs/merai CX grandrar.th; presa,tion &ugovado.es 2013;248637-654. -prnapdf. PuNishedSeptew&r 28.2012. a US MMI4RMOrbMO#.OIWWyRep. idenit 2012; 35. Ashtai 04. Phannacolo’ end effe of AccessedJ3RJary27.2014. 61(I):l0-13. carwiabis:a briefreview.BriPsychkflsy.2001.178: 19. USBureauof LuborStatistics.kn,al slate V. LynchME.CampbellF.Camaids for 101-106. unemployment.htw:llwwwblsgovflaumane.htrn. treatment ofthonic non-cancerpain;a systematic 36. Hermann0. KlagesE.WeIzelH,MarioK. AccessedFebruaryS.2014. reviewof randomizedtrials.&JGrn Phormac&. CroissantB.Lowefficacyofrni-opicid &ugs Wi 20lI:fl(5):735-744, 20. [hide GARosenblum0, ManS. (iccarorie0. op& withdrawalcyrriptorns.AddictBi&.2005:10 htertvmied epidemics:nationaldemographic 28. KtriarRN, ChambersWA,PertweeRG. (21:165.169. trench inbespitaraatiorssforheroin-and Pharmacologicalactions of and thew*utk uses 37. ScavooeJL. lWigRC,WestekiSPVan opid-rebted overdoses.1993-2009.PL0SOne. caonabisand caTnbi-)oies Anaesthesia.2001:56 BockstaeleU, Impactofcannthis usething 2013:g(2):e54496. doi10.t37VjournaI.ne (11)1059-1068. stabilizationon methadone maintenance .0054496. 29. AbramsDl,CoueyP.ShadeSB.KellyME. treatment. AmJAddid. 2013:22(4)344-351. II. KhoslaN.Juon HS.KirkGD.AslemborskiJ. BenowltzIlL.Cairabinoid-oploidinteractionIn 38. LynskeyMT.HeathAC.BucholzKK.et al. MehtaSN.Correlatesofnon-medicalprescription chronicpain.GinPhonuoro?Ther.2011:90(61:844- Escalationofdruguseinearly-onsetcarusabisuses drug use amonga cohortof injectiondrugusers In 851. vs co-twincontrols.24114.2003;289(4):427433. BaltimoreCity.AddictBehav.2011;36(12):12824287, 30. LynchME.ClarkM. Cannabisreduces oploid 39. YamaguchiK.Kandel08. Patterns ofdruguse 22. CiceroTJ,EllisMS.SurrattHL.Effectof dose Inthe treatment ofchronlcnon-cancer pain. fromadolescencetoyoung adulthood,Ill: abuse-deterrent formulationofOxyContin.WEngiJ PainSymptomManage.2003;25(6):496-498. predictorsofprogression.AmJPublicHealth.1984; Med.2012;367(2):187-189, 31. DunnKM.SaundersKW.RutterCM.et al. 7401:673-681. 23. PeavyKM.Banta-GreenCl,Kingston5. Opioidprescriptionsfor chronicpainand overdose; 40. FergussonOM.HorwoodU. Earlyonset HanrahanM,MerrillJO.CoffinP0. HookedoW a cohort study.AnnInternMed. 2010;152(2):B5-92, cannabisuse aridpsychosodaladjustment inyoung prescription-typeopiatespriorto usingheroin: 32. BoitnertAS.ValensteinM.BairMi,et al. adults.Addiction.1997:92(31:279-296. resultsfroma exchange surveyof syringe dients. Associationbetween opioidprescribingpatterns JPsychoactlyeDrugs,2012;44(3):259-263. 41. Kandel08. Doesmarijuanause causethe useof and oploidoverdose-relateddeaths. /4114.2011; other drugs?J4MA,2003:189(41:482483. 24. Angrist1.PisdikeJ. MostlyHarmless 305031:13151321. Economet4a:M EmØrldstsComponlnn.Princeton, 42. PaculaRL.SevignyEL Marijuanaliberalization 33. TandaG.PontieriFE.DiChiaraG.Cannablnoid NJ:PrincetonUniversity policies:whywe cant learnrtvj& frompolicystillin Press:2009. and heroir activitionof rTlesolinticdopaniine motion.JPallcyAnafL4,nage.2014230h212-U1. 25. SidneyS.Bed’JE TekawaIS.Quesen&nyCP. trmnissionby a cailmori p1opioklreceptor FriedmeiGo. Marijuanause and mortalityAmJ mechanism.Science.1997;276(5321);2048-2050. PublicHeolzh.1997:87(41:585590. 34. Scavoneii. Stertr kit VanBo&staeleU. Carviabinodand opioldinteractions:kupikatiorm
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BR FN 1) N Cl. F L S I.) N be Newflorkimcs http://nyti.ms/ltTVvp5
SUNDAYREVIEW Of Pot and Percocet
AUG. 29, 2014
GrayMatter
By MARCUSBACHHUBERand COLLEENBARRY
PRESCRIPTIONopioid painkillers like Percocet, Vicodin and OxyContinhave come under intense scrutiny in recent years because of the drastic rise in overdose deaths associated with their prolonged use. Meanwhile, access to medical marijuana has been expanding — 23 states and the District of Columbia have legalized its broad medical use — and chronic or severe pain is by far the most common condition reported among people using it. Could the availability of medical marijuana reduce the hazards of prescription painkillers? If enough people opt to treat pain with medical marijuana instead of prescription painkillers in states where this is legal, it stands to reason that states with medical marijuana laws might experience an overall decrease in opioid painkiller overdoses and deaths. To find out if this has actually happened, we and our colleagues Brendan Saloner and Chinazo Cunningham studied opioid overdose deaths in the United States from 1999 to 2010. Our findings, which were published on Monday in the journal JAMA Internal Medicine, suggest that this unexpected benefit of medical marijuana laws does exist. Pinpointing the effect of laws on health is notoriously difficult. For one thing, states that have passed medical marijuana laws are no doubt different in important ways from states that have not passed such laws. Differences in, say, social attitudes about drug use or overall health trends might affect rates of opioid painkiller deaths, independent of whether medical marijuana is legal.
http://www.nytimes.com/2014/08/31/opinion/sunday/of-pot-and-percocet.html?j=O 9/1/2014
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We hope the results of our study will spur further scientific investigation into the effects of these laws as well as the ways in which medical marijuana can and should be used in clinical practice.
Marcus Bachhuber, an internist, isa clinical scholar at the Philadelphia V.A.Medical Center. Colleen Barry is an associate professor of health policyand management at the Johns Hopkins Bloomberg School of Public Health.
A version of this op-ed appears in print on August 31, 2014, on page 5R12 of the New Yorkedition with the headline: Of Pot and Percocet.
© 2014 The New YorkTimes Company
http://www.nytimes.com/2O 14/08/31 /opinion/sunday/of-pot-and-percocet.html?r=O 9/1/2014