Intended for healthcare professionals


Cannabis liberalisation and the US opioid crisis

BMJ 2021; 372 doi: (Published 27 January 2021) Cite this as: BMJ 2021;372:n163

Linked Research

Association between county level cannabis dispensary counts and opioid related mortality rates in the United States

  1. Sameer Imtiaz, project scientist,
  2. Tara Elton-Marshall, independent scientist,
  3. Jürgen Rehm, senior scientist
  1. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
  1. Correspondence to: S Imtiaz sameer.imtiaz{at}

Too early to tell whether cannabis liberalisation reduces opioid deaths

The United States is in the midst of an unprecedented opioid crisis, partly worsened by the novel coronavirus disease pandemic.1 Approximately 10 million people misused prescription opioids, 808 000 people misused heroin, and two million people met the criteria for an opioid use disorder in 2018.2 In that same timeframe, 46 800 people died of an opioid overdose, with two thirds of the deaths involving synthetic opioids (including fentanyl and fentanyl analogues).3 In response to the rising burden of disease, a range of opioid related policies have been implemented, which have been geared towards reducing high risk opioid prescribing, improving access to treatment, and expanding overdose prevention efforts.4

One perspective points to the co-occurring cannabis liberalisation as a potential means of reducing opioid related harms. Increased availability of cannabis has been suggested to result in the partial substitution of opioids …

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