The association between cannabis use and outcome in pharmacological treatment for opioid use disorder

Abstract

Background With the ongoing opioid crisis and policy changes regarding legalization of cannabis occurring around the world, it is necessary to consider cannabis use in the context of opioid use disorder (OUD) and its treatment. We aimed to examine (1) past-month cannabis use in patients with OUD, (2) self-reported cannabis-related side effects and craving, and (3) the association between specific characteristics of cannabis use and opioid use during treatment in cannabis users. Methods Participants receiving pharmacological treatment for OUD (n = 2315) were recruited from community-based addiction treatment clinics in Ontario, Canada, and provided information on past-month cannabis use (self-report). Participants were followed for 3 months with routine urine drug screens in order to assess opioid use during treatment. We used logistic regression analysis to explore (1) the association between any cannabis use and opioid use during treatment, and (2) amongst cannabis-users, specific cannabis use characteristics associated with opioid use. Qualitative methods were used to examine responses to the question: “What effect does marijuana have on your treatment?”. Results Past-month cannabis use was reported by 51% of participants (n = 1178). Any cannabis use compared to non-use was not associated with opioid use (OR = 1.03, 95% CI 0.87–1.23, p = 0.703). Amongst cannabis users, nearly 70% reported daily use, and half reported experiencing cannabis-related side effects, with the most common side effects being slower thought process (26.2%) and lack of motivation (17.3%). For cannabis users, daily cannabis use was associated with lower odds of opioid use, when compared with occasional use (OR = 0.61, 95% CI 0.47–0.79, p < 0.001) as was older age of onset of cannabis use (OR = 0.97, 95% CI 0.94, 0.99, p = 0.032), and reporting cannabis-related side effects (OR = 0.67, 95% CI 0.51, 0.85, p = 0.001). Altogether, 75% of cannabis users perceived no impact of cannabis on their OUD treatment. Conclusion Past-month cannabis use was not associated with more or less opioid use during treatment. For patients who use cannabis, we identified specific characteristics of cannabis use associated with differential outcomes. Further examination of characteristics and patterns of cannabis use is warranted and may inform more tailored assessments and treatment recommendations.

Therapeutic Potential of Cannabis, Cannabidiol, and Cannabinoid-Based Pharmaceuticals

“…In particular, the noneuphorigenic cannabinoid CBD is viewed as having potential therapeutic use for the treatment of opioid use disorder (OUD); unfortunately, to date, only short pilot studies have been conducted, and therefore the effectiveness of this treatment remains unclear [138]. However, another recent study found that daily cannabis use was associated with lower opioid use during treatment of OUD [139]. These findings are in agreement with another study that found cannabis users show lower symptoms of withdrawal [140].…”

Exploring the association between cannabis and opioid use among adults in Washington State: Estimates from a Cross-Sectional Survey

“…Recent studies exploring the association between cannabis use on opioid misuse are conflicting. 4,5,6 In three recent studies exploring the association between cannabis and opioid use, two observed a positive association and one observed an inverse association. 4,5,6 The inverse association was observed in a clinical population in treatment for OUD in Ontario, Canada.…”

“I got a bunch of weed to help me through the withdrawals”: Naturalistic cannabis use reported in online opioid and opioid recovery community discussion forums

“…Additionally, several studies have found that medical cannabis patients report pain management as one of the most common reasons for cannabis use [10][11][12] and that cannabis use was associated with lower opioid use among people who use illicit drugs [13,14]. However, there are also ongoing concerns about cannabis use increasing the risk for non-medical opioid use and opioid and cannabis use disorders, especially among adolescents and young adults [15][16][17][18], and that cannabis use may lead to return to opioid use by people with a history of OUD [19][20][21][22].…”