{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:24:00Z","timestamp":1789709040875,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T00:00:00Z","timestamp":1626307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014660","name":"Society for the Study of Addiction","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014660","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004365","name":"Sydney Medical School","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004365","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>The idea that cannabis is a \u2018gateway drug\u2019 to more harmful substances such as opioids is highly controversial, yet has substantially impacted policy, education and how we conceptualize substance use. Given a rise in access to cannabis products and opioid\u2010related harm, the current study aimed to conduct the first systematic review and meta\u2010analysis on the likelihood of transitioning from cannabis use to subsequent first\u2010time opioid use, opioid use disorders (OUD), dependence or abuse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) guidelines, pubMed\/MEDLINE, Scopus, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials and Informit Health Collection were searched for full\u2010text articles assessing the likelihood of transitioning from cannabis to subsequent opioid use, and from opioid use to OUD, abuse or dependence given prior cannabis use. Analysis of subpopulations within studies were discussed narratively, and E\u2010values were calculated to assess the potential influence of unmeasured confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Six studies provided relevant data from the United States, Australia and New Zealand between 1977 and 2017, a total sample of 102\u2009461 participants. Random\u2010effects analysis of the adjusted pooled effect size indicates that the likelihood of transitioning from cannabis to opioid use, relative to non\u2010cannabis users, is odds ratio (OR)\u00a0=\u00a02.76, 95% confidence interval (CI)\u00a0=\u00a02.26\u20133.36, whereas the likelihood of transitioning from opioid use to OUD, abuse or dependence given prior cannabis use is OR\u00a0=\u00a02.52, 95% CI\u00a0=\u00a01.65\u20133.84. While the evidence was determined to be of low quality with moderate risk of bias, E\u2010values suggest that these findings are robust against unmeasured confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis found that while people who use cannabis are disproportionately more likely to initiate opioid use and engage in problematic patterns of use than people who do not use cannabis, the low quality of the evidence must be considered when interpreting these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.15581","type":"journal-article","created":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T10:22:21Z","timestamp":1626344541000},"page":"284-298","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Weeding out the truth: a systematic review and meta\u2010analysis on the transition from cannabis use to opioid use and opioid use disorders, abuse or dependence"],"prefix":"10.1111","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2732-1731","authenticated-orcid":false,"given":"Jack","family":"Wilson","sequence":"first","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use The University of Sydney  Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9714-1832","authenticated-orcid":false,"given":"Katherine","family":"Mills","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use The University of Sydney  Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5667-507X","authenticated-orcid":false,"given":"Tom P.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Addiction and Mental Health Group (AIM) University of Bath  Bath UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8452-364X","authenticated-orcid":false,"given":"Matthew","family":"Sunderland","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use The University of Sydney  Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0693-1012","authenticated-orcid":false,"given":"Rachel","family":"Visontay","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use The University of Sydney  Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1371-6986","authenticated-orcid":false,"given":"Christina","family":"Marel","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use The University of Sydney  Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1188374"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.74.7.668"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2000.9545053.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.175.4.351"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2002.00280.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(18)30337-7"},{"key":"e_1_2_8_8_1","unstructured":"Australian Institute of Health and Welfare (AIHW).National Drug Strategy Household Survey 2016: Detailed Findings. 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