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Lower codeine prescription demand in legal cannabis states

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Finding is ‘potentially promising from a public health perspective’

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There is a substantial, and promising, reduction in pharmacy-based codeine distribution in U.S. states that have green lit recreational cannabis, suggests a new study.

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Specifically, researchers from the University of Pittsburgh and Cornell University write in the peer-reviewed study, published this week in Health Economics, that there was a 26 per cent reduction in pharmacy-based codeine distribution after state legalization of adult-use cannabis and a 37 per cent drop after the law had been in place for four years.

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Investigators further discovered there was minimal impact on distribution of other opioids in any setting, as well as minimal impact on codeine distribution by hospitals, which often have less permissive policies than pharmacies, notes a statement on study findings.

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Researchers reached their conclusions after analyzing data from the U.S. Drug Enforcement Administration’s (DEA) Automation of Reports and Consolidation Orders System, which tracks the flow of controlled substances in the U.S. They considered legalization’s impacts on prescription opioid dispensing across all payers and endpoints, including pharmacies, hospitals and other distributors.

“Among prescription opioids, codeine is particularly likely to be used non-medically,” study authors write. “Thus, the finding that RCLs (recreational cannabis laws) appear to reduce codeine dispensing is potentially promising from a public health perspective,” they maintain.

Prescription opioids contribute to more than 10,000 overdose deaths each year, the study statement notes.

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“A reduction in the misuse of opioids can save lives,” contends lead author Shyam Raman, a doctoral candidate in Cornell’s Jeb E. Brooks School of Public Policy. Citing the substantial decrease in opioid shipments to pharmacies, Raman characterizes this “an overlooked potential benefit to legalizing recreational cannabis use.”

Investigators point out that codeine is an opioid with a high potential for misuse. “Our findings suggest recreational cannabis use may be a substitute for codeine misuse,” senior author Coleman Drake, Ph.D., and assistant professor of health policy and management at Pitt’s School of Public Health, says in the statement.

“While all substances have some risks, cannabis use is arguably less harmful to health than the non-medical use of prescription opioids,” adds Johanna Catherine Maclean, Ph.D. of George Mason University.

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“Codeine use often starts out innocently, with a prescription for a codeine-based cough syrup, reports Addiction Center.

But because codeine is less regulated than some opiates considered to be more dangerous, such as morphine and oxycontin, “getting and abusing it is relatively easy. This is despite codeine being very similar chemically to drugs such as morphine and hydrocodone. Though less potent, codeine provides effects similar to morphine,” the centre notes.

The DEA classifies codeine as a Schedule III substance, provided a medication contains no more than 90 milligrams, meaning it has “a moderate to low potential for physical and psychological dependence.”

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