American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Cannabis Legalization Does Not Influence Patient Compliance with Opioid Therapy

Prescription opioid use and opioid related deaths continue to increase nationwide. Several states have adopted legislation allowing for recreational use of cannabis. Little is known about how recreational cannabis laws impact compliance in chronic pain patients who have been prescribed opioid therapy. The goals of this study were to (1) retrospectively assess the effect of cannabis use on compliance with opioid therapy in a high-risk patient population and (2) determine the impact of legalization of recreational cannabis on patients prescribed therapeutic opioids.


We conducted a retrospective cohort study on results from a “high-risk” urine drug testing panel. Results from 1 year before and 1 year after initiation of recreational cannabis legislation were analyzed. This testing panel included qualitative assays for cannabinoids and 9 other common drugs of abuse in addition to a quantitative LC-MS/MS assay for 23 different opioids and metabolites. Opioid compliance was assigned by reviewing pathologists’ interpretations.


In the pre-legalization period, 1776 panels were performed, and in the post-legalization, 1648 panels were performed. An increase (6%) in the rate of positive cannabinoids screening results was observed after legalization of recreational cannabis; however, the overall compliance rate was consistent.


The results of this study suggest that legalization of recreational cannabis does not affect compliance rate in patients treated with opioid therapy for chronic pain.

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– Sheng-Ying Lo, PhDa,1, Gabrielle N. Winston-McPherson, PhDa,1, Amy J. Starosta, PhDb, Mark D. Sullivan, MDc, Geoffrey S. Baird, MD, PhDa, Andrew N. Hoofnagle, MD, PhDa, Dina N. Greene, PhDa

-This article originally appeared in the March issue of The American Journal of Medicine.

-To watch a video commentary from Dr. Alpert on this topic, please follow this link.

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