A new study has linked state laws legalizing marijuana to increased opioid addiction in Veterans Health Administration patients over time, with the sharpest increases among middle-aged and older men in chronic pain.
The analysis of VHA health records from January 2005 to December 2022 found opioid abuse decreased from 1.12% to 1.06% of patients in states without legalized cannabis. By contrast, it increased from 1.13% to 1.19% in states that legalized medical cannabis and remained stable in states that also legalized recreational marijuana.
Seventeen public health researchers from the VA and other institutions published the findings on Friday in JAMA Health Forum. Funding came from the National Institute on Drug Abuse, National Center for Complementary and Integrative Health, New York State Psychiatric Institute and VA Centers of Excellence in Substance Addiction Treatment and Education.
“The findings did not support state cannabis legalization as a means of reducing the burden of [opioid use disorder] during the ongoing opioid epidemic,” they wrote.
Most of the 3.2 million to 4.5 million patients studied each year were White men in their 60s.
The researchers noted that opioid abuse in these military veterans “increased significantly” after states legalized marijuana for medical and recreational purposes, with patients in chronic pain and older than 34 reporting the highest spikes after both.
The report comes as marijuana legalization efforts have stalled while the Trump administration and states ponder lagging tax revenues and health risks.
Ohio, Maryland and Michigan officials have proposed tax hikes on dispensaries to plug state budget gaps. The Montana Legislature passed a bill in April to limit the psychoactive content of cannabis gummies that the state blamed for poisoning dozens of underage children.
Most Americans live in the 39 states that have legalized medical marijuana since 1996, including 24 that have also allowed recreational cannabis since Colorado and Washington became the first in 2012.
However, no states have legalized recreational marijuana since 2023, and President Trump has proved unwilling to lift a federal ban on the drug.
Several experts not connected with Friday’s study said the findings demonstrate a need to regulate cannabis more tightly. They noted a proliferation of illegal marijuana growers and sellers.
“The findings here are consistent with the theory that cannabis legalization made the opioid epidemic worse,” said Keith Humphreys, a Stanford University psychologist and addiction researcher. “Cannabis legalization increases the number of people who are addicted, some of whom will seek out additional drugs.”
Marijuana advocates downplayed the study. They emphasized that veterans are a unique group with higher tendencies toward chronic pain, prescription drug abuse and Post-Traumatic Stress Disorder than their peers.
“There’s no strong evidence that simply having access to legal cannabis makes someone more likely to abuse fentanyl,” said Jerry Joyner, a Texas-based marijuana advocate who hosts the Weed & Whiskey podcast. “Fentanyl is showing up everywhere. If anything, access to regulated cannabis products might give people an alternative to sketchy street sources.”
Fentanyl, a synthetic opioid that is 50 times more powerful than heroin, is considered the key driver of an overdose crisis that accelerated during COVID-19 lockdowns. Nearly half a million Americans have died from opioid overdoses over the past five years.
Marijuana use has also surged in recent years and with higher concentrations of tetrahydrocannabinol or THC. THC is the psychoactive substance in cannabis that, in higher doses, can produce nausea and scream-vomiting, also known as “scromiting.”
The average potency of marijuana plant material has jumped from 1% to 3% THC content in the 1970s to 18% to 23% today, according to Smart Approaches to Marijuana, which warns about the potential harm of cannabis use.
In states with legalized marijuana, authorities have flagged an uptick in impaired driving and underage use. In November’s election, voters in Florida, North Dakota and South Dakota rejected well-funded ballot measures that would have legalized recreational cannabis in their states.
Recreational and medical marijuana remains illegal in Georgia, Indiana, Iowa, Kentucky, Tennessee, Texas and Wisconsin. They allow only the sale of nonpsychoactive cannabidiol oil derived from hemp, a variety of the cannabis plant often used for medical purposes.
Marijuana for any purpose and all CBD products remain illegal and criminalized in Idaho, Kansas, South Carolina and Wyoming.
Brian Swift, spokesman for the National Alliance to Stop Impaired Driving advocacy group, said roadside saliva drug testing in Indiana and Minnesota has confirmed a surge in intoxicated drivers abusing a combination of marijuana and other substances like fentanyl.
“The numbers of multi-substance drivers are extremely alarming,” said Mr. Swift, whose parents were killed in upper Michigan in 2013 by a logging truck driver who was high on marijuana.
• Sean Salai can be reached at ssalai@washingtontimes.com.