A recent study has concluded that there is no connection between cannabis use and non-medical opioid use among individuals undergoing pharmacotherapy for opioid use disorder.
The findings do not support the notion that cannabis either leads to increased opioid use or aids in its reduction.
Cannabis has become increasingly popular, partly due to its legalization in many places, fostering beliefs that its relatively lower risks compared to “harder” drugs could make it a viable treatment for drug addiction, especially opioid addiction.
However, research outcomes have been contradictory. Some studies suggest cannabis alleviates opioid withdrawal symptoms, while others suggest it might promote opioid use.
With over 60 million people worldwide struggling with opioid addiction and more than 100,000 dying annually from opioid overdoses, the question of whether cannabis can facilitate opioid cessation is critically important and warrants urgent investigation.
To address this issue, researchers from the Universities of Ribeirão Preto and São Paulo in Brazil, University Hospitals Medical Center in Cleveland, and Yale School of Medicine conducted a systematic review and meta-analysis.
Their goal was to provide a definitive answer regarding the impact of cannabis on individuals seeking to quit opioids.
“Understanding the interaction between cannabis and opioids is crucial for equipping healthcare professionals with evidence-based addiction treatment strategies, which can prevent overdose deaths and save lives,” emphasized Gabriel Costa, the study’s lead and co-corresponding author.
The study analyzed data from 10 longitudinal studies involving 8,367 participants (38% female) undergoing opioid replacement therapy (buprenorphine 21.3%, methadone 76.3%, or naltrexone 2.4%) for opioid use disorder.
Over an average follow-up period of approximately 10 months, participants were monitored for non-medical opioid use, defined as using opioids not prescribed to them, exceeding prescribed doses, or using opioids without a prescription.
Comparing the frequency of opioid use between cannabis users (typically obtaining cannabis from non-regulated sources) and non-users, the researchers found no correlation between cannabis use and rates of non-medical opioid use.
“We found no significant association between cannabis use and non-medical opioid use among patients receiving pharmacotherapies for opioid use disorder,” Costa reported.
“These findings neither support concerns that cannabis could exacerbate non-medical opioid use in individuals undergoing treatment for opioid use disorder, nor do they endorse its efficacy in reducing non-medical opioid use.”
The study’s implications are substantial, particularly for the operational practices of opioid treatment programs.
“Our findings challenge the practice of mandating cannabis abstinence as a prerequisite for receiving life-saving medications for opioid use disorder,” noted Joao De Aquino, co-corresponding author of the study.
“Instead, healthcare systems should adopt personalized treatment approaches that consider individual circumstances. This includes assessing cannabis use disorder, addressing pain management needs, and treating co-occurring psychiatric conditions such as depression and anxiety.”
Moreover, the study questions the increasingly popular belief that cannabis effectively aids in opioid withdrawal and cessation.
While research on the potential of cannabis and its cannabinoids to mitigate symptoms of opioid use disorder is limited, the authors stress the need for further studies to comprehensively evaluate their safety and efficacy.
Until then, they advocate for the use of currently available FDA-approved treatments.
“As potent synthetic opioids like fentanyl become more prevalent, it is critical that individuals with opioid use disorder have access to FDA-approved treatments,” De Aquino emphasized.
“Methadone, buprenorphine, and extended-release intramuscular naltrexone are well-established life-saving therapies and serve as the foundation for managing opioid use disorder.”
Acknowledging limitations such as inconsistent reporting of cannabis and opioid use, methodological variations across studies, and insufficient research specifically designed to look for the cannabis-opioid relationship, the researchers call for future studies to adopt more rigorous and standardized approaches.
“Our review offers clinical and methodological insights to guide future research in fully elucidating this relationship, particularly amidst shifting attitudes toward cannabis during the escalating opioid crisis,” the researchers concluded.
They caution that while their findings apply broadly to cannabis users, they may not necessarily extend to individuals with cannabis use disorder.
