Substance Use Disorders (SUDs) and consequent mortality from overdose are a public health nightmare. Between 1999 and 2007, the mortality rate from drug overdose more than doubled among 15-19- year-olds. Then, for reasons not well-understood, the mortality rate declined by 26% by 2014, but primarily among males. Since then, mortality from overdose has increased dramatically, especially among adolescents using opioids, especially heroin. Further analysis of these data reveals that 21.9% of the fatalities among 15-19- year-old females were due to suicide, compared to only 8.7% for males. This gender gap may be partially attributed to the different methods of suicide. Males typically use guns and cars, while suicidal females are most likely to ingest lethal doses of drugs. Yet the reasons for the overall increase remain unclear. One probable variable is the relationship between early onset marijuana use and subsequent use of opioids, including heroin that is now frequently cut with fentanyl.

Recently published findings by the National Institute on Drug Abuse (2017), in partnership with Columbia University, show that marijuana users are more likely than non-users to use, abuse and become addicted to opioids.

The National Epidemiologic Survey on Alcohol and Related Conditions interviewed more than 43,000 American adults and followed up with more than 34,000, three to four years later. The results: study participants who reported past-year marijuana use in their initial interview were 2.6 times more likely to initiate opioid abuse compared to non-marijuana users and 2.2 times more likely than non-users to become addicted (using DSM IV criteria) to opioids, including heroin at follow-up.

Why Does this Matter?

The recent crackdown on the pill mills and the aggressive prosecution of over prescribing physicians has dramatically decreased the availability of prescription opioids, which, concurrently drove up the cost. It’s simple supply and demand. As a result, cheap Mexican heroin, often cut with fentanyl, flooded the US market. Prescription opioid abusers and addicts began buying the cheaper heroin which is directly associated with increased mortality, largely due to the potency and rapid absorption of fentanyl, which inhibits the autonomic nervous system, resulting in respiratory distress and death. Second, the prevalence of marijuana use among adolescents is always linked to their perception of harm. As a result of recent legalization and the spread of misinformation regarding the health consequences of marijuana, the perception of harm among adolescents surveyed in the annual “Monitoring the Future” study (University of Michigan 1975-present) reveals that the overwhelming majority of adolescents do not see marijuana as harmful. But the data tells a different story.

Teens who regularly use the now highly potent marijuana are more than twice as likely to use opioids including heroin when compared to teens who do not use marijuana. The question of whether or not marijuana is a gateway drug is now moot. These data should guide physicians and policy makers regarding the use and legalization of marijuana.

For more information about the effects and trends of marijuana, please read: