Differential effect of cannabis use on opioid agonist treatment outcomes: Exploratory analyses from the OPTIMA study

Elkrief, Laurent; Bastien, Gabriel; McAnulty, Christina; Bakouni, Hamzah; Hébert, François-Olivier; Socías, M. Eugenia; Foll, Bernard Le; Lim, Ron; Ledjiar, Omar; Marsan, Stéphanie; Brissette, Suzanne; Jutras‐Aswad, Didier; Bornemisza, Susan; Bouman, Helen; Elliott, Sarah; Evans, Laura; Ghosh, Sumantra; Gursky, Lucas; Vezina, Lydia; Wild, C.; Yu, Alvis; Ahamad, Keith; Bach, Paxton; Brar, Rupinder; Fairbairn, Nadia; Fairgrieve, Christopher; Habibian, Sonia; Klaire, Sukhpreet; MacDonald, Scott; McLean, Mark; Nolan, Seonaid; Prinsloo, Gerrit; Sutherland, Cindy; Wood, Evan; Bozinoff, Nikki; Fischer, Benedikt; Franklin, M.; Hassan, Ahmed; Kahana, Dafna; Lagzdins, Dina; Marsh, David C.; Rehm, Jürgen; Barbeau, David L.; Bruneau, Julie; Maynard, Sidney; Talbot, Annie; Juteau, Louis-Christophe

doi:10.1016/j.josat.2023.209031

Cited by 3 publications

(6 citation statements)

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“…Although numerous epidemiological and observational studies have demonstrated the potential for cannabis-based products in managing opioid addiction and increasing retention rates to MOUD, there is a paucity of randomised clinical trials that have investigated the whole cannabis effect to date. In a 2023 study analysing data from a 24-week, open-label randomised controlled trial on participants with OUD ( n = 272) randomly assigned to either buprenorphine/naloxone ( n = 138) or methadone ( n = 134), measurements at 2-week intervals were taken of cannabis and opioid use, cravings and withdrawal [ 58 ]. This study found recent (recreational) cannabis use was not associated with opioid use, craving or withdrawal symptoms in individuals with prescription-type OUD [ 58 ].…”

Section: Medicinal Cannabis As An Emerging Therapy For Opioid Use Dis...mentioning

confidence: 99%

“…In a 2023 study analysing data from a 24-week, open-label randomised controlled trial on participants with OUD ( n = 272) randomly assigned to either buprenorphine/naloxone ( n = 138) or methadone ( n = 134), measurements at 2-week intervals were taken of cannabis and opioid use, cravings and withdrawal [ 58 ]. This study found recent (recreational) cannabis use was not associated with opioid use, craving or withdrawal symptoms in individuals with prescription-type OUD [ 58 ]. However, a number of other studies have highlighted the role of cannabis in improving retention rates to MOUD, which is a crucial factor in preventing further opioid abuse.…”

Section: Medicinal Cannabis As An Emerging Therapy For Opioid Use Dis...mentioning

confidence: 99%

“…THC or CBD). Current literature in this area unanimously agrees that larger, more rigorous and well-designed clinical trials are needed to establish cannabis’ effectiveness in treatment of OUD in the general population [ 58 , 84 ].…”

Section: Challenges and Limitations In The Implementation Of Medical ...mentioning

confidence: 99%

“…The Therapeutic Goods Administration and Poisons Standards of Australia categorises medicinal cannabis products based on the CBD and THC content, with products having higher THC content subjected to stricter prescribing and storage requirements. The variations in regulations and inconsistency in quality control standards create challenges in the production, distribution for therapeutic use and integration into mainstream medical practice [ 14 , 58 , 83 ]. They hinder the integration of cannabis use into formalised treatment protocols and trials for MOUD and make it difficult for patients to access high-quality cannabis products [ 14 , 58 ].…”

Section: Challenges and Limitations In The Implementation Of Medical ...mentioning

confidence: 99%

“…The variations in regulations and inconsistency in quality control standards create challenges in the production, distribution for therapeutic use and integration into mainstream medical practice [ 14 , 58 , 83 ]. They hinder the integration of cannabis use into formalised treatment protocols and trials for MOUD and make it difficult for patients to access high-quality cannabis products [ 14 , 58 ]. With prescribers currently requiring specific certifications and permit applications to prescribe evidence-based MOUD, the prescribing of CBD or THC can be expected to be just as difficult, if not more [ 93 ].…”

Section: Challenges and Limitations In The Implementation Of Medical ...mentioning

confidence: 99%

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The Role of Medicinal Cannabis as an Emerging Therapy for Opioid Use Disorder

Le,

Nguyen

et al. 2024

Pain Ther

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This narrative review explores current insights into the potential use of medicinal cannabis-related products as an emerging therapy for opioid use disorder in the landscape of increasing knowledge about medicinal cannabis-based products, commercialisation and global legalisation. Preclinical studies have provided preliminary insight into the putative neurobiological mechanisms that underpin the potential for medicinal cannabis to be considered a therapeutic in opioid use disorder and addiction. With the progressive legalisation of cannabis in many jurisdictions worldwide, contemporary research has highlighted further evidence that medicinal cannabis may have efficacy in reducing cravings and withdrawal effects, and therefore may be considered as an adjunct or standalone to current medications for opioid use disorder. Despite this potential, the landscape of research in this space draws from a large number of observational studies, with a paucity of rigorous randomised controlled trials to ascertain a true understanding of effect size and safety profile. With current challenges in implementation that arise from political and legal qualms about adopting medicinal cannabis on the background of associated social stigma, significant hurdles remain to be addressed by government, policy-makers, healthcare providers and researchers before medical cannabis can be introduced globally for the treatment of opioid use disorder.

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Section: Medicinal Cannabis As An Emerging Therapy For Opioid Use Dis...mentioning

confidence: 99%

Section: Medicinal Cannabis As An Emerging Therapy For Opioid Use Dis...mentioning

confidence: 99%

Section: Challenges and Limitations In The Implementation Of Medical ...mentioning

confidence: 99%

Section: Challenges and Limitations In The Implementation Of Medical ...mentioning

confidence: 99%

Section: Challenges and Limitations In The Implementation Of Medical ...mentioning

confidence: 99%

See 3 more Smart Citations

The Role of Medicinal Cannabis as an Emerging Therapy for Opioid Use Disorder

Le,

Nguyen

et al. 2024

Pain Ther

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Pharmacological Strategies to Decrease Long-Term Prescription Opioid Use: A Systematic Review

Ellerbroek,

Kalkman,

Kramers

et al. 2024

JCM

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Background/Objectives: As long-term prescription opioid use is associated with increased morbidity and mortality, timely dose reduction of prescription opioids should be considered. However, most research has been conducted on patients using heroin. Given the differences between prescription and illicit opioid use, the aim of this review was to provide an overview of pharmacological strategies to reduce prescription opioid use or improve clinical outcomes for people who experience long-term prescription opioid use, including those with opioid use disorder. Methods: We conducted a systematic database search of PubMed, Embase, CINAHL, and the Cochrane Library. Outcomes included dose reduction, treatment dropout, pain, addiction, and outcomes relating to quality of life (depression, functioning, quality of life). Results: We identified thirteen studies (eight randomized controlled trials and five observational studies). Pharmacological strategies were categorized into two categories: (1) deprescribing (tapering) opioids or (2) opioid agonist treatment (OAT) with long-acting opioids. Tapering strategies decreased opioid dosage and had mixed effects on pain and addiction. OAT with buprenorphine or methadone led to improvements in pain relief and quality of life, with a slight (non-significant) preference for methadone in terms of treatment retention (RR = 1.10 [CI: 0.89–1.37]) but not for other outcomes. Most studies had high dropout rates and a serious risk of bias. Conclusions: Tapering reduced prescription opioid doses had mixed effects on pain. OAT improved clinical outcomes without dose reduction. Based on our review findings, there is no clear preference for either tapering or OAT. Tapering may be considered first as it reduces dependency, tolerance, and side effects, but is associated with adverse events and not always feasible. OAT can be a suitable alternative. Non-pharmacological interventions may facilitate tapering. Further research is needed to identify novel pharmacological strategies to facilitate opioid tapering. Registration: PROSPERO 2022 CRD42022323468.

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The Therapeutic Potential of Cannabidiol in Revolutionising Opioid Use Disorder Management

Le,

Au,

Hua

et al. 2023

Cureus

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Opioid use disorder (OUD) is a significant cause of morbidity and mortality worldwide and is linked to a complex interplay of biopsychosocial factors as well as the increasing overprescription and availability of opioid medications. Current OUD management relies on the controlled provision of opioid medications, such as methadone or buprenorphine, known as opioid replacement therapy. There is variable evidence regarding the long-term efficacy of these medications in improving the management of OUD, thereby necessitating an exploration into innovative approaches to complement, or even take the place of, existing treatment paradigms. Cannabidiol (CBD), a non-psychoactive compound derived from the cannabis plant, has garnered attention for its diverse pharmacological properties, including anti-inflammatory, analgesic, and anxiolytic effects. Preliminary studies suggest that CBD may target opioid withdrawal pathways that make CBD a potential therapeutic option for OUD. This narrative review synthesises current literature surrounding OUD and offers a nuanced review of the current and future role of CBD in managing this condition. In doing so, we highlight the potential avenues to explore with respect to CBD research for the guidance and development of further research opportunities, framework and policy development, and clinical considerations before medicinal CBD can be integrated into evidence-based clinical guidelines.

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Differential effect of cannabis use on opioid agonist treatment outcomes: Exploratory analyses from the OPTIMA study

Cited by 3 publications

References 56 publications

The Role of Medicinal Cannabis as an Emerging Therapy for Opioid Use Disorder

The Role of Medicinal Cannabis as an Emerging Therapy for Opioid Use Disorder

Pharmacological Strategies to Decrease Long-Term Prescription Opioid Use: A Systematic Review

The Therapeutic Potential of Cannabidiol in Revolutionising Opioid Use Disorder Management

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