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Access to CBD Leads to Decrease in Opioid Prescriptions, Study Shows

A recent report published in the Southern Economic Journal on Oct. 26 found evidence that legal access to CBD has helped lead to a decrease in opioid prescriptions.

A study called “CBD as a cure-all? The impacts of state-level legalization of prescription cannabidiol (CBD) on opioid prescriptions,” was authored by economists associated with South Carolina-based Wofford College, and California State University Bakersfield. “We find that the ability to purchase CBD legally leads to 6.6% to 8.1% fewer opioid prescriptions,” the authors stated.

Researchers make it clear that it wasn’t just CBD legalization that led to opioid prescription reduction, but that of legal access to CBD products. “In general, we find that state level legalization of CBD products only leads to a statistically significant reduction in opioid prescriptions when states also allow for open and legal dispensaries, suggesting that adequate supply-side access is necessary to realize the potential benefits of legalization,” authors wrote.

The report stated that stores selling CBD help decrease opioid prescriptions by 3.5% just two years after legalization goes into effect. It’s not the same for every state though, as this statistic varied for states with stricter regulations on CBD sales, including the requirement that people provide their ID or submit their personal info to a registry. “…(i) state legalization of prescription CBD alone does not reduce opioid usage; (ii) regulations limited purchasing, such as ID laws, negate nearly all of the benefits of demand-side legalization; and (iii) supply-side access, either via interstate purchasing or legal and open dispensaries, are vital in using pain-management substances to fully combat the opioid epidemic.”

“Our paper provides important preliminary evidence that CBD may in fact reduce opioid prescription rates,” the authors said. “While CBD products may not necessarily be the cure-all they are marketed as, they do appear to be net substitutes for opioids.”

The authors examined individual state laws and regulations specifically focused on CBD, such as Iowa, Tennessee, and Texas, between 2010-2019. During that window, there was a significant shift in CBD as an accepted and mainstream product. “Although the fastest growing segment of the CBD market is over-the-counter [OTC] usage, the vast majority of states that have established industrial hemp programs did not do so until 2016, meaning that OTC CBD products were largely unavailable until later in our study period.”

They also examined Centers for Disease Control and Prevention (CDC) data for opioid prescriptions on a county level, but noted that it suggests “…that further research on the impacts of CBD is warranted.”

The 2018 Farm Bill transformed the hemp industry in the U.S. Prior to the passage of the bill though, access was more limited. As time passed, states such as Tennessee decided to permit legal importation of CBD products from outside the state in 2016.

The authors explained that while opioid prescriptions were reduced in those CBD-only states, the states that also allowed medical marijuana laws (MMLs) and/or recreational marijuana laws (RMLs) still made more of an impact on opioid prescription reduction. “Compared to states with no legal usage of marijuana, those who have adopted MMLs or RMLs prescribe fewer opioids per 100 population. However, these areas tend to be healthier and have more doctors, suggesting it is possible difference in opioid usage rates are not due to the presence of legal marijuana.”

A state with a variety of CBD-only dispensaries appears to lead to the most significant drops in opioid prescriptions though. “Importantly, we see that [states with] CBD laws have lower opioid prescribing rates than states with no laws, though still higher than in states with MMLs or RMLs,” However, when we look at states that have allowed CBD dispensaries, we see that opioid prescribing rates are lower than those found in states with MMLs or RMLs, even with similar objective health measures (obesity and diabetes) to states with CBD laws.”

Medical cannabis states experienced a 35% decrease in opioid prescriptions, but states that have not yet legalized still saw a decrease of 33%.

Researchers concluded that their study is just a glimpse into the positive benefits of CBD and its effect on opioid prescriptions. “While further work is needed to understand the degree to which our results are generalizable to the over-the-counter market for CBD, our results suggest policy makers should consider the costs of regulation and carefully balance the tradeoffs between ensuring the quality of and restricting access to CBD,” authors said in their conclusion.

In 2020, a former Drug Enforcement Administration (DEA) agent, Anthony Armour, who tried to swap opioids with CBD was fired from his position. Most recently in September 2023, the DEA defended its decision to fire the individual. “Mr. Armour argues that he ‘displayed negligence or poor decision-making,’ and DEA properly held him accountable for his poor decisions when they resulted in a verified positive drug test. DEA lost trust in Mr. Armour and properly removed him.”

Separately, the DEA is currently considering recommendations from the Department of Health and Human Services. It’s uncertain if the agency will move forward to reschedule cannabis into a less restrictive category that shows medical value of the plant.

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