State With Total Marijuana Ban
Led The Nation In OD Death Rate

Joe Loudon • COMBAT Communications Administrator

Dr. Kelvin Walls understands some people will abuse or misuse medical marijuana.

“We’ll have the same problems with medical marijuana that you can have with any prescribed medication,” Dr. Walls said. “You’ll have people try to sell it after they’ve had a prescription filled. People will get it—and this is something we’ve seen people do for years—give some to their family members to help them with whatever condition they might have.”

Those problems aside, Dr. Walls believes Missourians made the right decision in 2018 when they amended the State Constitution to legalize medical marijuana. People who might benefit from using the drug shouldn’t be denied its therapeutic benefits, he insists, because others might try to sell marijuana illegally or use it merely to get high.

“For some people it is the correct medicine to prescribe,” stressed Dr. Walls, who serves on the COMBAT Commission.


'THE CORRECT MEDICINE TO PRESCRIBE' — The correct medicine to prescribe varies from patient to patient.

'Spiraling Out Of Control'

Healing House, Inc. founder Bobbie Jo Reed doesn’t’ dispute that marijuana might be the best medicine for “certain conditions.” As someone whose non-profit provides transitional housing in Kansas City for people who’ve been in drug treatment—and who is, herself, a recovering addict—Reed worries the state’s medical marijuana regulations will prove ineffective at preventing marijuana from becoming more readily available for recreational use.

Reed leaves little doubt about whether or not she believes increased marijuana use might lead to more widespread drug addiction: “My concern as a person in long-term recovery is that we are going to end up like Colorado, where everybody is being written prescriptions for marijuana and addiction is spiraling out of control.”

A Google search for data about drug addiction in Colorado will generate links to a myriad studies and articles. Separating hyperbole from fact is not easy. Some stats appear contradictory, depending on the source: “Colorado Ranks 12th In Drug Addiction” vs. “Colorado Has Nation’s 3rd Highest Drug Addiction Rate.” And bias is likely an issue, with some organizations perhaps cherry-picking information to fit within an agenda to sway public opinion against or in favor of legalizing marijuana.

Increased Overdose Deaths

COMBAT only references surveys and studies that have clearly explained methodologies and/or were released by official state or federal agencies.

 • A Substance Abuse and Mental Health Services Administration (SAMSHA) survey in 2016 did reveal that Colorado was the only state reporting heavy consumption rates in all four of these major categories:

1) opioid painkillers for non-medical purposes
2) medical or recreational marijuana
3) alcohol
4) cocaine

SAMSHA surveyed individuals 12 or older. 

• A 2017 Colorado Department of Public Health & Environment (CDPHE) survey, however, concluded underaged—and, therefore, still illegal—marijuana use in the state had dropped since 2014. (Colorado legalized the drug’s recreational use in 2014 for adults over 21.)

The survey revealed Colorado adolescents actually used marijuana at a rate below the national average for teenagers.

• Drug overdose death rates have risen practically every year in Colorado since 2000, the year the state legalized medical marijuana. Between 2000 and 2015, overdoses claimed 10,552 lives in Colorado, the CDPHE reported. 

“In nearly every year, Colorado’s rate of drug overdoses was significantly higher than the national rate,” the CDPHE stated. However, while Colorado’s drug overdose rates showed signs of leveling off in 2015, the U.S. rates continued increasing. 

Missouri Higher OD Death Rate

What the CDPHE numbers don’t explain is whether or not there’s any correlation between marijuana legalization in Colorado and the state’s overdose death rate. Across the nation—and among all age groups—OD death rates have been on the rise since the turn of the century, according to the Centers For Disease Control & Prevention (CDC). 


STATE OD DEATH RATE STATS — Click on the map to view an enlarged version and for a chart rating states from those with the highest overdose death rates in 2017 to those with the lowest. Is there a correlation between marijuana legalization and the states' death rates? 

The overdose death rate in the United States was 21.7 per 100,000 population in 2017. Colorado, California, Oregon and Washington—four states allowing medical and recreational marijuana use—had OD death rates lower than the national rate. Meanwhile, 20 states exceeded the national rate: two with fully legalized marijuana use, 12 that allowed its use medically and six—Missouri among them—that, in 2017, still outlawed the drug entirely.

West Virginia, a state with a complete prohibition against marijuana, had the worst overdose death rate in America two years ago at 57.8 per 100,000—266% higher than the national rate.

“So, we have six states in ’17 that still had total bans on marijuana but still had a higher overdose death rate than the nation as a whole,” observed COMBAT Director Vince Ortega. “When you look at those CDC numbers, it’s a stretch to say there’s a direct cause and effect with marijuana legalization and the increase in overdose deaths since 2000. 

“The biggest factor in overdose deaths increasing is the opioid crisis, which just happens to have overlapped the last 20 to 25 years with a lot of states legalizing marijuana.”

Has Legalized Marijuana Saved Lives By Reducing Opioid Use?

In its special “Marijuana: The Medical Movement” edition published this spring, TIME cited numerous studies showing an apparent relationship between medical marijuana availability and reduced opioid use—and fewer opioid overdoses:

• Patients in a University of Michigan study used medical cannabis to control pain and reduced their opioid use by 64%.

• A 2014 study published in the Journal of the American Medical Association concluded opioid overdoses were 25% less frequent in states with legalized marijuana use.

But a more recent study published just last month in a National Academy of Sciences journal found that, while the 2014 study was accurate at the time, the “association between medical cannabis laws and opioid overdose mortality has reversed over time.”

The new study’s lead author, Stanford University researcher Chelesa Shover, told NBC News data collected in 2017 pointed to states “that enacted a medical cannabis law actually [having] higher opioid overdose deaths after the laws took effect.”

PAIN TREATMENT — In states where its use has been legalized, marijuana has often be prescribed to treat pain, an alternative to opioid medications. 

But she and other researchers have cautioned against drawing any conclusions based on the opioid death rates in states with legalized medical marijuana versus states that still completely ban the drug. Other factors, she stressed, play a role in opioid overdose rates and fatalities, including access within a state to addiction treatment and medications used to reverse the effects of an overdose.

“We don’t think cannabis was saving lives… 10 years ago,” Shover said, “and we don’t think it’s killing people now. We think these two factors are separate issues.”

To illustrate Shover’s point, compare the opioid overdose death rates in Colorado and Missouri from 2017: 

• That year Colorado had 578 overdose deaths involving opioids—10.0 per 100,000 people, well below the national rate (14.6).

• Meanwhile, in Missouri the opioid overdose death rate was higher at 16.5. Opioid overdoses killed 952 people in Missouri that year.

 Synthetic opioids, primarily fentanyl, accounted for 56 deaths in Missouri in 2012. That number jumped to 618 in 2017.