Cannabis has been used for thousands of years for a variety of reported medical purposes. While the data on cannabis use in medical conditions is well studied, however, its benefit remains unproven and conflicting.
Myths vs Facts
At the basic science level, there is evidence suggesting cannabinoids may have pain-relieving qualities, as they are found on the same nerves that transmit pain signals and they interact with similar chemicals that transmit pain., The most common reason stated by people consuming cannabis for medical purposes is “pain.” (Figure 1) 1. One of the reasons used to legalize is that cannabis would be a safer alternative to opioids and will curb the opioid and overdose epidemic.
Medical providers have become more sensitized to the opioid crisis and in turn, the number of prescriptions has decreased over time (Figure 2) 2. The use of naloxone, the antidote for opioid overdose, has also increased significantly, likely saving thousands of lives each year.
Unfortunately, the number of overdose deaths has reached ever-higher numbers over the last several years, strongly correlating with more states legalizing cannabis use.
Colorado: A Failed Experiment
For example, Colorado legalized marijuana for medical purposes in 2000 with Amendment 20 and implemented in 2001. Nearly 90% of medical marijuana patients have “severe pain” as their qualifying condition. The number of overdose deaths has continued to reach new levels every year, despite the case made that legalizing marijuana would help.(Figure 3) 3 . Furthermore, overdose deaths from other companion drugs, such as methamphetamine and cocaine, have also risen in all states with cannabis programs. Fentanyl has become a national threat to public health and safety and more education in this space is ongoing and expanding yet fails to include the known link to cannabis use, particularly early onset use. Fentanyl overdose death rates are higher in marijuana states compared to non-marijuana states (Figure 4) 4.
Debunking the Myth
Summarizing some of the medical literature, the National Academies Press in 2017 issued a comprehensive report suggesting there is moderate evidence that cannabis is an eﬀective painkiller. Within the details of that report, the products studied to that date were either synthetic derivatives (dronabinol or nabilone) or products not available in the United States (nabiximols), not medical dispensary cannabis5. Since then, there has been sufficient data to rebut that theory showing that there is a nearly 23% increase in opioid overdose deaths in medical marijuana states6. More recent data strongly suggests the expanding legal access to cannabis is contributing to our opioid epidemic7.
The tight relationship between cannabinoids and opioids is becoming more clear. The number one risk factor for adolescent opioid misuse is having ever used marijuana8. Adolescents who start using cannabis at a younger age (12-17 years old) have nearly twice the addiction rate to opioids 3 years later in the same age group9 and adolescents who misuse opioids are higher risk of self-harm or suicidal behavior10. Currently marijuana is the most prevalent substance found in completed teen suicide in Colorado (Figure 5).
The number one predictor of adult opioid misuse is having used marijuana before the age of 1811. Adults who use cannabis are more likely to develop opioid use disorder or misuse their prescription opioids 3 years later compared to those who do not use cannabis. (OLFSON). Furthermore, acquiring a medical marijuana card increases the risk of developing cannabis use disorder and has no impact on pain severity12. The National Survey of Drug Use and Health, 2020, showed that past-year marijuana use was significantly associated with increased odds of opioid dependence and past-year opioid misuse13.
The Public Health Effects of Cannabis are Counterproductive
It is apparent that expansion of cannabis programs is contributing to our national opioid and poly-drug overdose death crisis and has had no overall impact as an opioid substitute. It is critical that state and national leaders use science to guide policy in the cannabis space, rather than public opinion.
By Kenneth Finn, MD
- Pratt, , Stevens, A., Thuku, M. et al. Benefits and harms of medical cannabis: a scoping review of systematic reviews. Syst Rev 8, 320 (2019)
- 2021 OVERDOSE EPIDEMIC REPORT: Physicians’ actions to help end the nation’s drug- related overdose and death epidemic —and what still needs to be done; https://m365- emarketing-uploads.s3.amazonaws.com/images/trial_4d789c7ac246ab97/AMA-2021- Overdose-Epidemic-Report_92021.pdf
- Colorado Department of Public Health and Environment, State Unintentional Drug Overdose Reporting System; https://cdphe.colorado.gov/center-for-health-and- environmental-data/registries-and-vital-statistics/state-unintentional-drug
- Archie Bleyer, Brian Barnes, Kenneth Finn; United States marijuana legalization and opioid mortality epidemic during 2010–2020 and pandemic implications; Journal of the National Medical Association; Volume 114, Issue 4; 2022; Pages 412-425
- National Academies of Sciences, Engineering, and Medicine; Health Eﬀects of Cannabis and Cannabinoids: the Current State of the Evidence and Recommendations for Research; 2017; https://nap.nationalacademies.org/catalog/24625/the-health-eﬀects-of-cannabis- and-cannabinoids-the-current-state
- Chelsea L. Shovera,1, Corey S. Davisb, Sanford C. Gordonc, and Keith Humphreys; Association between medical cannabis laws and opioid overdose mortality has reversed over time; 2019; PNAS
- Neil Mathur, Christopher J. Ruhm, Marijuana legalization and opioid deaths, Journal of Health Economics, Volume 88, 2023
- Centers for Disease Control and Prevention; Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students — Youth Risk Behavior Survey, United States, 2019; Supplements / August 21, 2020 / 69(1);38–46
- Volkow ND, Han B, Einstein EB, Compton Prevalence of Substance Use Disorders by Time Since First Substance Use Among Young People in the US. JAMA Pediatr. 2021 Jun 1;175(6):640-643
- Fontanella CA, Steelesmith DL, Brock G, Bridge JA, Campo JV, Fristad Association of Cannabis Use With Self-harm and Mortality Risk Among Youths With Mood Disorders. JAMA Pediatr. 2021;175(4):377–384.
- Adway Wadekar; Understanding Opioid Use Disorder (OUD) using tree-based classifiers; Drug and Alcohol Dependence; Volume 208; 2020
- Gilman JM, Schuster RM, Potter KW, Schmitt W, Wheeler G, Pachas GN, Hickey S, Cooke ME, Dechert A, Plummer R, Tervo-Clemmens B, Schoenfeld DA, Evins Eﬀect of Medical Marijuana Card Ownership on Pain, Insomnia, and Aﬀective Disorder Symptoms in Adults: A Randomized Clinical Trial. JAMA Netw Open. 2022 Mar 1;5(3):e222106.
- XMajed M. Ramadan, Jim E. Banta, Khaled Bahjri & Susanne B. Montgomery (2020) Marijuana users are likely to report opioid misuse among adults over 50 years in representative sample of the United States (2002–2014), Journal of Addictive Diseases, 39:1, 66-73