Abstract
Background
Co-prescribing of scheduled drugs is endemic in the United Sates, increasing health
risks to patients and the burden on healthcare systems.
Purpose
We conducted a pragmatic historical cohort study to measure the effect of enrollment
in a state-authorized United States' Medical Cannabis Program (MCP) on scheduled II–V
drug prescription patterns.
Procedures
Eighty-three chronic pain patients, who enrolled in the New Mexico MCP between April
1, 2010 and October 3, 2015, were compared with 42 nonenrolled patients over a 24-month
period (starting 6 months before enrollment for the MCP patients) using the Prescription
Monitoring Program. The outcome variables include baseline levels and pre- and postenrollment
monthly trends in the number of drug prescriptions, distinct drug classes, dates prescription
drugs were filled, and prescribing providers.
Findings
Twenty-eight MCP patients (34%) and 1 comparison group patient (2%) ceased the use
of all scheduled prescription medications by the last 6 months of the observation
period. Age- and sex-adjusted regressions show that, although no statistically significant
differences existed in pre-enrollment levels and trends, the postenrollment trend
among MCP patients is statistically significantly negative for all 4 measures (decreases
in counts of −0.02 to −0.04, P values between <.001 and .017), whereas the postenrollment trend is 0 among the comparison
group. Controlling for time-invariant patient characteristics suggested that MCP patients
showed statistically significantly lower levels across all 4 measures by 10 months
postenrollment.
Conclusions
Legal access to cannabis may reduce the use of multiple classes of dangerous prescription
medications in certain patient populations.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Opioid abuse in chronic pain—Misconceptions and mitigation strategies.New Engl J Med. 2016; 374: 1253-1263
- Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996–2013.Am J Public Health. 2016; 106: 686-688
- Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes. The CBHSQ Report: December 18, 2014.Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD2014
- Worldwide prevalence and trends in unintentional drug overdose: A systematic review of the literature.Am J Public Health. 2015; 105: e29-e49
- Overdose Death Rates.(Available at:) (Accessed April 29, 2017)
- Drugs most frequently involved in drug overdose deaths: United States, 2010–2014. National vital statistics reports; vol. 65 no 10.National Center for Health Statistics, Hyattsville, MD2016
- Medical marijuana laws reduce prescription medication use in Medicare Part D.Health Affairs. 2016; 35: 1230-1236
- The effect of medicinal cannabis on pain and quality-of-life outcomes in chronic pain: A prospective open-label study.Clin J Pain. 2016; 32: 1036-1043
- Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999–2010.JAMA Intern Med. 2014; 174: 1668-1673
- State medical marijuana laws and the prevalence of opioids detected among fatally injured drivers.Am J Public Health. 2016; 106: 2032-2037
- Cannabis as a substitute for alcohol and other drugs.Harm Reduct J. 2009; 6: 35
- Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors.Drug Alcohol Rev. 2016; 35: 326-333
- Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients.Int J Drug Policy. 2017; 42: 30-35
- An efficient method of estimating seemingly unrelated regressions and tests for aggregation bias.J Am Stat Assoc. 1962; 57: 348-368
- Cannabinoids for medical use: A systematic review and meta-analysis.JAMA. 2016; 3913: 2456-2473
- Cannabis use among military veterans after residential treatment for posttraumatic stress disorder.Psychol Addict Behav. 2011; 25: 485-491
- Cannabidiol in patients with treatment-resistant epilepsy: An open-label interventional trial.Lancet Neurol. 2016; 15: 270-278
- Cannabinoids in the treatment of epilepsy.N Engl J Med. 2015; 373: 1048-1058
- Adverse effects of medical cannabinoids: A systematic review.CMAJ. 2008; 178: 1669-1678
- Cannabis as a secondary drug is not associated with a greater risk of death in patients with opiate, cocaine, or alcohol dependence.J Addict Med. 2017; 11: 34-39
- Pharmacology and effects of cannabis: A brief review.Br J Psychiatry. 2001; 178: 101-106
- Does cannabis use increase the risk of death? Systematic review of epidemiological evidence on adverse effects of cannabis use.Drug Alcohol Rev. 2010; 29: 318-330
- Wide-ranging online data for epidemiologic research (WONDER).CDC, National Center for Health Statistics, Atlanta, GA2016 (Available at:) (Accessed June 12, 2017)
- Increases in drug and opioid-involved overdose deaths—United States, 2010-2015.MMWR Morb Mortal Wkly Rep. 2016; 65: 1445-1452
- Benzodiazepine use in the United States.JAMA Psychiatry. 2015; 72: 136-142
- Benzodiazepine use and risk of mortality among patients with schizophrenia: A retrospective longitudinal study.J Clin Psychiatry. 2016; 77: 661-667
- The association between benzodiazepines and influenza-like illness-related pneumonia and mortality: A survival analysis using UK Primary Care data.Pharmacoepidemiol Drug Saf. 2016; 25: 1263-1273
- Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: Retrospective cohort study.BMJ. 2014; 348: g1996
- Cognitive effects of long-term benzodiazepine use.CNS Drugs. 2004; 18: 37-48
- Benzodiazepine use and risk of incident dementia or cognitive decline: Prospective population based study.BMJ. 2016; 352: 90
- Is long-term use of benzodiazepine a risk for cancer?.Medicine. 2015; 94: e483
Article info
Publication history
Published online: September 09, 2017
Footnotes
This work was partially funded by the Medical Cannabis Research fund (http://mcrf.unm.edu/).
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
