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Implications of prescription drug monitoring and medical cannabis legislation on opioid overdose mortality

Elyse Phillips, MPH, Julie Gazmararian, PhD, MPH


Objectives: To determine whether specific state legislation has an effect on opioid overdose mortality rates compared to states without those types of legislation.

 Design: Ecological study estimating opioid-related mortality in states with and without a prescription drug monitoring program (PDMP) and/or medical cannabis legislation.

Setting and participants: Opioid-related mortality rates for 50 states and Washington DC from 2011 to 2014 were obtained from CDC WONDER. PDMP data were obtained from the National Alliance for Model State Drug Laws, and data on medical cannabis legislation from the National Organization for the Reform of Marijuana Laws.

Main outcomes and measures: The relationship between PDMPs with mandatory access provisions, medical cannabis legislation, and opioid-related mortality rates.

Methods: Multivariate repeated measures analysis performed with software and services.

Results: Medical cannabis laws were associated with an increase of 21.7 percent in mean age-adjusted opioid-related mortality (p < 0.0001). PDMPs were associated with an increase of 11.4 percent in mean age-adjusted opioid-related mortality (p = 0.005). For every additional year since enactment, mean age-adjusted opioid-related mortality rate increased by 1.7 percent in states with medical cannabis (p = 0.049) and 5.8 percent for states with a PDMP (p = 0.005). Interaction between both types of legislation produced a borderline significant decrease of 10.1 percent (p = 0.055). For every year states had both types of legislation, interaction resulted in a 0.6 percent decrease in rate (p = 0.013).

Conclusion: When combined with the availability of medical cannabis as an alternative analgesic therapy, PDMPs may be more effective at decreasing opioid-related mortality.


prescription drug monitoring, opioids, opioid overdose, medical cannabis

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Home and Recreational Safety: Prescription Drug Overdose in the United States: Fact Sheet. Available at Accessed January 24, 2016.

Behavioral Health Coordinating Committee, Prescription Drug Abuse Subcommittee: Addressing Prescription Drug Abuse in the United States: Current Activities and Future Opportunities. Washington, DC: U.S. Department of Health and Human Services.

Gudoski AJ: Prescription Drug Monitoring Programs: Combating prescription drug misuse. Nurse Pract. 2015; 40(11): 28-33.

Legal Medical Marijuana States and DC: Laws, Fees, and Possession Limits. Available at Accessed June 5, 2017.

Koppel BS, Brust JC, Fife T, et al.: Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the guideline development subcommittee of the American Academy of Neurology. Neurology. 2014; 82(17): 1556-1563.

Cohen SP: Cannabinoids for chronic pain. BMJ. 2008; 336(7637): 167-168.

Elikottil J, Gupta P, Gupta K: The analgesic potential of cannabinoids. J Opioid Manage. 2009; 5(6): 341-357.

Lynch ME, Campbell F: Cannabinoids for treatment of chronic non-cancer pain: A systematic review of randomized trials. Br J Clin Pharmacol. 2011; 72(5): 735-744.

Zhang MW, Ho RCM: The cannabis dilemma: A review of its associated risks and clinical efficacy. J Addict. 2015; 2015: 707596.

Carter GT, Javaher SP, Nguyen MH, et al.: Re-branding cannabis: The next generation of chronic pain medicine? Pain Manag. 2015; 5(1): 13-21.

Desroches J, Beaulieu P: Opioids and cannabinoids interactions: Involvement in pain management. Curr Drug Targets. 2010; 11(4): 462-473.

Degenhardt L, Lintzeris N, Campbell G, et al.: Experience of adjunctive cannabis use for chronic non-cancer pain: Findings from the pain and opioids IN treatment (POINT) study. Drug Alcohol Depend. 2015; 147: 144-150.

Haffajee RL, Jena AB, Weiner SG: Mandatory use of prescription drug monitoring programs. JAMA. 2015; 313(9): 891-892.

National Alliance for Model State Drug Laws: States that Require Prescribers and/or Dispensers to Access PMP Database in Certain Circumstances. Charlottesville, VA: National Alliance for Model State Drug Laws, 2015.

Executive Office of the President of the United States: Epidemic: Responding to America's Prescritiption Drug Abuse Crisis. Washington, DC: Executive Office of the President of the United States, 2011.

Gonzalez AM, 3rd, Kolbasovsky A: Impact of a managed controlled-opioid prescription monitoring program on care coordination. Am J Manag Care. 2012; 18(9): 516-524.

Green SL, Pfenning S: Optimizing the use of state prescription drug monitoring programs for public safety. J Nurs Regul. 2015; 6(3): 4-10.

Centers for Disease Control and Prevention, National Center for Health Statistics: Multiple Cause of Death 1999-2014 on CDC WONDER Online Database. 2015. Available at Accessed January 17, 2016.

NORML: State Laws. Available at Accessed June 5, 2017.

United States Census Bureau: 2010 Census Urban and Rural Classification and Urban Area Criteria. Washington, DC: United States Census Bureau, 2010.

U.S. Census Bureau: 2014 American Community Survey 1-Year Estimates, Table R1810; generated by Elyse Phillips; Using American FactFinder. Available at Accessed February 19, 2016.

U.S. Census Bureau: 2014 American Community Survey 1-Year Estimates, Table S1501; generated by Elyse Phillips; Using American FactFinder. Available at Accessed January 19, 2016.

Bureau of Labor Statistics: Local Area Unemployment Statistics. Available at Accessed January 20, 2016.

Department of Health and Human Services, Centers for Disease Control and Prevention: New Research Reveals the Trends and Risk Factors Behind America's Growing Heroin Epidemic: Heroin Use Seen Increasingly in Most Demographic Groups. Department of Health and Human Services; Centers for Disease Control and Prevention, July 7, 2015.

Garcia AM: State laws regulating prescribing of controlled substances: Balancing the public health problems of chronic pain and prescription painkiller abuse and overdose. J Law, Med Ethics. 2013; 41(s1): 42-45.

Lewis DA, Park JN, Vail L, et al.: Evaluation of the overdose education and naloxone distribution program of the Baltimore student harm reduction coalition. Am J Public Health 2016; 106(7): 1243-1246.

Naloxone Overdose Prevention Laws: Available at Accessed February 5, 2017.

Bachhuber MA, Saloner B, Cunningham CO, et al.: Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA. 2014; 174(10): 1668-1673.

Kandra KL, McCullough A, Ranney L, et al.: North Carolina health professionals' communication with adolescents about smoking. N C Med J. 2013; 74(3): 193-199.

Davis CS, Pierce M, Dasgupta N: Evolution and convergence of state laws governing controlled substance prescription monitoring programs, 1998-2011. Am J Public Health. 2014; 104(8): 1389-1395.



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