Medical Cannabis, Opioid Use, and the Opioid Mortality Crisis: - - PowerPoint PPT Presentation
Medical Cannabis, Opioid Use, and the Opioid Mortality Crisis: Evidence for Kentucky W. David Bradford 1 1 University of Georgia September 24, 2018 September 24, 2018 Bradford Medical Cannabis and Kentucky 1 / 28 Introduction to issues
1University of Georgia
September 24, 2018
Bradford Medical Cannabis and Kentucky
September 24, 2018
1 / 28
Cannabis policy - both medical and recreational - is changing rapidly around the world. Most changes to these policies are fairly recent, so there is often not enough time passed for data to be available. Still, a rich literature is developing with unique data challenges.
Bradford Medical Cannabis and Kentucky
September 24, 2018
2 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
3 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
4 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
5 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
6 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
7 / 28
January 2017: review of >10,000 peer reviewed studies by the National Academies of Sciences, Engineering and Medicine. Conclusive evidence of cannabis effectiveness for:
chronic pain, chemotherapy-induced nausea spasticity associated with multiple sclerosis.
Moderate evidence of cannabis effectiveness for sleep disorders.
Bradford Medical Cannabis and Kentucky
September 24, 2018
8 / 28
Currently, 31 states and the District of Columbia have passed laws that recognized the value “whole plant” medical cannabis. As of May 2018, 17 states had legalized Low THC / High CBD extracts Pathways for access vary.
Home cultivation is permitted in some states. Many state MCLs include a dispensary program (all states since 2009 have this provision).
Every individual state law included a list of qualifying conditions that must be met before the patient can receive full protection.
Bradford Medical Cannabis and Kentucky
September 24, 2018
9 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
10 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
11 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
12 / 28
One issue that has received surprisingly little attention is the question of whether medical cannabis is actually being used clinically to any significant degree. To the extent that cannabis is used by physicians to manage the conditions for which it has clinical evidence, then one would expect it to be primarily a substitute for existing prescription.
Bradford Medical Cannabis and Kentucky
September 24, 2018
13 / 28
Little was known about whether medical cannabis is being used clinically to any significant degree. Using data on all prescriptions filled by Medicare Part D enrollees in the U.S. from 2010 to 2013 we found that the use of prescription drugs fell significantly once an MCL was put in place. We have since expanded this work to examine the effect of MCLs on prescription drug spending in both Medicare and Medicaid, up through 2015.
Bradford Medical Cannabis and Kentucky
September 24, 2018
14 / 28
Main Questions:
Did implementing an effective MCL change the prescribing patterns of physicians in Medicare Part D for FDA-approved prescription medications (for all drugs and for on-label only drugs)? Does the type of MCL (dispensary-based vs. only home-cultivation) affect prescribing patterns? Does the response to MCL vary based on setting (urban vs. rural)?
Bradford Medical Cannabis and Kentucky
September 24, 2018
15 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
16 / 28
We have data from 2010 to 2015, with 133 million observations. We control for type of MCL:
Indicator for whether states only permit home cultivation Indicator for whether a dispensary is opened.
We estimate the model separately for urban and rural counties.
Bradford Medical Cannabis and Kentucky
September 24, 2018
17 / 28
Our overall results were very similar, but...
The effect of dispensary-based MCLs were more than twice as effective at reducing pain medications as home cultivation. Nearly all of the benefit was seen in urban counties, and no statistically significant effect was observed in rural counties.
Bradford Medical Cannabis and Kentucky
September 24, 2018
18 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
19 / 28
We followed up our 2016 study and applied the same methodology to Medicaid. Using data on all prescriptions filled by Medicaid FFS enrollees in the U.S. from 2007 to 2014 we found that the use of prescription drugs fell significantly once an MCL was put in place.
Bradford Medical Cannabis and Kentucky
September 24, 2018
20 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
21 / 28
Research team at the University of Georgia expanded on our 2016 Health Affairs work to examine association between MCLs and
We used data on all opioid prescriptions filled by Medicare Part D enrollees in the U.S. from 2010 to 2015. We examined type of opioid and type
Bradford Medical Cannabis and Kentucky
September 24, 2018
22 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
23 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
24 / 28
As we have seen, there is reason to suspect that MCLs can prompt diversion away from opioid use. Bachhuber et al. (2014) conducted a state-level analysis of
mortality fell after any MCL went into effect (diff-in-diff). Powell, et al. (2018) find that when active dispensaries are taken into account, opioid-related mortality falls by between 25%-27% also using NVS.
Bradford Medical Cannabis and Kentucky
September 24, 2018
25 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
26 / 28
Bradford Medical Cannabis and Kentucky
September 24, 2018
27 / 28
We have strong evidence that access to medical cannabis can shift people away from pain medications in general, and opioids in particular. Other research finds consistent benefit from reduced overdose mortality when medical cannabis laws go into effect. The best population-level evidence finds little consistent evidence that MLCs are strongly associated with increases in traffic accidents / fatalities, alcohol abuse, or youth substance use (i.e., a “gateway effect”). MCL type (dispensaries vs. home cultivation) and setting (urban vs. rural)
Appropriately designed MCLs can save both lives and money.
Bradford Medical Cannabis and Kentucky
September 24, 2018
28 / 28