Amalie K. Kropp Lopez, MS MD Candidate Geisinger Commonwealth School of Medicine Class of 2023 Scranton, Pennsylvania

Implementation of Recreational Marijuana and Decreased Prescription Opioid Use Interview with:

Amalie K. Kropp Lopez, MS MD Candidate Geisinger Commonwealth School of Medicine Class of 2023 Scranton, Pennsylvania

Amalie K. Kropp Lopez

Amalie K. Kropp Lopez, MS
MD Candidate
Geisinger Commonwealth School of Medicine Class of 2023
Scranton, Pennsylvania What is the background for this study?

Response: The opioid crisis is still affecting America, effecting millions of people from all walks of life. With the high risks of abuse and overtreatment with opioids, marijuana has been a newly reconsidered alterative for pain treatment. This study sought to quantify the changes in prescription opioid distribution using data reported by the Drug Enforcement Administration in Colorado after the legalization of recreational marijuana which gave the public increased access to its pain-relieving effects. What are the main findings?

Response: When comparing Colorado to two states that did not implement recreational marijuana, Utah and Maryland, there was a statistically significant decrease in Colorado and Maryland for opioids used for pain. There was a larger reduction (-31.5%) from 2012 to 2017 in Colorado than in both other states. Also, Colorado had a greater decrease in codeine and oxymorphone, two opioid medications used to treat pain. Colorado and Maryland had similar demographics in terms of population, home ownership, education, and uninsured rates. Utah was selected as a geographically similar state with some comparable characteristics such as median income and uninsured rate. What should readers take away from your report?

Response: This is one of the first studies evaluating the legalization of recreational marijuana and how the amount of opioid distribution changed within a state over a decade. While we cannot prove the causation between the two factors with this naturalistic design, these policy changes offer a new framework for providers to consider marijuana as a treatment for pain, making it a step in a direction which contributes to a larger evidence base including the 2017 National Academy of Sciences Cannabis Report. Right now, 33 states and the District of Columbia have legalized marijuana either medically or recreationally. Opioids, while effective for treating cancer and acute non-cancer pain, are risky as shown by the increasing rates of opioid use disorder and elevated distribution of buprenorphine and methadone. Marijuana offers a comparatively lower risk of addiction and virtually no overdose risk. What recommendations do you have for future research as a result of this work?

Response: There needs to be more research done on this topic to continue characterizing how marijuana can be beneficial for the treatment of pain as either a replacement or as an adjunct to opioids. Right now, with the limited data collected, we were not able to track opioids on an individual level. There are also many confounding factors that can impact pain treatment. When selecting our comparison states, we tried to look for similar BMIs, annual household incomes, population, and other demographic factors. A larger national study is needed. Is there anything else you would like to add?

Response: This study is a small, but important, step in the direction of understanding how we are dealing with the opioid crisis and the importance of consideration of other treatment options, such as marijuana. These types of investigations will also allow the public to evaluate if the national and state policy changes are having a significant impact on the continued excesses in opioid distribution. Naturalistic studies like this are extremely challenging to interpret as there are multiple demographic and socioeconomic factors which contribute to both prescription opioid and marijuana use. However, the more studies on this topic that are done that include more states or countries will help complete our understanding and maintain the highest safety standards for patients.

Also, the Drug Enforcement Administration’s Automation of Reports and Consolidated Ordering System (ARCOS) is a publically available database which is comprehensive and could be considered the gold-standard. We continue to be surprised by the infrequency that ARCOS is used by biomedical scientists, health care researchers, and data journalists.

Disclosures: BJP is part of an osteoarthritis research team supported by Pfizer. The other authors have no disclosures.


Kropp Lopez AK, Nichols SD, Chung DY, Kaufman DE, McCall KL, Piper BJ. Prescription opioid distribution after the legalization of recreational marijuana in Colorado. International Journal of Environmental Research and Public Health 2020; 17(9):e3251.



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Last Updated on June 22, 2020 by Marie Benz MD FAAD