The legalization of recreational cannabis reduces the demand for prescriptions filled through state Medicaid programs, according to a study by researchers affiliated with Cornell University and Indiana University. The researchers also documented a significant decrease in the number of prescriptions for types of drugs commonly prescribed to treat pain, depression, anxiety, sleep, psychosis, and seizures.

Shyam Raman, a doctoral student in the Cornell Jeb E. Brooks School of Public Policy, and Indiana University doctoral student Ashley Bradford conducted an analysis of data obtained from the Centers for Medicare and Medicaid Services for all 50 states from 2011 to 2019. The timing of the research coincided with the legalization of cannabis in nearly a dozen states.

“These results have important implications,” Raman told the Cornell Chronicle. “The reductions in drug utilization that we find could lead to significant cost savings for state Medicaid programs. The results also indicate an opportunity to reduce the harm that can come with the dangerous side effects associated with some prescription drugs.”

In states that had legalized recreational cannabis, the researchers saw a significant change in the number of prescriptions to treat sleep and anxiety disorders. But they did not see a meaningful impact on the number of prescriptions to treat nausea.

The study, “Recreational Cannabis Legalizations Associated with Reductions in Prescription Drug Utilizations Among Medicaid Enrollees,” was published on April 15 in the journal Health Economics. The researchers noted that other studies have focused on the impact legalizing medical cannabis has on the use of opioids. But this is one of the first studies that focused on how legalizing cannabis for use by adults can influence the use of a broad range of prescription drugs. The researchers noted that the decline in prescriptions may be influenced by a reduction in visits to primary care providers when patients begin treating medical conditions with cannabis.

Cannabis and Opioids

In March, a study from researchers at Thomas Jefferson University in Philadelphia showed that osteoarthritis patients filled statistically fewer prescriptions for opioids six months after beginning medical cannabis compared to six months before treatment. Additionally, one-third of the study subjects stopped filling opioid prescriptions completely. The researchers also reported improvements in the patients’ overall quality of life.

And earlier this month, a separate study found that CBD and THC do not enhance the rewarding effects of opioids, suggesting that the risk of addiction is not increased when the compounds are used in conjunction with one another. Lawrence Carey, Ph.D., a postdoctoral fellow at the University of Texas Health Science Center in San Antonio who conducted the study, said a combination of compounds may be a safer alternative for patients with chronic pain.

“There is intense interest in using medical marijuana in patients with chronic pain because compounds in marijuana like CBD and THC may produce pain relief themselves or enhance the pain-relieving effects of opioids,” Carey said in a statement about the research. “This means people could potentially use lower doses of opioids and still get relief from pain. Taking less pain medication could also lead to a lowered risk of addiction or physical dependence to opioids.”

Carey noted that research is continuing to determine if THC and CBD can help reduce the symptoms of opioid withdrawal.

“A big reason why people continue to take opioids after they become addicted is the appearance of withdrawal symptoms,” he said. “We are using what we learned from this study to determine whether these doses—which didn’t alter choice for food or drug rewards—may help relieve opioid withdrawal or decrease relapse and drug seeking behavior following periods of abstinence.”

The research comes as the nation continues a dramatic spike in overdose deaths spurred by the opioid crisis. In November, the CDC reported that more than 100,000 people had died of an overdose over a 12-month period, the highest number of deaths ever recorded in the span of a year. More than 75% of the reported overdose deaths were related to opioids.