With cannabis becoming more widely legalized across the United States, dispensaries are growing more accessible. Although that means people are receiving safer products to consume, there are still those who seek marijuana from other sources — and that can mean life or death.

According to a June 13 report issued by the State of Michigan Multijurisdictional Task Forces, about 2,993 people in Michigan died from drug overdoses in 2022. The task force cited statistics by the U.S. Centers for Disease Control and Prevention.

A main driver of these overdose deaths — fentanyl.

Fentanyl is a synthetic opioid that is made to be 50 to 100 times more potent than morphine, according to UC Davis Health. The substance is approved to treat severe traumatic pain, such as advanced cancer. It is used typically in emergency departments and hospitals and can also be prescribed, UC Davis Health said.

Although it is used by health professionals, it is also used by illegal drug manufacturers. Fentanyl comes in forms such as pills, powder and liquid. However, it can also be laced into heroin, counterfeit pills, methamphetamine and cocaine, UC Davis Health said.

Aside from being laced in those substances, fentanyl can also be found in marijuana. The main concern of fentanyl-laced products is the difficulty of being able to detect it, according to Recovery Centers of America. Oftentimes, patients being treated for an opioid overdose are unaware they took opioids.

Angela Volk, a certified advanced alcohol drug counselor and co-owner of J & A Counseling and Evaluation in Midland, agreed.

“We have had individuals come in for what they will say was heroin use and sometimes part of their treatment is drug testing,” she said. “And some folks sometimes are shocked when we say, ‘We tested you and you were certainly positive for opiates. But did you know you also tested positive for fentanyl?’ and for some people it's a shock. They have no clue.”

If marijuana users are unaware of the drug being laced with fentanyl or other drugs, it is all the more likely they will overdose. Recovery for America said if an individual consumed their typical dose of marijuana without realizing it was laced with fentanyl, the side effects could be severe.

Just a small dose of fentanyl can be deadly, according to UC Davis Health. Two milligrams alone can cause overdose or death. However, fentanyl cannot be detected through smell or taste, which makes it all the more of a threat.

According to the CDC, more than 150 people die every day in the United States from synthetic opioids like fentanyl. Therefore, it is important to know how to look out for the signs of marijuana being laced with fentanyl. Provided by the addiction treatment organization Defining Wellness Centers, here are a few tactics:

- Smell it: Marijuana’s natural smell is earthy like grass or leaves. If it smells like chemicals, paint thinner or acetone, it is potentially laced.

- Look at it: Blue-white crystals spotted on marijuana indicate the potential for fentanyl.

- Test strips: To use a fentanyl test strip, dilute some of the substance with water and then let it drip onto the strip. It will provide results within 15 minutes. However, the strips do not test the potency of quantity of fentanyl.

When mixing substances, such as fentanyl and marijuana, it quickens the effects. If an individual is on depressants, fentanyl can slow down breathing and heart rates dramatically, Recovery Centers of America said.

What do the symptoms of a fentanyl overdose look like, according to the CDC?

- Pinpoint pupils

- Confusion

- Slurred words

- Sudden fatigue or unconsciousness

- Slowed breathing

- Slowed heart rate

- Cold and/or clammy skin

- Choking or gurgling sounds

- Limp body

- Discolored skin (especially in lips and nails)

What to do in the case of a fentanyl overdose?

- Call 911 immediately

- Administer naloxone (narcan) if it is available

- Try to keep the person awake and breathing

- Turn the person on their side to prevent choking

- Stay with the person until help arrives

Volk said that at J & A Counseling and Evaluation, every counselor and support staff has narcan available for free to administer it to anyone who needs it.

“You didn’t see that 10 (or) 15 years ago,” she said.

Narcan is a life-saving medication that, if given in time, it can reverse an opioid overdose by restoring regular breathing within three minutes, according to the CDC. It is available in every state across the U.S. and can be bought without a prescription in most states.

Although Volk said the counseling center she works at offers narcan as well as medically assisted treatment that provides other medications for clients to deter opiate use — they are still always working to catch up.

“We come up with these alternatives and then a different substance comes out,” she said. “So, we're constantly chasing our tail.”

Besides fentanyl, Recovery Centers of America said marijuana has also been found to be laced with:

- Heroin

- LSD

- PCP

- Methamphetamine

- Cocaine

- Ketamine

Is marijuana a gateway drug?

Volk said whenever she is talking to clients that have moved on to other substances, almost all of them have said that marijuana was a substance they used prior.

“However, not everybody that uses marijuana will tell me that they go and use other substances,” she said.

She made the point that there are numerous factors that go into people’s substance use, such as their genetic predisposition, their environment and their age of first use.

“I don't think it's this simple yes or no, except the part that I can significantly say as the folks that have moved on, they will tell me that marijuana was the substance that they used first, or alcohol,” Volk said. “But not everybody moves up.”

According to the National Institute on Drug Abuse, there has been research that infers marijuana use is likely to precede use of other substances. There is also a correlation with alcohol and nicotine addiction.

The NIDA mentioned a term referred to as "cross-sensitization," which essentially means priming the brain for a heightened response to other drugs. It was concluded that cross-sensitization is not just the case with marijuana, but also alcohol and nicotine. The NIDA also found that majority of people who use marijuana do not go on to use more extreme substances.

In correlation with Volk’s statement, the NIDA said besides biological mechanisms, a person’s social environment is tied to their risk for drug use.

“An alternative to the gateway-drug hypothesis is that people who are more vulnerable to drug-taking are simply more likely to start with readily available substances such as marijuana, tobacco or alcohol, and their subsequent social interactions with others who use drugs increases their chances of trying other drugs,” the NIDA said.

Before coming to a concise answer to cannabis being a gateway drug, there is a need for further research, the NIDA concluded.

For help with substance use disorder or substance misuse, contact any of these programs:

- Substance Use Disorder Treatment: UC Davis Health

- Substance Abuse and Mental Health Services Administration

- Substance Abuse and Treatment Resources (CDC)

- J & A Counseling and Evaluation (Midland)

- Michigan Therapeutic Consultants (Lansing, Mount Pleasant and Gaylord)

- Addiction Solutions Counseling (Mount Pleasant)