Interesting JAMA article by Emergency Physician Esther Choo regarding the likely transition of opiate use/abuse to marjiuana use/abuse.
With the current nationwide epidemic of opioid abuse, dependence, and fatalities, clinicians are being asked by federal agencies and professional societies to control their prescribing of narcotic medications for pain. Federal guidelines emphasize tapering, discontinuing, and limiting initiation of these drugs except in provision of end-of-life care.1 Reducing reliance on opioids, however, is a massive task. According to one estimate, more than 650 000 opioid prescriptions are dispensed each day in the United States.2 Unless the nation develops an increased tolerance to chronic pain, reduction in opioid prescribing leaves a vacuum that will be filled with other therapies.Enter cannabis. As of August 2016, the District of Columbia and 25 states have legalized cannabis for medical use. Recreational use of cannabis has been legalized in 4 of these states and Washington, DC, and like initiatives are pending in other states.3 The mandated transition to limit use of opioids, paired with the current climate around liberalizing cannabis, may lead to patients’ formal and informal substitution of cannabis for opioids. Observational studies have found that state legalization of cannabis is associated with a decrease in opioid addiction and opioid-related overdose deaths