The United States is currently experiencing what has commonly been referred to as the “worst drug epidemic in U.S. history.” As it stands today, the abuse of opioids, such as prescription opiates, heroin, and illegally manufactured fentanyl, is the leading cause of death for people under the age of 50 in the country. There are an estimated 115 deaths per day caused by opioid overdose with 16,000 deaths a year from prescription opioids alone.
In light of this, there has been a lot of talk surrounding the relationship with marijuana and opioids. The only firmly established relationship in the literature is one showing that marijuana use can often be a precursor to opioid use. It’s true that most people who use marijuana don’t go on to misusing opiates, but it’s also true that most people who misused opiates used marijuana first. But the for-profit pot industry wants to say something else. The pot industry is attempting to tout the legalization of marijuana as a solution for the opioid crisis, citing various medical studies. A new article published in the Journal of Addiction says that this conclusion is weak and premature.”

Top-Line Understanding:

• A recent study found that before 2009, the existence of legally protected pot dispensaries in a state correlates with a lower number of opiate deaths in that state.

• This correlation disappears after 2009. Authors interpret this as the “post-Ogden memo era” and surmise that pot dispensaries were more strictly controlled after 2009.

• The study does not control for naloxone distribution as a reason for a reduction in opiate mortality, and it is highly dubious to assume pot shops became less widespread and more controlled after 2009. Indeed, after 2009, pot shop regulations remained extremely lax, and the number of pot shops exploded in response to the industry protections in the Ogden memo.

• Multiple studies have shown no substitution between opiates and marijuana and no reduction in opiate use by those who also use marijuana. Studies also show a higher dosing of opiates/greater likelihood of opiate abuse in patients who also use cannabis.

It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis

Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Search for more papers by this author There is very weak evidence to support the claim that expanding access to medical cannabis will reduce opioid overdose deaths in the United States.


Conclusions:
• Beware of interpretations of the RAND study that claim it proves medical marijuana reduces opioid deaths; RAND will be debunking this presently.

• Population ecology studies like the RAND study need to be confirmed with studies of individual users; current individual user studies have the opposite conclusion.

• A study of over 34,000 individual marijuana users showed they were over 2 times more likely to abuse prescription opioids or initiate prescription opioid misuse

“[C]annabis use, even among adults with moderate to severe pain, was associated with a substantially increased risk of nonmedical prescription opioid use….” —The American Journal of Psychiatry (2017)