Implications of Prescription Drug Monitoring and Medical Cannabis Legislation on Opioid Overdose Mortality Open Access

Abstract

Background: In response to the opioid epidemic in the United States, medical cannabis laws and expanding prescription drug monitoring programs (PDMPs) have the potential to combat rising rates of opioid overdose.

Methods: This study assessed the effect of legislation on opioid overdose mortality using multivariate repeated measures analysis. State level opioid related mortality rates for 50 states and the District of Columbia from 2011 to 2014 were obtained from CDC WONDER. State PDMPs with mandatory access provision data was obtained from the National Alliance for Model State Drug Laws, and data on state medical cannabis legislation from the National Organization for the Reform of Marijuana Laws. Covariates examined were state level aggregate rates for the population on disability, population living in an urban area, educational attainment, and unemployment from 2011-2014.

Results: Medical cannabis laws were significantly associated with an increase of 21.7% in mean age adjusted opioid related mortality (p < .0001). PDMPs with a mandatory access provision were significantly associated with an increase of 11.4% in mean age adjusted opioid related mortality rate (p=0.005). When time after enactment was included, for every additional year since enactment, the mean age adjusted opioid related mortality rate increased by 1.7% in states with medical cannabis (p=0.049), and 5.8% for states with a PDMP (p=0.005). The interaction between both types of legislation produced a borderline significant decrease of 10.1% (p=0.055). For every year states had both types of legislation, interaction resulted in a decrease of 0.6% (p=0.013).

Conclusions: States with either legal medical cannabis or PDMPs with mandatory access provisions were associated with higher rates of opioid related mortality than states without such laws. When accounting for the amount of time each type of legislation had been enacted, this association was markedly reduced in states with medical cannabis legislation. While PDMPs continue to be underutilized, when combined with the availability of medical cannabis as an alternative analgesic therapy, they may be more effective. Continued follow up of medical cannabis laws over time is important to understand the full effect these new laws may have on opioid related mortality and opioid prescribing trends.

Table of Contents

Abstract............................................................................................................................. 1

I. Introduction.................................................................................................................. 2

II. Background.................................................................................................................. 4

III. Methods..................................................................................................................... 17

IV. Results....................................................................................................................... 22

V. Discussion................................................................................................................. 25

VI. Conclusion................................................................................................................ 30

VII. References............................................................................................................... 31

VIII. Tables..................................................................................................................... 40

Appendices..................................................................................................................... 43

Appendix A................................................................................................................... 43

Appendix B................................................................................................................... 45

Appendix C................................................................................................................... 46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Sociology, Public and Social Welfare Health Sciences, Epidemiology
Keyword	Cannabis Opioid Overdose Marijuana Prescription Drug Monitoring PDMP
Committee Chair / Thesis Advisor	Gazmararian, Julie A, Emory University

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