Talk of the Town: Marijuana makes the opioid epidemic worse

In Arizona, the opioid death rate was falling before medical marijuana was legalized here, in 2010. Subsequently, between 2012 and 2016, the opioid death rate increased by nearly 75 percent. Despite that evidence, the marijuana lobby insists that pot can save us from the opioid crisis. Across the country, billboards sponsored by a medical marijuana company proclaim “states that legalized marijuana had 25% fewer opioid-related deaths.”

That statement is incredibly misleading. The “25 percent” number comes from a study published in the Journal of the American Medical Association (JAMA), but that study only shows correlation, not causation. As the researchers acknowledge, they don’t know what caused the lower rates of opioid mortality.

However, there’s evidence that the cause is not marijuana. While people do use pot to replace prescription opioids, other research shows they do that just as often in states without medical marijuana as in states where medical use of marijuana is legal. So legal weed is not causing that 25 percent difference in opioid overdose deaths.

Here’s a better explanation. A study published last year by the Brookings Institution Press found that white Americans with no college degree are dying in unexpectedly high numbers, especially from opioid overdose. They’re called deaths of despair. These are chronically unemployed or under-employed working-class Americans who feel society has left them behind.

And they tend to live in states without medical marijuana. In 2010 — when the JAMA study ended — the ten states with the most opioid prescriptions per capita all had very low rates of college education, and none had legalized use of medical marijuana. In contrast, most of the medical marijuana states had high rates of college education.

In other words, states with medical marijuana laws had fewer of the non-college educated whites who are dying of overdose at such high rates. That’s why they had fewer opioid-related deaths. Pot had nothing to do with it, and the claim that marijuana decreases opioid problems is wrong.

Meanwhile, there’s good evidence that marijuana increases opioid abuse. Research published in the September 2017 American Journal of Psychiatry found that teenage marijuana users are at least twice as likely to abuse opioids later in life.

This is the gateway effect, which skeptics say has been disproved. But the gateway effect is real. When adolescent rats are given THC, the opioid pathways in the brain change. When these same rats are later given heroin, they use it more often and use more of it. This is a biological effect marijuana has on the developing teenage brain.

I work with heroin addicts. They almost all used marijuana daily in their early teens. That’s not a coincidence. Marijuana makes teens more likely to abuse opioids.

And where do the most teens use pot? According to the National Survey on Drug Use and Health, the twenty states with the highest rates of adolescent use have all legalized medical and often recreational marijuana. Colorado, the first to have both, tops the list.

So thanks to medical marijuana and legalization of it, the country has far more adolescents with the altered brain circuitry that leads to opioid abuse. Legalization makes the opioid epidemic more severe and more intractable.

But in a classic case of pouring gasoline on a raging fire, the pot lobby is trying to convince us that loosening marijuana laws is the cure.

Ed Gogek, M.D., is a psychiatrist specializing in substance abuse and the author of Marijuana Debunked: A handbook for parents, pundits and politicians who want to know the case against legalization. He resides in Prescott.