
The impact of cannabis access laws on opioid prescribing - hckr_nj
https://doi.org/10.1016/j.jhealeco.2019.102273
======
t34543
> Analyzing a dataset of over 1.5 billion individual opioid prescriptions
> between 2011 and 2018, which were aggregated to the individual provider-year
> level, we find that recreational and medical cannabis access laws reduce the
> number of morphine milligram equivalents prescribed each year by 11.8 and
> 4.2 percent, respectively.

As a former marijuana user this seems obvious to me. I don’t understand why
federal legalization has been so difficult. There are many benefits despite
the potential of unknown risk.

Maybe my beliefs are a little out there. I wish for all drugs to be
decriminalized. Portugal’s model seems to be working quite well.

[https://time.com/longform/portugal-drug-use-
decriminalizatio...](https://time.com/longform/portugal-drug-use-
decriminalization/)

~~~
doc_gunthrop
> I don’t understand why federal legalization has been so difficult.

Look into the history of laws surrounding marijuana in the United States and
you'll start to understand the politics behind it.

For example, here's a statement from John Ehrlichman[1], Assistant of Domestic
Affairs to former president Richard Nixon.

> “You want to know what this was really all about?” he asked with the
> bluntness of a man who, after public disgrace and a stretch in federal
> prison, had little left to protect. “The Nixon campaign in 1968, and the
> Nixon White House after that, had two enemies: the antiwar left and black
> people. You understand what I’m saying? We knew we couldn’t make it illegal
> to be either against the war or black, but by getting the public to
> associate the hippies with marijuana and blacks with heroin, and then
> criminalizing both heavily, we could disrupt those communities. We could
> arrest their leaders, raid their homes, break up their meetings, and vilify
> them night after night on the evening news. Did we know we were lying about
> the drugs? Of course we did.”

1:
[https://en.wikipedia.org/wiki/John_Ehrlichman](https://en.wikipedia.org/wiki/John_Ehrlichman)

~~~
refurb
Pretty sure this quote has been discredited. Some reporter said he said it,
but after he died, so it can’t be confirmed. His family says that quote
doesn’t sound like him at all. Even if he did say it, it’s one guys opinion
and doesn’t reflect gov’t policy.

~~~
jdietrich
It's an incontrovertible historical fact that the prohibition of opium and and
cocaine was substantially racially motivated.

[https://en.wikipedia.org/wiki/Harrison_Narcotics_Tax_Act](https://en.wikipedia.org/wiki/Harrison_Narcotics_Tax_Act)

~~~
refurb
Don’t disagree, but that doesn’t prove racism was Nixon’s reason for the war
on drugs.

~~~
save_ferris
One of Nixon's chief advisers admitted in an interview years later that the
war on drugs was explicitly targeted at black people[0]. Criminalizing blacks
was a primary objective of this policy.

0: [https://qz.com/645990/nixon-advisor-we-created-the-war-on-
dr...](https://qz.com/645990/nixon-advisor-we-created-the-war-on-drugs-to-
criminalize-black-people-and-the-anti-war-left/)

~~~
meowface
It likely was a motive, but it doesn't necessarily make the quote real. I have
trouble believing Nixon or his advisors would give a supervillain monologue
like that, personally, even if those were their exact intentions.

~~~
tim333
Well as one of the earlier links said

>Nixon advisor: We created the war on drugs to “criminalize” black people and
the anti-war left

so it was more their political enemies in general rather than a race. Not to
say it wasn't part racist.

~~~
leetcrew
read the whole thread man. I don't think anyone here doubts that drug
enforcement in America is racially motivated, but you're the third person to
cite that very dubious quote.

------
peckrob
A friend of mine served in Iraq and has a lot of health problems related to
his time there. He has a shoebox full of medications for various ailments but,
when he can use marijuana, he only needs like 5 of them.

So every few months he drives three states over to the closest legal state,
stays for a few days and buys enough to last him until his next visit. From
what I understand, this experience is not uncommon at all. There are even
AirBnB's that cater specifically to these "medical refugees" coming in to buy
there because they cannot get the medication they need in their home states.

It is really insane to me that prohibition of a plant continues despite all
the evidence of its positive benefits. Especially when drugs that are far more
dangerous to you than marijuana can be purchased at your corner drug store
without even showing an ID.

~~~
Aperocky
Imagine being pulled over while traveling.

So insanely risky, especially considering speed traps are not illegal and cops
practically camp where speed limit drops by bits.

~~~
donarb
A few years ago, a friend of mine here in Seattle went to visit his friend in
Ohio, who wanted him to bring some legal pot. He took a train to Chicago, then
rented a car to drive the rest of the way. He got stopped in Indiana,
consented to a search where the officer found the pot in the car. My friend
was lucky, he only got a warning with the pot seized, he was carrying a bit
more than what would be considered a personal stash.

The cop told him that a quarter of the rental cars he stopped on the highway
were carrying some form of contraband. Apparently, out of state rental cars on
the highway attract police attention.

~~~
syshum
And they were most likely looking for large amounts of cash, Cops love the
Seize cash, anyone carrying more than 10K in cash will likely never see it
again, perfectly legal under Civil Asset Forfeiture

------
sarcasmatwork
Big Pharma once fought rec cannabis, now they are trying to take over it.

[https://www.theguardian.com/sustainable-
business/2016/oct/22...](https://www.theguardian.com/sustainable-
business/2016/oct/22/recreational-marijuana-legalization-big-business)

[https://www.zerohedge.com/news/2019-08-12/big-pharma-
takeove...](https://www.zerohedge.com/news/2019-08-12/big-pharma-takeover-
medical-cannabis)

~~~
pstuart
And they're trying the same thing with kratom:
[https://www.kratomutopia.org/real-reason-fda-targeting-
krato...](https://www.kratomutopia.org/real-reason-fda-targeting-kratom/)

~~~
freedomben
The FDA/DEA war on Kratom is truly heinous. The worst part is certain media
outlets (like USA Today) are happy to regurgitate FDA propaganda without even
mentioning the counter arguments. There are a few articles I see in other
outlets that are fair, but more often than not it's the government-approved
line.

~~~
peteretep
Kratom is addictive and you can overdose on it, neither of which is generally
considered true for cannabis. It seems odd to mention both in the same breath.

~~~
freedomben
You can _not_ over dose on kratom. You'll become nauseous and throw up long
before reaching a toxic level. It is addictive tho. But so is caffeine, and
even sugar, but nobody wants to ban those.

~~~
0xdeadb00f
This is also similar to marijuana IIRC. You pass out long before you're ever
able to reach toxic levels of THC. I'm not sure how true this is though, only
something I heard from someone in HS who was a massive stoner.

------
ogre_codes
_Personal anecdote warning_

Marijuana is a reasonably effective pain treatment which is readily available
without prescription. Even without the really scary stuff surrounding Opiates,
I'm far more likely to use the pain meds I can pick up at the corner
dispensary. The cost of weed is far less and more important, availability and
bullshit hoops I have to go through are far less.

About the only downside to weed is you gotta smoke it unless you process it
first and making edibles or an infusion with a sous vide is not very difficult
at all.

[https://www.sousweed.com/blog/2015/6/13/sous-vide-
cannabis-b...](https://www.sousweed.com/blog/2015/6/13/sous-vide-cannabis-
butter) [https://medium.com/sous-vide/sous-vide-thc-infused-
cocktails...](https://medium.com/sous-vide/sous-vide-thc-infused-
cocktails-7689265aa7ac)

~~~
jakear
Sousweed eds are also more potent than store bought ones [1], and deliver more
effect that smoking the source. Given I live in a legal state and enjoy
cooking, especially experimental cooking, I'm considering very small-scale
distributing in 2020.

[1]: IMO, I use top-shelf for my eds; generic ones are probably a lot of
shwag, and the "mg THC" ratings are incredibly inconsistent.

~~~
ogre_codes
Largely matches my experience. I make infusions and usually have to cut it
quite a bit before sharing, otherwise people get entirely too baked too
quickly.

I enjoy crafting more than consuming so I tend to have way more than I can
consume and give most of it away.

------
mikestew
Anecdotally, I just got out of the hospital after some serious surgery on
Christmas (maybe not “emergency”, but if they did it on 12/25 it obviously
couldn’t wait). I’ve got a Vicodin subscription, my wife filled it, but I
don’t plan on using it unless I have to. I live in WA, which legalized weed,
and I plan to just smoke (well, vape) up. OTC meds aren’t quite enough, but
yeesh, the next step is Vicodin? Nah, way too much, I think the weed will tide
me over.

But if cannabis weren’t legal in WA, I’d probably just take the Vicodin
because OTC isn’t enough. So for my current situation, cannabis falls right in
that happy middle I need, and to bring it back on topic, keeps me off the hard
stuff.

~~~
anonytrary
I highly recommend against smoking or vaping marijuana and instead choosing
edible oils[0]. These sublingual oils are the safest way to ingest marijuana,
and they are just as effective (if not more) as other forms of edibles. Not
only that, but you can administer surgically precise doses very easily, since
you control exactly how many drops you take.

[0] [https://www.leafly.com/products/edibles/tinctures-
sublingual](https://www.leafly.com/products/edibles/tinctures-sublingual)

~~~
mikestew
Thanks for the pointer. Looks like the store down the road has a wide
selection. I’ve also been reading the other comments on making butter and the
like, which I might give a whirl since I’m not leaving the house for a while.
:-)

~~~
Zod666
If you have never had edibles I'd proceed with caution. Weed is much more
psychoactive when ingested and lasts way longer. If you take too much, you'll
be in a bad place for hours instead of 45 min with smoking.

~~~
anonytrary
Uh, no. This is simply not true with sublingual tinctures where the
concentration is very well-defined per drop. This only holds true for brownies
and other food-based edibles where you don't know the concentration...

~~~
GordonS
I can also recommend tinctures over edibles, but be sure to use a highly
concentrated one, so you don't swallow any (this is actually quite difficult
if you hold any more than a tiny amount of liquid under you tongue or between
your gums and teeth!

For at least the first few times using edibles, I'd also advise the GP to be
extremely cautious, and especially so if you don't have a precise source; the
effects of vaping/smoking are 1-2 hours, but can be 5-7 with edibles - if you
have too much, you're in for something akin to a bad trip (it's not the same,
but the closest I can describe it), feeling nauseous, anxious and paranoid. It
really is absolutely _horrible_

~~~
anonytrary
Curious why you are recommending against swallowing tincture drops. I
typically swish the drops around in my mouth for 30s-2min depending on how
quickly I want the high to onset, then I swallow. There are also times where I
_only_ swallow and I still get high.

Sure, drops will last longer than smoking/vaping, but the high is much milder
and less intense (holding the amount of THC/CBDs constant). As someone who
used to get anxiety and paranoia from weed, I can say that drops are much more
benign in that manner.

------
m0zg
Could also be because it's getting to be a huge pain in the ass to get
prescribed opioids. You have to go to the doctor, often several times, and
then you get to pay a pretty penny to fill the prescription. Much easier to
smoke a doobie or eat a brownie. Convenience wins every time.

IMO the best strategy for the drug war is to make MJ and other drugs with very
low addiction potential (shrooms, LSD) available nationwide, and continue to
harshly prosecute the sale (but not possession) of crack, heroin and fentanyl.

That way people who feel like they need drugs to deal with their life
situation will choose MJ out of convenience alone.

------
anonytrary
Not surprising that marijuana is a sort of strange attractor that prevents
people from using harder drugs. Also not surprising that the federal
government doesn't just _execute faster_ and legalize it nation-wide already.
I find it mind-boggling that you can be dying from opioids in one state and
not another just because the state you're in happens to have banned a benign
plant that can help save you and wean you off of opioids.

~~~
wayoutthere
Let’s be real, the government was at best complicit in the opioid crisis. The
Sacklers did a lot of lobbying; meanwhile “big marijuana” didn’t exist until
very recently.

------
skizm
If you're against drug legalization, this is like hearing "allowing people to
steal whatever they want is causing less murder". Allowing everyone to do bad
things, in order to slightly reduce the number of really bad things is not a
basis for legalizing something.

Now I'm personally for the recreational legalization of all drugs in general,
but this is a poor argument, just like increased tax revenue is a poor
argument. Proponents of legalization should be arguing that anyone should be
able to do whatever they want to their own body as long as they're not hurting
anyone else.

~~~
nerdponx
What do opponents of marijuana legalization actually believe?

The only coherent opposition to it I've ever heard is that it's difficult to
test for marijuana intoxication on the side of the road. Which still doesn't
really make sense when you consider that people are clearly doing it anyway
(and now can easily cross state lines with no marijuana in their possession
but quite a bit of THC in their blood).

~~~
pstuart
They believe that it is a bad thing that bad people do. And that because
they're bad people they deserve bad things to happen. Because drugs are bad,
m'kay?

Seriously, I can only guess because none of it makes sense to begin with.

------
annoyingnoob
There are parallels to the prohibition of alcohol here. During prohibition you
were more likely to find liquor. Even after prohibition for some time liquor
was more popular - my grandparents were more likely to have a cocktail than a
beer or wine. Today people drink more beer and wine than liquor, there are
more options, we don't have to go straight for the hard stuff.

------
jariel
It's difficult to buy their causality thesis.

Opioid addiction rates across states (and nations) already varies quite
wildly, totally independent of weed laws, which were all quite similar some
time ago. And the variation is large, far beyond the 5-10% supposed
relationship in the paper.

Organisational, legal, social attitudes towards opioids change quite
frequently as well - these would be very hard to normalise for.

If someone can validate how they crack the normalisation to achieve causality
I'd love to hear about it.

~~~
sjy
The statistical methods are explained in detail and the article was published
in what appears to be a reputable peer-reviewed journal. What kind of
validation are you looking for?

~~~
jariel
It seems to me there's a huge range of factors they didn't and can't possibly
control for. Particularly availability of black market opioids. And if I'm not
misreading - the changing policies of opioid scrips over time, a lot of which
is 'trendy' i.e. socially driven as much as policy driven (i.e. individual
doctors making changes in their practice because they read something).

More specifically, I'm always wary of 'top down' science that doesn't consider
the myriad of real world considerations regarding their thesis; specifically
they don't actually _talk to people_ (or even take surveys) to get a feel for
what is actually happening.

What if they had a lot of conversations and did a few surveys and found that
people tended to not medicate 'en masse' for specific interventions?

I honestly don't understand how researchers can look at such an intensively
social and behavioural subject without getting a personal feel for the
prevalent behaviours.

I'll bet doctors, social workers on the front line have pretty good insight
into what's going on.

So my question was pointed to anyone who understood this paper or issue in
detail who could articulate in so many words 'why the correlation is valid'.

------
disordinary
Always seemed insane to me that pharmaceutical drugs based on Marijuana are
bad but drugs that share a base with heroin are okay.

------
refurb
Don’t have access to the paper, but would love to see how they controlled for
dropping opioid use.

The roll out of marijuana legislation overlaps quite nicely with an overall
effort to reduce opioid prescriptions.

I imagine it would be difficult to control for that effect.

~~~
sjy
The link is to the full text of the article. The method (difference in
differences) is well-known from the famous study on minimum wage laws (Card
and Krueger, 1994).

> To examine the effect of cannabis access laws on opioid prescriptions, we
> estimate a series of difference-in-differences models, exploiting the
> staggered adoption of cannabis access laws over time ... Following Bradford
> et al. (2018); Buchmueller and Carey (2018) and Patrick et al. (2016), we
> include controls for [several] different legal changes that may impact
> opioid prescriptions in a series of robustness checks ... As described in
> detail in the appendix, we test our data for parallel trends between
> providers in states that adopted cannabis access laws and those in states
> that did not. We are unable to reject the null hypothesis of parallel
> trends, which supports the use of difference-in-differences models.

------
spydum
while opioids are clearly awful when abused, they are at least a controlled
substance and a bit expensive. There are MANY more people who manage pain with
alcohol due to it's price point and availability.. I'm very interested to see
the effects there. a quick search turns up some papers, but nothing recent or
with any significant data..
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700545/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700545/)

~~~
GordonS
I recall seeing a study recently looking at using GHB for chronic pain
management (which has similar effects to alcohol, but without the hangover).

IIRC, it did work somewhat, but of course the participants felt "drunk".

I suffer from chronic pain caused by small fiber neuropathy in my arms and
legs, and can add a single data point: alcohol does help _a bit_ \- but the
way it does so is more by "distraction", whereas opioids really seem to reduce
the pain. It's also completely impractical if you want to drive, work, look
after children etc (normal life, basically). But I can certainly see why
people would use alcohol if they were unable to obtain prescription medicines
that helped them.

------
time0ut
It is 2020. Just legalize it already. And legalize DMT and mushrooms while
you're at it. So many can benefit from these natural and relatively safe
remedies.

~~~
kasi
Anecdotally, DMT made me black out and go crazy for 20 minutes. I would not
make it easily available.

~~~
pstuart
But you got ahold of it despite its legality. Ironic, no?

These drugs should be treated as seriously as any other (know your drug!).
Some will fail to do that, but that is how it goes.

The moment I hear "drug X caused this bad thing to happen" I think of how much
suffering alcohol consumption does globally on a daily basis. That tempers all
associated concerns.

~~~
Cougher
"That tempers all associated concerns."

Until you compare the number of sufferers as a percentage of users, there is
no tempering of concerns here.

~~~
dunmalg
One might say the same thing about building a significant degree concern based
upon random anecdotes.

------
beenBoutIT
One day MDMA legalization will significantly reduce both alcohol consumption
and DUIs.

~~~
goatsi
If you want it to remain effective and to avoid serious complications
(depression, anxiety, loss of verbal fluency) MDMA can't be taken anywhere
near frequently enough to replace alcohol for the average individual.

~~~
pstuart
That was supposed to be GHB.

------
sjy
> Information on opioid prescriptions comes from Symphony Health’s IDV®
> (Integrated Dataverse) dataset ... The dataset includes approximately 90% of
> all prescriptions filled at outpatient pharmacies in the United States
> between 2011 and 2018 ... Each observation includes the year the
> prescription was filled, the eleven-digit national drug code (NDC) for the
> prescription, the total days’ supply for the prescription, the quantity of
> drugs, an encrypted patient identifier, and an encrypted healthcare provider
> identifier.

Given what we’ve learned about data re-identification [1], this sounds like a
pretty scary dataset. Does anybody know more about it? Do you need to pay for
access? Is access restricted to researchers who can be trusted not to attempt
re-identification?

[1] [https://en.wikipedia.org/wiki/Data_re-
identification](https://en.wikipedia.org/wiki/Data_re-identification)

------
PeterZhizhin
When I see these types of research, I wonder if it is a short-term or a mid-
term effect of marijuana legalization. There was a time when Heroin was a
legal trade-mark that was available over-the-counter... It was thought that
only weak could get addicted to it while short-term effects were recognized.

------
bureaucrat
Marijuana legal states are rich or have been gentrified so they use less
opioid.

------
slimed
"Marijuana laws" are what caused this mess in the first place. The title of
this post makes it sound like government is doing something rather than
getting out of the way.

~~~
connicpu
Recreational Marijuana Laws has generally meant regulating it in a manner very
similar to Alcohol. Given what we've seen with black market products being cut
with dangerous chemicals that have sent people to the hospital, I'm happy to
know my state performs quality control tests on the marijuana products I'm
buying.

~~~
slimed
Do you really believe that people would "cut" legal marijuana with "dangerous
chemicals" and sell it from their dispensary? This barely ever happens with
_illegal_ marijuana. The reason drugs like heroin and cocaine are cut is to
increase profit margin, either through dilution with a relatively harmless
substance, or (more dangerously) a cheaper, more potent alternative like
fentanyl in the case of heroin. Marijuana cannot be "cut" in this way, and it
is the black market that incentivizes it with other drugs. I should be able to
grow it for myself and my friends and family but that's still illegal most
places that have rec laws. These laws are preferable to prohibition but it is
not the laws that are helping people. It's the plant itself that is doing so.

~~~
donarb
It's not so much someone cutting pot with dangerous drugs. In the past when
you bought from someone, even regularly, there'd be that infrequent time where
the guy's supplier didn't come through so the quality or amount was less than
the time before.

With pot shops, they print out the THC content on every label so you can buy a
consistent product at a regular price every time.

~~~
slimed
You don't need a government agency to test for THC potency. Businesses can and
do already solve that problem. That doesn't seem to be what the parent
commenter was getting at, regardless.

As an experienced grower I would trust myself and others I know who have
expertise. I wouldn't need a lab test before consuming their product. As a
frequent user, exact THC content is not really that relevant. Not nearly as
much as knowing the strain and growing process, which as the grower, or the
customer of a reputable grower or dispensary, I would know.

We're talking about _a plant_. The worst that can happen to you is a Peggy
Noonan style freak out. Yet we're setting up a system where rent seekers will
squat on grow and distribution licenses and the price will inevitably go up.

~~~
DanBC
Cannabis is less likely to be adulterated than other drugs, but it does still
happen and legalising and regulating it makes this less likely.

Page 36:
[https://www.researchgate.net/publication/235912814_CUT_A_Gui...](https://www.researchgate.net/publication/235912814_CUT_A_Guide_to_Adulterants_Bulking_Agents_and_Other_Contaminants_Found_in_Illicit_Drug)

------
trekrich
This is not good news for big pharma, they dont want people using less drugs.
They want you using more. Its morally bad.

