Clinical Scorecard: Impact of Prescription Opioid and Cannabis Regulation on Opioid Overdose Mortality Rates
At a Glance
Category
Detail
Condition
Opioid overdose mortality
Key Mechanisms
Prescription drug monitoring programs (PDMPs) with must-query mandates and legalization of medical and recreational cannabis supply
Target Population
United States counties affected by opioid overdose deaths from 2013-2020
Care Setting
Public health and policy regulation settings
Key Highlights
Must-query PDMPs were associated with a small increase in opioid-involved overdose deaths (0.8 additional deaths per 100,000 person-years).
Legal cannabis supply alone was not independently associated with changes in opioid overdose deaths during the study period.
Must-query PDMPs enacted alongside legal cannabis supply were associated with more opioid overdose deaths compared to must-query PDMPs without legal cannabis.
Guideline-Based Recommendations
Diagnosis
Use PDMP data to identify patients at risk of opioid use disorder or overdose.
Management
Implement must-query PDMPs requiring prescribers to check prescription histories before prescribing opioids.
Consider the potential unintended consequences of stricter opioid prescribing policies, including increased use of illicit opioids.
Monitoring & Follow-up
Monitor opioid prescribing patterns and overdose mortality rates following PDMP implementation.
Track changes in opioid overdose deaths in relation to cannabis legalization policies.
Risks
Stricter opioid prescribing regulations may inadvertently increase demand for illicit opioids such as heroin and synthetic opioids.
Cannabis legalization did not reduce opioid overdose deaths in the studied period and may not mitigate risks associated with PDMP policies.
Patient & Prescribing Data
Patients prescribed opioids in states with must-query PDMPs and varying cannabis legalization statuses
Must-query PDMPs can modify prescribing practices but may not reduce opioid overdose mortality; cannabis legalization does not independently reduce overdose deaths.
Clinical Best Practices
Incorporate PDMP checks as a standard practice before prescribing controlled substances to identify high-risk patients.
Be aware of the potential for increased illicit opioid use following stricter prescription regulations.
Consider alternative pain management strategies, though cannabis legalization alone has not demonstrated reduction in opioid overdose deaths.
Continuously evaluate the impact of opioid prescribing policies and cannabis laws on overdose mortality to inform policy adjustments.
by Magdalena Cerdá, Katherine Wheeler-Martin, Emilie Bruzelius, Christine M Mauro, Stephen Crystal, Corey S Davis, Samrachana Adhikari, Julian Santaella-Tenorio, Katherine M Keyes, Kara E Rudolph, Deborah Hasin, Silvia S Martins
