ArticleAddictive behaviors2026
Early onset of cannabis use and risk for opioid use disorder across two decades in the United States.
Article in Addictive behaviors, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOpioid use disorder (OUD) and other risky forms of opioid engagement significantly impact the health of Americans. Those who use cannabis at an early age may be at greater likelihood of OUD and riskier forms of opioid misuse.
methodsWe used data on individuals aged 18 years and older from the cross-sectional annual National Survey on Drug Use and Health data collected from 2002 to 2024, and two independent surveys comprising the National Epidemiological Survey on Alcohol and Related Conditions (2001-2002,2012-2013). Logistic regression with survey procedures were used to examine the association between cannabis use prior to age 15 and opioid use disorder, injection heroin and fentanyl use.
resultsCannabis use onsets predominantly preceded first use of opioids. Use of cannabis prior to age 15 was robustly associated with past year (Odds Ratio OR ranging from 1.57 to 4.20) and lifetime (OR range 1.88-2.28) OUD, even after adjustment for sociodemographic and substance use measures. Additional control for behavioral factors only modestly attenuated effect sizes (OR range: 1.27-3.24). Early cannabis use was also associated with injection heroin use (OR range: 3.00-5.81) and misuse of illegally manufactured fentanyl (OR range: 2.19-3.01).
conclusionEven after accounting for correlated variables, onset of cannabis use during early adolescence is associated with increased likelihood of OUD and riskier forms of opioid use that increase vulnerability to overdose and mortality. In this era of cannabis legalization, heightened vigilance is required to deter early onset of cannabis use.
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