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The Pharming of Cannabis: Have We Not Learned the Lesson from the Overuse of Opioids?
opioid, 2023 Presentation Dr Berry
Marijuana Legalization and Opioid Deaths

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.

fatal, opioid, Fatalities, Medical, 2023 Presentation Dr Berry
Cannabis and the Gateway Drug Theory

Whilst the Gateway Theory, may give us further pause in our public health policy making, it should not be the key driver of such policy formulation. The drug, in and of itself, has way too many other community diminishing issues that warrant it being kept out of the permission, let alone promotion space. But be rest assured, cannabis use will not lessen drug use engagement and the mounting harms these practices bring, so any action that creates, enables or expands a ‘gateway’ to self and community harm inducing drug use should be called out for what it is, in both policy and practice.

gateway, pathway, Johnnys Ambassadors, opioid
Is marijuana use associated with decreased use of prescription opioids

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.

opioid, drivers, PubMed
Understanding Opioid Use Disorder (OUD) using tree-based classifiers

Machine learning can accurately predict adults at risk for OUD, and identify interactions among the factors that pronounce this risk. Curbing early initiation of marijuana may be an effective prevention strategy against opioid addiction, especially in high risk groups.

OUD, opioid
Reducing the risks of distortion in cannabis research

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 

Research, Medical, risks, opioid
Medical and non-medical cannabis use and risk of prescription opioid use disorder: Findings from propensity score matching.

Medical and non-medical cannabis use both were both associated with increased risks of prescription opioid misuse. Medical cannabis use, however, was not associated with prescription opioid use disorder, and non-medical cannabis was. There appeared to be differential associations between cannabis use and prescription opioid use disorder by cannabis use purpose.

Does Medical Cannabis Reduce Use of Prescription Opioids?

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).

olfson, opioid
Why Marijuana Will Not Fix the Opioid Epidemic

In 2017 Colorado had a record number of opioid overdose deaths from any opioid, including heroin and Colorado has had a medical marijuana program since 2001.
There are several reasons as to why any reported benefit will be outstripped by lack of benefit and increased risk of harm, and why cannabis is contributing to ongoing opioid use, and subsequently, the opioid epidemic.

  1. There is evidence in animal models showing adolescent rats exposed to THC will develop enhanced heroin self administration as adults which may be due to activation of mesolimbic transmission of dopamine by a common mu opioid receptor mechanism.,
  2. More than 90% of heroin users report a prior history of marijuana use compared to a prior history of painkiller use (47%).13
  3. Prospective twin studies demonstrated that early cannabis use was associated with an increased risk of other drug abuse. This particular study was conducted when the THC content was much lower than todays products which can reach 95% THC.
  4. Currently there is no widely available or accepted medical literature showing any benefit for pain with dispensary cannabis in common pain conditions. 

There is currently a large and growing body of evidence showing that cannabis use increases, rather than decreases non-medical prescription opioid use and opioid use disorder, based on followup of more than 33,000 people. Concurrent use of cannabis and opioids by patients with chronic pain appears to indicate a higher risk of opioid misuse. Closer monitoring for opioid-related aberrant behaviors is indicated in this group of patients and it suggests that cannabis use is a predictor of aberrant drug behaviors in patients receiving chronic opioid therapy.
There is sufficient and expanding evidence demonstrating that medical marijuana use will not curb the opioid epidemic. There is further evidence that marijuana is a companion drug rather than substitution drug and that marijuana use may be contributing to the opioid epidemic rather than improving it.

opioid, Finn, ncbi
increased risk of prescription opioid misuse

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.

DFAF: The Truth About Marijuana

pathway, heroin, opioid, video
Opioid Use During Pregnancy
opioid, Pregnancy, DFAF
More Coloradans died last year from drug overdoses than any year in the state’s history. That shows how the opioid epidemic is changing.

The preliminary figures show that 959 people died in Colorado last year from drug poisoning, a figure that includes both intentional and unintentional overdoses. In 2016, 912 people died. In 2000, for comparison, drug poisonings claimed fewer than 400 lives.

Recreational Cannabis Legalization and Opioid-Related Deaths in Colorado, 2000-2015

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.



opioid, Colorado
SAMHSA Head Stands Firm on Marijuana's Dangers Also says younger generation of providers is key to opioid fight

I'm here to tell you this is not a safe drug," McCance-Katz said during a town hall event at "NatCon18," the National Council for Behavioral Health's annual conference.
"Americans have a right to know that and we should be telling them that," she continued.
And while tobacco and alcohol rates have declined among pregnant women in recent years, illicit drugs -- mainly marijuana but also opioids -- have increased from 78,000 women in 2015 to 111,000 in 2016, she said.
On the contrary, "marijuana use was associated with substantially increased risk of addiction and overdose for opioids," she said, citing research from Mark Olfson, MD, MPH, and colleagues in the American Journal of Psychiatry.

McCance-Katz, SAMSHA, opioid
Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically

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.

opioid, study, Research
Big Marijuana moves to exploit the Opioid Epidemic

Marijuana use is associated with an increased risk of prescription opioid use.  
Marijuana use seems to strengthen the relationship between pain and depression and anxiety, not ease it.


Drug Free America, opioid

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

opioids, opioid
Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States



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

opioid, psychiatryonline
Treatment of acute cannabinoid overdose with naloxone infusion

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]

opioid, synergistic
Substance abuse rarely starts with opiate use on its own

We therefore must educate our youngsters, parents and educators before any use of marijuana or alcohol begins. We then must identify those individuals for whom marijuana or alcohol use has become problematic, getting them into an effective program of treatment before they progress to more dangerous alternatives.
Schools must revamp curriculums so children understand that any opioid misuse, be it prescription or street drugs, is a "red line" that they cannot cross.

School, opioid, opinion
Opioid crisis declaration by President Trump welcomed in Florida

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).

Benefits and Harms of Cannabis in Chronic Pain or Post-traumatic Stress Disorder: A Systematic Review

"We found no observational studies that met inclusion criteria, but a growing body of cross-sectional literature suggests negative opioid-related correlates among individuals who use cannabis and opioids concurrently. These include opioid misuse;9,10,99,133 a greater number of opioid refills;99 a longer duration of opioid use; a higher dose of opioid medication prescribed;9 and endorsement of using opioids and other pain medications without a prescription.134"

Veterans, opioid, study
Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States

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

psychiatryonline, opioid
Washington Poison Center Toxic Trends Report* 2016 Annual Opioid Report

The Washington Poison Center (WAPC) saw a slight increase in calls regarding opioid exposures in 2016 (n=1,696) compared to 2015 (n=1,672). Of the calls received, over 70% (n=1,199) of the exposures occurred in individuals 20 years of age or older.

2016, Washington, opioid
Mexican army faces uphill battle against opium poppies

"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.

opioid, Mexico
Cost of heroin epidemic tops $1 billion a year in Florida
heroin, Florida, opioid
SAM, opioid
Marijuana and Opioid Conncection
The Marijuana-Opioid Connection

Connection between legalization of marijuana and increase opioid addiction.
The effects of marijuana on the brain of an unborn child. Predisposing children for addiction. Here are the studies cited. 

Colorado, Pregnancy, opioid, video
Relationship between Nonmedical Prescription-Opioid Use and Heroin Use

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.

opioid, heroin
Number Using Opioids and Marijuana on the Rise

"We found support for the synergistic effect on an individual level; people who tend to use more marijuana also tend to use more opioids," said Scott Novak, PhD, senior research scientist at RTI International, a leading research institute in Research Triangle Park, North Carolina.
What's worrisome is that the positive association between cannabis and opioid use is growing stronger. The study found that over time, people were using these drugs more often; there were more opioids days and more cannabis days.

medscape, opioid, Studies, NSDUH
Today’s Heroin Epidemic Infographics

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.

CDC, Infographics, heroin, opioid
Marijuana and Opioid "Cross Talk" Risks for the Born, the Unborn
madras, Research, powerpoint, opioid, Pregnancy
Chart: Colorado among states with growing heroin, prescription drug abuse problem

"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

opioid, Colorado, legalization
Drug czar: Teen pot use could fuel opioid abuse
Teen, youth, opioid, abuse
Marijuana- 2014 Dr. Madras Presentation
madras, opioid, Pregnancy, youth, powerpoint, Brain
Cannabis Use during Adolescent Development: Susceptibility to Psychiatric Illness
adolescent, Psychiatric, addiction, Schizophrenia, opioid, Studies
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