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 2001.6
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.
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There is evidence in animal models showing adolescent rats exposed to THC will develop enhanced heroin self administration as adults11 which may be due to activation of mesolimbic transmission of dopamine by a common mu opioid receptor mechanism.11,12
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More than 90% of heroin users report a prior history of marijuana use compared to a prior history of painkiller use (47%).13
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Prospective twin studies demonstrated that early cannabis use was associated with an increased risk of other drug abuse.14 This particular study was conducted when the THC content was much lower than todays products which can reach 95% THC.
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Currently there is no widely available or accepted medical literature showing any benefit for pain with dispensary cannabis in common pain conditions.17
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.19 Concurrent use of cannabis and opioids by patients with chronic pain appears to indicate a higher risk of opioid misuse.20 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.
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