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Abstract
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Too early to tell whether cannabis liberalisation reduces opioid deaths
The United States is in the midst of an unprecedented opioid crisis, partly worsened by the novel coronavirus disease pandemic.1 Approximately 10 million people misused prescription opioids, 808 000 people misused heroin, and two million people met the criteria for an opioid use disorder in 2018.2 In that same timeframe, 46 800 people died of an opioid overdose, with two thirds of the deaths involving synthetic opioids (including fentanyl and fentanyl analogues).3 In response to the rising burden of disease, a range of opioid related policies have been implemented, which have been geared towards reducing high risk opioid prescribing, improving access to treatment, and expanding overdose prevention efforts.4
One perspective points to the co-occurring cannabis liberalisation as a potential means of reducing opioid related harms. Increased availability of cannabis has been suggested to result in the partial substitution of opioids for cannabis in managing pain.4 In a linked paper, Hsu and colleagues (doi:10.1136/bmj.m4957) contribute to this area of research by using an ecological design paired with county data from 2014 to 2018.5 Specifically, they examine the association between average counts of cannabis dispensaries--stores authorised to sell cannabis--and opioid overdose deaths among US states with medicinal or recreational cannabis legalisation. Additional controls for county population characteristics, state provision of recreational cannabis sales, and opioid related policies are included in the models.
Hsu and colleagues show that increases in average counts of medicinal and recreational cannabis dispensaries are jointly and independently associated with reduced deaths from opioid overdose, especially synthetic opioid overdose. Three methodological enhancements are noteworthy. Firstly, counties are modelled as the unit of analysis to enable within state differences to be considered. Secondly, average counts of cannabis dispensaries are modelled as the explanatory variable to achieve a closer approximation of the availability of cannabis.6 Thirdly, states without medicinal or recreational cannabis legalisation are excluded from the main analyses to exercise better control over broader differences in the social and legal environments...
Language: en |