Is legalized cannabis the answer to America’s opioid crisis? This provocative question is garnering significant attention from the team at Clinical Reference Laboratory (CRL) and could potentially impact the entire life insurance space. Dr. Steven J. Rigatti, a medical director at CRL, comments below with his thoughts on recent literature and previous CRL research, and how risk assessors should view the subject moving forward.
A recent study¹ in the Journal of the American Medical Association reviews the recent downward trend in life expectancy in America. Researchers identify that life expectancy increased from 1959 until 2011, plateauing until 2014, and declining thereafter. Much of this life expectancy decrease is due to an increase in certain specific causes of death during midlife (between ages 25 and 64). There were many such causes, including diabetes, hypertensive disorders, suicide, accidents, mental health disorder and alcoholic liver disease. However, the single cause of death with the greatest contribution to this trend was drug overdose. Public attention to this issue began to increase in the mid-2010s, but researchers found that the geometric increase in drug overdose deaths began around 1999. In percentage terms, the increase has been staggering. Between 1999 and 2017, the rate of drug overdose deaths increased by 531% among those age 25 to 34, 268% among those age 35 to 44, 351% among those age 45 to 54, and a massive 909% for those age 55 to 64. Far and away, the drugs most strongly associated with this increase in overdose deaths are opioids, both legal and illicit.
Even as this crisis was occurring, several American states moved toward less restrictive policies on the growth, possession and use of marijuana for medicinal or, in some cases, recreational purposes. Later, some research was published suggesting that, in states where medicinal marijuana was legalized, the death rates from opioid overdose fell. Specifically, a study² in JAMA Internal Medicine in 2014 analyzed the opioid overdose death rates in states that did and did not have medical marijuana laws, and it compared death rates before and after passage within the same state. They found a substantial decrease in death rates, on the order of 20%, in those states with passed medical marijuana laws, with larger decreases several years after passage.
…Some research was published suggesting that, in states where medicinal marijuana was legalized, the death rates from opioid overdose fell.”
Additional studies³ published in JAMA Internal Medicine in 2018 showed a decrease in Medicare and Medicaid prescriptions for opioids in states which implemented medical marijuana laws. The decrease was on the order of 6 to 8%, and was higher in those states which permitted marijuana dispensaries rather than just home cultivation.
The current state of research on this topic is covered by a 2019 meta-analysis⁴ published in the journal Injury Epidemiology. The authors report that the reductions in opioid prescriptions are modest, and that the effect on mortality is mostly restricted to states with dispensaries. So, while it is becoming clear that opioid overdose deaths and opioid prescription rates are somewhat lower in states allowing medicinal marijuana, it is going to take more than that to bring the death rates down to their pre-Millennial levels.
What This Means for Insurers
For insurers who utilize opioid testing in their underwriting, it would be premature to conclude that the rise of marijuana dispensaries will lead to a reversal of the decade-long trend of increasing opioid overdose deaths. Further, prior research at CRL has shown a slight increase in mortality among those who test positive for marijuana at the time of application compared to those who test negative.
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References
¹JAMA. 2019;322(20):1996–2016.
²JAMA Intern Med. 2014;174(10):1668–1673.
³JAMA Intern Med. 2018;178(5):679–680
⁴Inj Epidemiol. 2019; 6: 38.
About The Author
Dr. Steven J. Rigatti is a consulting medical director with Clinical Reference Laboratory, with 12 years’ experience in the life insurance industry. He is the current chair of the Mortality Committee of the American Academy of Life Insurance Medicine.