PainRelief.com Interview with:
Daniel Kaufman, MS
Geisinger Commonwealth School of Medicine
Brian J. Piper, PhD, MS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA 18510
PainRelief.com: What is the background for this study?
Response: The opioid epidemic has stricken the United States and caused thousands of deaths nationally. Researchers continue to search for a solution to the ongoing escalation in opioid related deaths, with some states turning to medical cannabis as a potential alternative treatment for chronic pain. The objectives of this study were to:
- To determine if medical cannabis program implementation had any effect on opioid overdoses at a state-wide level
- To contribute to the discussion of researchers searching for a solution to the opioid epidemic facing the United States
- Begin the discussion on the standardization of autopsy procedures, including death/overdose determination
PainRelief.com: What are the main findings?
Response: In this research, we found a statistically significant increase in opioid overdose deaths in states without medical cannabis programs, while finding a non-significant rise in states with medical cannabis programs. These findings show a possible influence of medical cannabis programs on opioid-related deaths in the United States.
Perhaps more importantly, there was tremendous variability in the quality of death determination across states. The Centers for Disease Control uses a three-tiered system. Excellent was defined as ≥ 90% of drug overdose death certificates mentioning at least one specific drug in 2014, with the change in percentage of drug overdose deaths mentioning at least one specific drug differing by < 10 percentage points from 2014 to 2015. Good was defined as 80% to <90% of drug overdose death certificates mentioning > one specific drug in 2014, with the change in the percentage of drug overdose deaths mentioning > one specific drug differing by <10 percentage points from 2014 to 2015. The remaining states were classified as “less than good”.
PainRelief.com: What should readers take away from your report?
Response: Medical cannabis may be a viable alternative to the prescription opioids causing the epidemic. Along with this, readers should also start to consider other alternatives to pain management. Although research seems promising, there are several factors that may interfere with the opioid overdose data integrity. Standardization of opioid overdose procedures is crucial if public policy is based on this data. Currently, states with higher reporting quality also report significantly more opioid overdoses.
Because each state has their own independent procedure to determine and report causes of death (especially overdose) in their autopsy procedures, it is difficult to effectively research opioids and their public health effects. In addition, the increasing rate of fentanyl related deaths has possibly skewed opioid overdose statistics and has made it difficult to distinguish between fentanyl related deaths and other opioid related overdoses. This confound is often unappreciated in discussions of the opioid overdose epidemic.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: The WONDER database used in this report is a fantastic resource for public health research. However, researchers and journalists that make use of this information should be extremely cautious about comparing states that have high and low quality overdose data.
Quasi-experimental research studies are easy to conduct but the data can be difficult to interpret. This is especially true in the area of cannabis policy where states that adopted medical cannabis differ on multiple factors from states that have not.
Disclosures: Brian Piper is part of an osteoarthritis research team supported by Pfizer. The other authors have no disclosures.
Kaufman DE, Nihal AM, Leppo JD, Staples KM, McCall KL, Piper BJ. Opioid mortality following implementation of medical cannabis programs in the United States. Pharmacopsychiatry 2020; https://pubmed.ncbi.nlm.nih.gov/33621991/.
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