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The idea that cannabis is a ‘gateway drug’ 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‐related harm, the current study aimed to conduct the first systematic review and meta‐analysis on the likelihood of transitioning from cannabis use to subsequent first‐time opioid use, opioid use disorders (OUD), dependence or abuse.

Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, pubMed/MEDLINE, Scopus, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials and Informit Health Collection were searched for full‐text articles assessing the likelihood of transitioning from cannabis to subsequent opioid use, and from opioid use to OUD, abuse or …