Marijuana legalization and opioid deaths

J Health Econ. 2023 Mar;88:102728. doi: 10.1016/j.jhealeco.2023.102728. Epub 2023 Jan 6.


Many states have legalized marijuana over the last two decades, initially for medical purposes and more recently for recreational consumption. Despite prior research, it remains unclear how these policies are related to rates of opioid-involved overdose deaths, which have trended rapidly upwards over time. We examine this question in two ways. First, we replicate and extend previous investigations to show that the prior empirical results are frequently fragile to the choice of specifications and time periods, and probably provide an overly optimistic assessment of the effects of marijuana legalization on opioid deaths. Second, we present new estimates suggesting that legal medical marijuana, particularly when available through retail dispensaries, is associated with higher opioid mortality. The results for recreational marijuana, while less reliable, also indicate that retail sales may be correlated with greater death rates relative to the counterfactual of no legal cannabis. A likely mechanism for these effects is the emergence of illicit fentanyl, which has increased the riskiness of even small positive effects of cannabis legalization on the consumption of opioids.

Keywords: Cannabis; Marijuana; Marijuana legalization; Medical marijuana; Opioid deaths; Recreational marijuana.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Cannabis*
  • Commerce
  • Humans
  • Legislation, Drug
  • Medical Marijuana* / adverse effects


  • Analgesics, Opioid
  • Medical Marijuana