Weed: A Gateway to Opioids?

By William Wagner

The jury is still out on whether marijuana is a gateway to harder drugs, say researchers from Australia’s University of Sydney who did an exhaustive study on the subject. Other issues we cover in this week’s “From the Journals” include the latest statistics on overdose deaths in 2020 and a substance use disorder (SUD) guide relating to the justice system.

**From Addiction:
The Path from Marijuana to Opioids**

A meta-analysis by the University of Sydney’s Matilda Centre for Research in Mental Health and Substance Use on whether marijuana use creates a dangerous pattern of behavior that can lead all the way to opioids is, well, inconclusive. Despite taking on a topic that has been much discussed, the researchers found that there has been surprisingly little substantive scholarship on the matter. In fact, they deemed only six studies to be of high enough quality to be included in their meta-analysis. A synthesis of those studies indicates that people who use cannabis are more than twice as likely to graduate to opioids as those who don’t, but the evidence still seems somewhat flimsy and, in some cases, contradictory.

Cannabis was consumed by approximately 192 million people (3.8%) aged 15-64 years in 2018, making it the most commonly used illicit drug world-wide.”—study in “Addiction”

The University of Sydney team writes in Addiction that more research is imperative, because “findings that cannabis use precedes and may influence opioid use has considerable implications for public health. Cannabis was consumed by approximately 192 million people (3.8%) aged 15-64 years in 2018, making it the most commonly used illicit drug world-wide.”

From the Centers for Disease Control and Prevention (CDC):
The Grim Overdose Tally

As the data continues to flow in, the overdose outlook worsens. According to new provisional statistics from the CDC, more than 93,000 people in the U.S. died from a drug overdose in 2020, an increase of nearly 30% year-over-year. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), says many of those deaths involved, unbeknownst to the users, substances that were laced with fentanyl. And, of course, the COVID-19 pandemic contributed mightily to the troubling statistics.

“This is the highest number of overdose deaths ever recorded in a 12-month period, and the largest increase since at least 1999,” Volkow said in a statement. “These data are chilling. The COVID-19 pandemic created a devastating collision of health crises in America.”

opioid overdoses — Emergency situations, the norm with opioids, have only grown since the onset of the pandemic.

To stem the overdose tide, Volkow believes we must take a more innovative and aggressive approach to treatment. “This has been an incredibly uncertain and stressful time for many people, and we are seeing an increase in drug consumption, difficulty in accessing life-saving treatments for substance use disorders and a tragic rise in overdose deaths,” she said. “As we continue to address both the COVID-19 pandemic and the opioid crisis, we must prioritize making treatment options more widely available to people with substance use disorders.”

Judges need guidance, too—and a new resource from the ORN provides just that for drug-related criminal offenses. The ORN, funded by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), is aiming to provide a more nuanced understanding of SUD for the justice system.

“While being charged with maintaining the law, keeping communities safe and reducing recidivism and costs for the justice system, judges, like health professionals, are also on the front lines of addressing the increasing opioid overdose crisis and the rising rates of stimulant use,” Kathryn Cates-Wessel, ORN principal investigator, said in a news release. “This resource guide was created to fill a critical gap in an understanding of the medical aspects of substance use disorders and co-occurring psychiatric disorders.”

Top photo: Sharon McCutcheon; bottom photo: Obi Onyeador