Objectives. To examine the association between Colorado’s legalization of recreational cannabis use and opioid-related deaths.

Methods. We used an interrupted time-series design (2000–2015) to compare changes in level and slope of monthly opioid-related deaths before and after Colorado stores began selling recreational cannabis. We also describe the percent change in opioid-related deaths by comparing the unadjusted model-smoothed number of deaths at the end of follow-up with the number of deaths just prior to legalization.

Results. Colorado’s legalization of recreational cannabis sales and use resulted in a 0.7 deaths per month (b = −0.68; 95% confidence interval = −1.34, −0.03) reduction in opioid-related deaths. This reduction represents a reversal of the upward trend in opioid-related deaths in Colorado.

Conclusions. Legalization of cannabis in Colorado was associated with short-term reductions in opioid-related deaths. As additional data become available, research should replicate these analyses in other states with legal recreational cannabis.