{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:30:14Z","timestamp":1788197414589,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T00:00:00Z","timestamp":1588809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008591","name":"Fahs-Beck Fund for Research and Experimentation","doi-asserted-by":"publisher","award":["2017-01"],"award-info":[{"award-number":["2017-01"]}],"id":[{"id":"10.13039\/100008591","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>There have been dynamic changes in prescription opioid use in the US but the state level policy factors contributing to these are incompletely understood. We examined the association between the legalization of recreational marijuana and prescription opioid distribution in Colorado. Utah and Maryland, two states that had not legalized recreational marijuana, were selected for comparison. Prescription data reported to the Drug Enforcement Administration for nine opioids used for pain (e.g., fentanyl, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone) and two primarily for opioid use disorder (OUD, methadone and buprenorphine) from 2007 to 2017 were evaluated. Analysis of the interval pre (2007\u20132012) versus post (2013\u20132017) marijuana legalization revealed statistically significant decreases for Colorado (P &lt; 0.05) and Maryland (P &lt; 0.01), but not Utah, for pain medications. There was a larger reduction from 2012 to 2017 in Colorado (\u201331.5%) than the other states (\u201314.2% to \u201323.5%). Colorado had a significantly greater decrease in codeine and oxymorphone than the comparison states. The most prevalent opioids by morphine equivalents were oxycodone and methadone. Due to rapid and pronounced changes in prescription opioid distribution over the past decade, additional study with more states is needed to determine whether cannabis policy was associated with reductions in opioids used for chronic pain.<\/jats:p>","DOI":"10.3390\/ijerph17093251","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T03:10:38Z","timestamp":1588821038000},"page":"3251","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Prescription Opioid Distribution after the Legalization of Recreational Marijuana in Colorado"],"prefix":"10.3390","volume":"17","author":[{"given":"Amalie K.","family":"Kropp Lopez","sequence":"first","affiliation":[{"name":"Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9035-5953","authenticated-orcid":false,"given":"Stephanie D.","family":"Nichols","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, University of New England, Portland, ME 04103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Y.","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth L.","family":"McCall","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, University of New England, Portland, ME 04103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2295-445X","authenticated-orcid":false,"given":"Brian J.","family":"Piper","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1111\/j.1525-1497.2006.00415.x","article-title":"Measuring pain as the 5th vital sign does not improve quality of pain management","volume":"21","author":"Mularski","year":"2006","journal-title":"J. General. Intern. Med."},{"key":"ref_2","unstructured":"Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, National Academies Press."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.amepre.2018.01.034","article-title":"Trends in medical use of opioids in the U.S., 2006\u20132016","volume":"54","author":"Piper","year":"2018","journal-title":"Am. J. Prev. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ypmed.2019.02.017","article-title":"Trends in the medical supply of fentanyl and fentanyl analogues: United States, 2006 to 2017","volume":"123","author":"Collins","year":"2019","journal-title":"Prev. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pashmineh, A.A.R., Cruz-Mullane, A., Podd, J.C., Lam, W., Kaleem, S.H., Lockard, L., Mandel, M., Chung, D.Y., Simoyan, O.M., and Davis, C.S. (2020). Rise and regional disparities in buprenorphine utilization in the United States. Pharm. Drug Saf., in press.","DOI":"10.1101\/19006163"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1097\/j.pain.0000000000001612","article-title":"The contribution of obesity to prescription opioid use in the United States","volume":"160","author":"Stokes","year":"2019","journal-title":"Pain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1111\/add.14741","article-title":"Prescription opioid availability and opioid overdose-related mortality rates in Medicaid expansion and non-expansion states","volume":"114","author":"Swartz","year":"2019","journal-title":"Addiction"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e6272","DOI":"10.7717\/peerj.6272","article-title":"Opioid distribution trends (2006\u20132017) in the US Territories","volume":"7","author":"Cabrera","year":"2019","journal-title":"PeerJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"967","DOI":"10.15585\/mmwr.mm6843a3","article-title":"Racial\/ethnic and age group differences in opioid and synthetic opioid\u2013involved overdose deaths among adults aged \u226518 years in metropolitan areas\u2014United States, 2015\u20132017","volume":"68","author":"Lippold","year":"2019","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_10","unstructured":"National Conference of State Legislatures (2020, March 07). Marijuana Overview: Legalization. Available online: http:\/\/www.ncsl.org\/research\/civil-and-criminal-justice\/marijuana-overview.aspx."},{"key":"ref_11","first-page":"785","article-title":"Medical cannabis for the treatment of chronic pain and other disorders: Misconceptions and facts","volume":"127","author":"Hill","year":"2017","journal-title":"Pol. Arch. Int. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1001\/jamainternmed.2014.4005","article-title":"Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999\u20132010","volume":"74","author":"Bachhuber","year":"2014","journal-title":"JAMA Int. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.2105\/AJPH.2017.304059","article-title":"Recreational cannabis legalization and opioid-related deaths in Colorado, 2000\u20132015","volume":"107","author":"Livingston","year":"2017","journal-title":"Am. J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"14764","DOI":"10.1523\/JNEUROSCI.4291-09.2009","article-title":"Cannabidiol, a nonpsychotropic component of cannabis, inhibits cue-induced heroin seeking and normalizes discrete mesolimbic neuronal disturbances","volume":"29","author":"Ren","year":"2009","journal-title":"J. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1001\/jamainternmed.2018.1007","article-title":"Association of medical and adult-use marijuana laws with opioid prescribing for Medicaid enrollees","volume":"178","author":"Wen","year":"2018","journal-title":"JAMA Int. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1377\/hlthaff.2016.1135","article-title":"Medical marijuana laws may be associated with a decline in the number of prescriptions for Medicaid enrollees","volume":"36","author":"Bradford","year":"2017","journal-title":"Health Aff."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1001\/jamainternmed.2018.0266","article-title":"Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population","volume":"178","author":"Bradford","year":"2018","journal-title":"JAMA Int. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1177\/0269881117699616","article-title":"Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep","volume":"31","author":"Piper","year":"2017","journal-title":"J. Psychopharm."},{"key":"ref_19","unstructured":"Anthony, J.C. (2006). The Epidemiology of Cannabis Dependence: Cannabis Dependence: Its Nature, Consequences and Treatment, Cambridge University Press."},{"key":"ref_20","unstructured":"Earleywine, M. (2002). Understanding Marijuana: A New Look at the Scientific Evidence, Oxford University Press."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.drugalcdep.2010.11.004","article-title":"Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)","volume":"115","author":"Hasin","year":"2011","journal-title":"Drug Alcohol. Depend."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hall, W.D., and Pacula, R.L. (2003). Cannabis Use and Dependence: Public Health and Public Policy, Cambridge University Press.","DOI":"10.1017\/CBO9780511470219"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e027117","DOI":"10.1136\/bmjopen-2018-027117","article-title":"Descriptive, observational study of pharmaceutical and non-pharmaceutical arrests, use, and overdoses in Maine","volume":"9","author":"Simpson","year":"2019","journal-title":"BMJ Open"},{"key":"ref_24","unstructured":"National Academies of Sciences, Engineering, and Medicine (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, The National Academies Press."},{"key":"ref_25","unstructured":"Hartig, H., Geiger, A., Hartig, H., and Geiger, A. (2019, April 21). 62% of Americans Favor Legalizing Marijuana. Available online: https:\/\/www.pewresearch.org\/fact-tank\/2018\/10\/08\/americans-supportmarijuana-legalization\/."},{"key":"ref_26","first-page":"1166","article-title":"The increasing use of cannabis among older Americans: A public health crisis or viable policy alternative?","volume":"57","author":"Kaskie","year":"2017","journal-title":"Gerontologist"},{"key":"ref_27","unstructured":"(2019, September 01). Amendments and Propositions on the 2012 Ballot. Available online: https:\/\/www.sos.state.co.us\/pubs\/elections\/Initiatives\/ballot\/contacts\/2018.html."},{"key":"ref_28","unstructured":"Ingold, J. (2020, March 07). World\u2019s First Legal Recreational Marijuana Sales Begin in Colorado. Available online: https:\/\/www.denverpost.com\/2014\/01\/01\/worlds-first-legal-recreational-marijuana-sales-begin-in-colorado\/."},{"key":"ref_29","unstructured":"Drug Enforcement Administration (2020, March 10). Automation of Reports and Consolidated Orders System (ARCOS), Available online: http:\/\/www.deadiversion.usdoj.gov\/arcos\/."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1093\/pm\/pnz159","article-title":"Opioid prescribing laws are not associated with short-term declines in prescription opioid distribution","volume":"21","author":"Davis","year":"2020","journal-title":"Pain Med."},{"key":"ref_31","unstructured":"U.S. Census Bureau QuickFacts: United States (2019, September 01). Census Bureau QuickFacts, Available online: https:\/\/www.census.gov\/quickfacts\/fact\/map\/US\/INC110217."},{"key":"ref_32","unstructured":"State of Childhood Obesity (2020, March 11). Adult Obesity Rates. Available online: https:\/\/stateofobesity.org\/adult-obesity\/."},{"key":"ref_33","unstructured":"Kaiser Family Foundation (2020, March 11). Health Insurance Coverage. Available online: https:\/\/www.kff.org\/other\/state-indicator\/adults-19-64\/?activeTab=map&currentTimeframe=0&selectedDistributions=uninsured&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D."},{"key":"ref_34","unstructured":"Kaiser Family Foundation (2020, March 11). Status of Action on Medicaid Expansion. Available online: https:\/\/www.kff.org\/health-reform\/state-indicator\/state-activity-around-expanding-medicaid-under-the-affordable-care-act\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/S0091-3057(98)00012-4","article-title":"The enhancement of morphine antinociception in mice by delta9-tetrahydrocannabinol","volume":"60","author":"Smith","year":"1998","journal-title":"Pharmacol. Biochem. Behav."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e8108","DOI":"10.7717\/peerj.8108","article-title":"Dynamic changes in prescription opioids from 2006 to 2017 in Texas","volume":"7","author":"Ighodaro","year":"2019","journal-title":"PeerJ"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"102273","DOI":"10.1016\/j.jhealeco.2019.102273","article-title":"The impact of cannabis access laws on opioid prescribing","volume":"69","author":"McMichael","year":"2020","journal-title":"J. Health Econ."},{"key":"ref_38","unstructured":"Centers for Disease Control and Prevention (CDC) (2005). Increase in poisoning deaths caused by non-illicit drugs--Utah, 1991\u20132003. MMWR Morb. Mortal. Wkly. Rep., 54, 33\u201336."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"453","DOI":"10.7326\/M17-1812","article-title":"Trends in U.S. Drug Overdose Deaths in non-Hispanic blacks, Hispanics, and non-Hispanic whites: 2000\u20132015","volume":"168","author":"Shiels","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_40","unstructured":"(2020, April 12). Initiative Measure No. 502, Available online: https:\/\/sos.wa.gov\/_assets\/elections\/initiatives\/i502.pdf."},{"key":"ref_41","unstructured":"(2020, April 12). Measure 91, Available online: https:\/\/www.oregon.gov\/olcc\/marijuana\/Documents\/Measure91.pdf."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/9\/3251\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:26:13Z","timestamp":1760174773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/9\/3251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,7]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["ijerph17093251"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17093251","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/702811","asserted-by":"object"}]},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,7]]}}}