Buprenorphine–cannabis interaction in patients undergoing opioid maintenance therapy

Vierke, C; Marxen, Brigitte; Böettcher, Michael; Hiemke, Christoph; Havemann-Reinecke, Ursula

doi:10.1007/s00406-019-01091-0

Cited by 21 publications

(13 citation statements)

References 37 publications

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“…The results of this narrative systematic review generate information about cannabis–drug interactions based on the available data. Furthermore, in the cases where there was no explicit information of changes in pharmacokinetic and clinical parameters, quantitative changes were established with the information available in the relevant publication [ 16 , 17 , 19 , 20 , 21 , 22 , 32 , 38 , 39 , 40 ], allowing for an extension of the option to classify the clinical relevance of cannabis–drug interactions.…”

Section: Discussionmentioning

confidence: 99%

Clinical Relevance of Drug Interactions with Cannabis: A Systematic Review

Lopera

Rodríguez

Amariles

2022

JCM

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Concomitant use of cannabis with other drugs may lead to cannabis–drug interactions, mainly due to the pharmacokinetic mechanism involving the family of CYP450 isoenzymes. This narrative systematic review aimed to systematize the available information regarding clinical relevance of cannabis–drug interactions. We utilized the PubMed/Medline database for this systematic review, using the terms drug interactions and cannabis, between June 2011 and June 2021. Articles with cannabis–drug interactions in humans, in English or Spanish, with full-text access were selected. Two researchers evaluated the article’s inclusion. The level of clinical relevance was determined according to the severity and probability of the interaction. Ninety-five articles were identified and twenty-six were included. Overall, 19 pairs of drug interactions with medicinal or recreational cannabis were identified in humans. According to severity and probability, 1, 2, 12, and 4 pairs of cannabis–drug interactions were classified at levels 1 (very high risk), 2 (high risk), 3 (medium risk), and 5 (without risk), respectively. Cannabis–warfarin was classified at level 1, and cannabis–buprenorphine and tacrolimus at level 2. This review provides evidence for both the low probability of the occurrence of clinically relevant drug interactions and the lack of evidence regarding cannabis–drug interactions.

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Section: Discussionmentioning

confidence: 99%

Clinical Relevance of Drug Interactions with Cannabis: A Systematic Review

Lopera

Rodríguez

Amariles

2022

JCM

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“…One urine sample was excluded as it was positive for tetrahydrocannabinol (THC), a potential P450 3A4 inhibitor that might interact with buprenorphine metabolism. 14 Another exclusion criterion was creatinine level <20 mg/dL 10 ; however, creatinine level in all urine samples was >20 mg/dL. As a result, 240 urine samples from 41 patients were included in this study.…”

Section: Methodsmentioning

confidence: 99%

Buprenorphine Dosage and Urine Quantitative Buprenorphine, Norbuprenorphine, and Creatinine Levels in an Office-Based Opioid Treatment Program

et al. 2021

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Background: Treatment progress is routinely monitored by urine testing in patients with opioid use disorder (OUD) undergoing buprenorphine medication-assisted treatment (MAT). However, interpretation of urine test results could be challenging. This retrospective study aims to examine the results of quantitative buprenorphine, norbuprenorphine, and creatinine levels in urine testing in relation to sublingual buprenorphine dosage to facilitate an accurate interpretation of urine testing results. Methods: We reviewed the medical charts of 41 consecutive patients, who were residing in halfway houses where their medication intake was closely monitored and who had enrolled in an office-based MAT program at an urban clinic between July 2018 and June 2019. The patients’ urine testing results were reviewed, and demographic variables were recorded. We focused on the patients treated with 8-, 12-, or 16-mg/day of buprenorphine, examining their urine buprenorphine, norbuprenorphine, and creatinine levels. Analysis of variance tested the statistical association between the dosage and urine testing results on the norbuprenorphine-to-creatinine ratio. Results: A total of 240 urine samples from 41 patients were included for this study. The 41 patients received a mean buprenorphine dose of 10.5 ± 3.7 mg/day (range, 4-20 mg/day). Then, this study examined the distribution of the 240 urine samples and then focused on 184 urine samples that came from the 33 patients who were treated with 8-, 12-, and 16-mg/day of buprenorphine, the 3 most common dosages. All of the 184 urine samples had a creatinine level of >20 mg/dL and buprenorphine-to-norbuprenorphine ratio <50:1. The average norbuprenorphine-to-creatinine ratio in the 8 mg/day dosage group was 3.85 ± 2.24 × 10−4 (n = 66; range, 0.44-11.12). The respective ratios in the 12- and 16-mg dosage groups were 5.64 ± 3.40 × 10−4 (n = 83; range, 1.55-22.72) and 6.23 ± 4.92 × 10−4 (n = 35; range, 1.37-27.12). The 3 dosage groups differed significantly in the mean ratios ( P < .01), except when the 12- and 16-mg dosage groups were compared ( P = .58). The results of this study thus suggest that prescribers should pay attention to the following features: (1) unexpected substance(s) in urine testing, (2) creatinine level under 20 mg/dL, (3) buprenorphine-to-creatinine ratio over 50:1, (4) buprenorphine dosage over 24 mg/day, and (5) norbuprenorphine-to-creatinine ratio consistently under 0.5 × 10−4 in patients treated with 8 mg/day or 1.5 × 10−4 in patients treated with 12 mg/day or more. Conclusion: This study suggested parameters for interpreting quantitative urine test results in relation to buprenorphine intake dose in office-based opioid treatment programs.

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“…In addition to the pharmacodynamic synergistic effects that cannabis has with coadministered opioids, there are potential pharmacokinetic interactions as well 58 59. In the perioperative setting, special attention should be paid to potential cannabinoid interactions with warfarin, direct oral anticoagulants, and clopidogrel (table 2).…”

Section: Introductionmentioning

confidence: 99%

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

Shah

Schwenk

Sondekoppam

et al. 2023

Reg Anesth Pain Med

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BackgroundThe past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear.MethodsIn November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement.ResultsNine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes.ConclusionsSpecific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.

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Buprenorphine–cannabis interaction in patients undergoing opioid maintenance therapy

Cited by 21 publications

References 37 publications

Clinical Relevance of Drug Interactions with Cannabis: A Systematic Review

Clinical Relevance of Drug Interactions with Cannabis: A Systematic Review

Buprenorphine Dosage and Urine Quantitative Buprenorphine, Norbuprenorphine, and Creatinine Levels in an Office-Based Opioid Treatment Program

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

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