Expect a decline in opioid-related deaths among KyMCP patients
Multiple states' data suggest cannabis is a safer alternative to opioids
Kentucky’s medical cannabis program (KyMCP) is just starting, with patients able to apply for a card as of January 1. Based on other state program data, I predict chronic pain will be the diagnosis most applicants will list as their qualifying condition. Many of those patients will be coming into the program already using some type of opioid for pain management.
I am asked by clinicians and patients often if cannabis is “as good as” opioids for pain. Patients want to know if they can substitute or lower their dose of opioids for fear of “getting hooked.” Clinicians are increasingly trigger-shy to prescribe opioids, unwilling to accept liability if the patient develops opioid use disorder.
These fears aren’t unfounded. Kentucky’s estimated statewide opioid-use disorder (OUD) prevalence was 5.5% and 5.9% for 2018 and 2019, respectively, ranging from 1.3% to 17.7% across Kentucky counties. Counties with the highest OUD rates were the easternmost region.1 Furthermore, in 2021, there were 1,897 deaths from opioid overdose in Kentucky, accounting for 80% of all drug overdose deaths in the state. For comparison, nationwide, opioid overdose deaths accounted for 75% of all drug overdose deaths the same year.2
There are multiple studies that have demonstrated opioid burden is reduced when cannabis-based medication is added. We can look to other states’ data to predict if Kentucky’s OUD rates (and overdose deaths) will decline when patients can legally access cannabis medicine.
Utah’s medical cannabis program went online in 2018. In 2024, a study was published on the impact of cannabis access on opioid use in their participants.3 The study was a retrospect cohort of patients diagnosed with chronic pain (as identified by ICD-10 codes). The investigators matched cannabis consumption data from transactions at dispensaries with the medial records of patients. This allowed for a comprehensive analysis of cannabis use patterns. Opioid prescriptions were standardized in morphine milligram equivalents (MME) per month to facilitate cross-comparison of different opioids and dosages. The analysis controlled for covariates like age, sex, race, smoking status, type of pain, and cannabis product used.
The study authors reported that Utah’s medical cannabis program was associated with a significant decrease in opioid prescriptions and opioid-related mortality rates among registered patients. Indeed, the study reported an 84% reduction in opioid prescriptions in participants during the study period. Since the program’s start in 2018, Utah’s deaths related to opioids in that state have decline, suggesting safe, legal cannabis as a therapeutic alternative may have contributed to the decline. The findings of this study in Utah align with a broader trend in other states with medical cannabis programs.
Based this recent Utah study, and data from many other states, I expect a welcome decline in opioid prescriptions and opioid-related complications (and deaths) among registered patients in Kentucky.
Drug Alcohol Depend. 2022 Nov 22;242:109710. doi:10.1016/j.drugalcdep.2022.109710.
https://www.kff.org/statedata/mental-health-and-substance-use-state-fact-sheets/kentucky/
Management Science Association, Inc., Impact of Cannabis on Opioid Prescriptions in Chronic Pain: Insights from Recent Research in Utah, 2024