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Latest Research Shows Cannabis Legalization May Help Prevent Opioid Overdoses, But Only Temporarily

Cannabis legalization seems to help prevent opioid overdoses and other opioid-related health harms—but only temporarily.

Professor Coleman Drake from the Pitt Public Health Department of Health Policy and Management at the University of Pittsburgh is the lead author of a peer-reviewed study published last month in the journal Health Economics, comparing opioid-related ER visits in states with legal recreational cannabis against those in prohibition states. 

Drake and his colleagues found that states in which recreational cannabis was legalized saw a 7.6 percent decline in opioid-related visits to hospital emergency rooms, especially among 25- to 44-year-olds and men.

That cohort didn’t surprise Drake and his team, who cited research showing legalization is associated with increased cannabis consumption by men and people aged 25 to 44. However, they’re not sure the increased sales are taking place on the legal market. 

The Relationship Between Cannabis Legalization and Opioids

While Drake acknowledges there are some people for whom cannabis prohibition had a deterrent effect but now see incentive in buying cannabis without legal risk, he points to another means by which legalization leads to increased consumption of cannabis.

“When a product is legalized,” Drake explains, “it reduces the price of illegal cannabis. In that sense, we’ve seen a number of states where legal vendors lower the price of their stuff so people aren’t tempted to go to the legal dispensary where it costs you $50 or $60 to buy an eighth—they’ll sell it to you for $20 or $30.”

Drake and his team began their research considering what economists call “substitute and complement”: they wished to consider the effects of a new substance being allowed into legal markets and chart how that effects other substances.

“In our case we were interested in opioids,” Drake tells Cannabis Health. “Does having cannabis as something you can consume legally change whether people consume opioids?”

How Cannabis Affects Withdrawal And Pain Management

To start, Drake and his co-authors considered two facts about cannabis: it has potential in mitigating withdrawal symptoms, and it can be a substitute in pain management. 

“Cannabis provides pain relief properties, and we think people demand opioids because of their pain-relieving properties,” Drake says. “At least, that’s why a lot of people start [taking them], whether through their doctor or through illicit markets.”

Drake and his team crunched data on opioid-related ER visits from 29 states, including California, Maine, Massachusetts, and Nevada, which legalized cannabis for adult use between 2011 and 2018, while data from the remaining 25 prohibition states was used as a control. The reduction in visits was consistent across the four rec-legal states, compared with states where adult-use cannabis remained illegal—except the decline in ER visits only lasted for about six months.

“Then it starts to dissipate,” he says. “Why does this effect go away?”

A new study shows that while cannabis legalization seems to help prevent opioid overdoses and other opioid-related health harm, the effect is only temporary.

Decline in Overdoses and ER Visits Temporary

Drake and his team suggest a possible explanation: many of those with opioid use disorder begin consuming opioids in order to manage pain. Those seeking to end their use may try cannabis for the pain that led them to opioids, and discover it’s effective.

“Cannabis is a legitimate form of pain relief, so maybe that works,” Drake suggests. 

“But what we’re afraid might be happening—this is pure speculation based on what we know in the literature—is that the pain is treated, but the person still has a craving for opioids. Cannabis helps with withdrawal, but it still doesn’t fundamentally address the craving. That’s where people need medications for opioid use disorder, like buprenorphine or methadone. That’s the stuff that helps control [cravings], and cannabis doesn’t provide that.”

Drake concludes the study suggests, simultaneously, that cannabis is genuinely helpful, but it’s also not a panacea, particularly not for opioid use disorder.

“It’ll be interesting to see as more states [legalize] and we have more data in the future,” Drake says. “We’ll also see things over long time periods, so we’re not sure how that relationship is going to evolve.” 

In particular, he looks forward to studies on patients who are using opioid agonist medications like buprenorphine for maintenance treatment, but who are also using cannabis. 

“We don’t know, but what we think is happening is that cannabis is helping with pain relief, but it’s fundamentally not treating opioid use disorder, and that might explain this dissipation. Future research is needed.”

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