opioid

These results indicate that legal medical marijuana, particularly when available through retail dispensaries, is associated with higher opioid mortality. The results for recreational marijuana, while less reliable, also suggest that retail sales through dispensaries are associated with greater death rates relative to the counterfactual of no legal cannabis.

CONCLUSIONS:
Drivers who test positive for marijuana are significantly more likely to test positive for prescription opioids. Longitudinal studies with rigorous designs and toxicological testing data are needed to further address the substitution hypothesis between marijuana and prescription opioids.

But  the  lives  of  vulnerable  people  may  be  put  at  risk when  science  is  distorted  for corporate  or  ideological  ends.  As  noted,  several  USstates  responded  to the  much-hypedoriginal study of cannabis and opioid overdosesby authorizing the use of medical cannabis to treat  heroin-addicted  individuals.  Advice  that  opioid  users  should use medical  cannabis toreplace  opioid  agonist  therapies  (e.g.,  methadone,  buprenorphine) poses significant  risk because abrupt cessation of these medications dramatically increases the risks of an overdose death if users return to opioid use 

Is the solution to the opioid epidemic as simple as the legalization of medical cannabis? Commenting on the Bachhuber et al. analysis (1), Finney et al. (4) cautioned that an ecological fallacy may be present—individuals using medical marijuana could have elevated overdose mortality rates even though there is a state-level reduction. They contended that a prospective study of individual pain patients was necessary to assess relationships between cannabis use, use of opioid medications, and other substance use (4).
 

New research suggests that marijuana users may be more likely than nonusers to misuse prescription opioids and develop prescription opioid use disorder. The study was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and Columbia University.

Note:  If you look at the blue bar you will see that opioid deaths have more than quadrupled since medical marijuana was legalized in Colorado (in 2000). And deaths rose from 377 in 2012 (year mj legalized) to 504 in 2016. No evidence that legal marijuana is helping in Colorado- if anything it could be contributing to making the opioid epidemic worse!

But the conclusion is not supported by data. This study and others that conclude marijuana helps fight the opioid crisis do not consider the many other strategies that have been implemented to fight opioid abuse, including the PDMP, treatment and Narcan. Nor is there any proof people are substituting marijuana for opioids. And this particular CO research (below) flies in the face of the actual data/ facts!

Opioid deaths in Colorado have increased based on the data from Colorado Public Health and Environment Dept.

Study's conclusion does not seem to match data.

Conclusions: Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use.

“The opioid crisis appears to be worsening where marijuana has been legalized.” - JAMA INTERNATIONAL MEDICINE JOURNAL, 2018

The overlapping endocannabinoid and endogenous opioid systems may explain this patient's response to therapy, and this synergistic relationship is discussed.
The endocannabinoid and endogenous opioid systems are syngergistic, which may explain the effect of naloxone in cannabis toxicity. Cannabinoid and opioid receptors belong to the rhodopsin subfamily of G-protein-coupled receptors which, when activated, reduce cellular levels of cyclic adenosine monophosphate (cAMP) by inhibiting adenylyl cyclase [8
Robledo P, Berrendero F, Ozaita A, et al. Advances in the field of cannabinoid–opioid cross-talk. Addict Biol. 2008;13:213–224. [Google Scholar]]. Both cannabinoid and opioid receptors are located primarily at presynaptic terminals, and their activation inhibits the release of several neurotransmitters. Opioid and cannabinoid receptor activation also modifies the permeability of sodium, potassium, and calcium channels [8Robledo P, Berrendero F, Ozaita A, et al. Advances in the field of cannabinoid–opioid cross-talk. Addict Biol. 2008;13:213–224. [Google Scholar]]. Receptors of both systems coexist in the central nervous system (CNS) with overlapping distribution in the brain, brainstem, and spinal cord [9Scavone JL, Sterling RC, Van Bockstaele EJ. Cannabinoid and opioid interactions: implications for opiate dependence and withdrawal. Neurosci. 2013;248:637–654. [Google Scholar]]. Cannabinoid and opioid receptors also co-localize in γ-Aminobutyric acid (GABA)ergic neurons with potential coupling to a second messenger systems and formation of heterodimers between the two receptors [11Pickel VM, Chan J, Kash TL, et al. Compartment-specific localization of cannabinoid 1 (CB1) and mu opioid receptors in rat nucleus accumbens. Neurosci. 2004;127:101–112. [Google Scholar]
].

The largest increases in opioid-related deaths in Florida from 2014 to 2015 were from the following drugs: Buprenorphine (up 102 percent), heroin (up 74 percent), fentanyl (up 69 percent), codeine (up 57 percent), and Oxymorphone (up 42 percent).

Cannabis use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.

"Every time we destroy a field ... the locals come back to plant after our personnel has left the area," said Colonel Cipriano Cruz Quiroz, chief of staff of a special narcotics eradication unit based in Badiraguato, Sinaloa state.
 

Furthermore, the study shows that people engaged in the non-medical use of prescription opioids rarely use heroin. Also, the transition to heroin for people abusing prescription opioids occurs at a lower rate than for others. The research indicates that the primary causes in the increase in heroin use and associated overdoses are lower market prices and higher purity for heroin.
 

Heroin use is part of a larger substance abuse problem.

Nearly all people who used heroin also used at least 1 other drug. Most used at least 3 other drugs.
Heroin is a highly addictive opioid drug with a high risk of overdose and death for users.
People who are addicted to…

Alcohol are 2 times more likely to become addicted to heroin.
Marijuana are 3 times more likely to become addicted to heroin.
Cocaine are 15 times more likely to become addicted to heroin..
Prescription opioid painkillers are 40 times more likely to become addicted to heroin.
SOURCE: National Survey on Drug Use and Health (NSDUH), 2011-2013.

"Marijuana is the 800-pound gorilla in the room, when in fact, 295 Coloradans died two years ago of prescription drug overdoses," he notes. 
In 2012, 36 drivers who tested positive for marijuana were involved in fatal car crashes, according the Colorado Department of Transportation. And 19-year-old Levy Thamba jumped to his death after consuming six times the recommended dose of a marijuana edible in April 2014