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Meta analysis seeks to strengthen argument for cannabis in harm reduction

Photo credit: Scott Graham on Unsplash

When speaking directly to frontline harm reduction workers, there is no question that cannabis is an effective and safe tool for addiction treatment, pain management, and the substitution of substances baring extremely fatal wakes.

Whether an injection site supervisor or an operator of a substitution program, there are hundreds of individuals with stories of those who, when at their wit’s end with the purported solutions of the medical system, found relief in the plant. And while testimony from these workers is profoundly moving and plays an important role in courtrooms and council chambers, I have witnessed firsthand Vancouver city councillors tell these individuals their work is illegal, unsafe, and lacking evidence.

Though Canadian legalization is often lauded for “freeing the weed”, municipalities have been slow in changing bylaws to support non-profits working to get cannabis in the hands of vulnerable populations. To garner political support and ultimately change regulations at the city level, hard data is the most convincing stigma buster. A recent meta analysis focusing on cannabis and opioid-related harms aims to bolster the debate for cannabis substitution.

Authored by Isabella MacMillan and social work professor Kevin Gorey of the University of Windsor, the analysis scraped numerous scientific and scholarly databases published from January 1, 2010 to January 1, 2020. They compiled and reviewed 11 longitudinal studies conducted in Canada and the United States observing opioid-related outcomes before and after legalization.

The goal was to answer the question: “Are there significantly fewer opioid-related harms, morbid and mortal, in states and provinces that have legalized marijuana, ostensibly, where cannabis products are more readily available?”

All save for one of the primary studies supported their cannabis protection hypothesis, observing clear associations with a significant reduction in opioid-related harms post-legalization.

Overall, risks associated with opioid use diminished by seven per cent and 35 per cent after subsequent recreational cannabis legalization. Prescriptions, which nearly doubled throughout the U.S. in just 10 years and have continued to increase since, decreased by eight per cent. It also reports an overall 25 per cent drop in opioid overdose mortality in Canada, further diminished after recreational marijuana was legalized.

Additionally, opioid-related motor vehicle accident fatalities observed a 21 per cent reduction overall, and an astounding 50 per cent decline among drivers aged 21 to 40. Hospitalizations related to opioid dependence or abuse decreased by 23 per cent, and the outcome included evidence to suggest a decrease in related suicides and homicides.

The analysis also addressed the uptick in consumption of cannabis post legalization, adding, “any in-kind harms due to the more prevalent use of marijuana seem minuscule… For example, only a one per cent increase in marijuana-dependent hospitalizations were observed in Colorado after legalization.”

This meta-analytic study sampled populations such as medicare enrollees and “general population adults”, and further suggests the outcome may underestimate the positive impact access and decriminalization could have on the “more vulnerable populations who may stand to benefit most from cannabis substitutions.”

The report reads: “Given the commonness of opioid prescribing in North America as well as the horrible consequent loss of life due to opioid-related overdoses, such holds the promise of saving hundreds of thousands of lives over the next generation.”

The study, in preprint status, was submitted in April and is currently awaiting peer review for Harm Reduction Journal.

This article is available under a Canadian Creative Commons licence.