Abstract
BackgroundWith 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.MethodsParticipants 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?”.ResultsPast-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.ConclusionPast-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.
Highlights
The health and policy landscapes of substance use and addiction are changing as jurisdictions around the world legalize recreational cannabis while facing an ongoing opioid crisis
Using subgroup analysis by sex, we found the association between reporting cannabisrelated side effects and lower odds of opioid use to hold for men (OR = 0.55, 95% confidence intervals (CI) 0.40, 0.75, p < 0.001), but not for women (OR = 0.86, 95% CI 0.59, 1.26, p = 0.442)
Use; n (%) Age of first cannabis use in years; mean (SD) Age at first regular cannabis use in years; mean (SD) Self-reported cannabis side effects; n (%) Type of side effects reported amongst individuals reporting cannabis-related side effectsa; n (%) Sexual problems Weight gain Paranoia Hallucinations Lack of motivation Slower thought process Decreased school/work performance Other Marijuana cravings score; mean (SD) Self-reported impact of cannabis on medication-assisted treatment (MAT) No impact Helps with opioid cravings Helps with opioid withdrawal symptoms Helps with MAT dose Helps with pain management Increases effect of MAT Other positive effects Worsens opioid use disorder (OUD) symptoms Unsure
Summary
The health and policy landscapes of substance use and addiction are changing as jurisdictions around the world legalize recreational cannabis while facing an ongoing opioid crisis. Understanding the impact of cannabis use for patients with opioid use disorder (OUD) in the light of high rates of concurrent use is important [3]. Outcomes in MAT are variable [9, 10], and ongoing examination of the impact of modifiable factors such as psychiatric comorbidity and polysubstance use on treatment is important. 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
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