Impact of Prescription Opioid and Cannabis Regulation on Opioid Overdose Mortality Rates

Overview

This study analyzed U.S. county-level data from 2013-2020 to assess the effects of must-query prescription drug monitoring programs (PDMPs) and legal cannabis supply on opioid overdose deaths. Results showed that must-query PDMPs were associated with a slight increase in opioid overdose mortality, while legal cannabis supply alone was not linked to reduced overdose deaths. Furthermore, must-query PDMPs combined with legal cannabis access did not reduce opioid overdose mortality rates.

Background

Opioid overdose deaths in the United States reached record highs in 2022, with prescription opioids contributing to a significant proportion of fatalities. Prescription drug monitoring programs (PDMPs) have been widely implemented to regulate opioid prescribing and reduce misuse. Must-query PDMPs require prescribers to check prescription histories before prescribing controlled substances and have been considered more effective. Cannabis legalization has been proposed as a potential alternative for pain management that might reduce opioid use and related harms, but evidence on its impact on opioid overdose mortality remains mixed.

Data Highlights

Key Findings

• Must-query PDMPs were independently associated with an average increase of 0.8 opioid-involved overdose deaths per 100,000 person-years.
• Legalization of medical or recreational cannabis supply was not independently associated with changes in opioid overdose mortality during 2013-2020.
• Counties with must-query PDMPs enacted alongside legal cannabis supply experienced 0.7 more opioid overdose deaths per 100,000 person-years compared to must-query PDMPs without legal cannabis.
• Stricter opioid prescribing policies did not reduce overdose deaths in a period dominated by nonprescribed opioid overdoses.
• The presence of legal cannabis supply did not mitigate the unintended consequences of PDMPs on opioid overdose mortality.

Clinical Implications

Clinicians should recognize that mandatory PDMP checks alone may not reduce opioid overdose deaths and may be associated with unintended increases in mortality, potentially due to shifts toward illicit opioid use. Cannabis legalization, while promising as an alternative for pain management, did not demonstrate a protective effect on opioid overdose mortality in this period. Comprehensive strategies beyond PDMP mandates and cannabis access are needed to effectively address opioid overdose mortality.

Conclusion

In the context of rising opioid overdose deaths driven largely by illicit opioids, must-query PDMPs and expanded legal cannabis supply were not associated with reductions in opioid overdose mortality. These findings highlight the complexity of opioid overdose prevention and the need for multifaceted approaches.

References

1. Horwitz et al 2024 -- Impact of Prescription Opioid and Cannabis Regulation on Opioid Overdose Mortality Rates