Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use

J Gen Intern Med. 2019 Aug;34(8):1419-1426. doi: 10.1007/s11606-018-4782-2. Epub 2019 Jan 25.


Objective: To determine the association of medical marijuana legalization with prescription opioid utilization.

Methods: A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006-2014. Adults with pharmacy and medical benefits for the entire calendar year were included in the population for that year. Multilevel logistic regression analysis, controlling for patient, person-year, and state-level factors, were used to determine the impact of medical marijuana legalization on the three opioid use measures. Sub-group analysis among cancer-free adults and cancer-free adults with at least one chronic non-cancer pain condition in the particular year were conducted. Alternate regression models were used to test the robustness of our results including a fixed effects model, an alternate definition for start date for medical marijuana legalization, a person-level analysis, and a falsification test.

Results: The final sample included a total of 4,840,562 persons translating into 15,705,562 person years. Medical marijuana legalization was found to be associated with a lower odds of any opioid use: OR = 0.95 (0.94-0.96), chronic opioid use: OR = 0.93 (0.91-0.95), and high-risk opioid use: OR = 0.96 (0.94-0.98). The findings were similar in both the sub-group analyses and all the sensitivity analyses. The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR = 1.00; CI 0.99-1.01) or antihypertensives (OR = 1.00; CI 0.99-1.01).

Conclusions: In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use. However, further research assessing risk versus benefits of medical marijuana legalization and head to head comparisons of marijuana versus opioids for pain management is required.

Keywords: chronic opioid use; marijuana; medical marijuana legalization; opioids; pain.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use*
  • Chronic Pain / drug therapy
  • Chronic Pain / epidemiology
  • Drug Prescriptions* / standards
  • Female
  • Humans
  • Legislation, Drug / standards
  • Legislation, Drug / trends*
  • Male
  • Medical Marijuana / adverse effects
  • Medical Marijuana / therapeutic use*
  • Middle Aged
  • Opioid-Related Disorders / diagnosis
  • Opioid-Related Disorders / epidemiology*
  • Risk Factors


  • Analgesics, Opioid
  • Medical Marijuana