The United States records about 300 drug overdose deaths (106,699 annual deaths in 2021) every day, as per data by the Centers for Disease Control and Prevention (CDC). Of these, 75 percent are because of opioid overdose.
Opioid use disorder (OUD) is not only country-specific but a significant global health issue with high economic costs and mortality rates.
Existing FDA-approved treatments include methadone, buprenorphine, and naltrexone, but people with OUD often use other substances, including cannabis, as a way to wean off opioid addiction.
The researchers of this study did a meta-analysis of 10 studies involving 8,367 individuals with OUD. It was found that cannabis use does not significantly impact non-medical opioid use.
The studies included individuals undergoing pharmacotherapy for OUD, with methadone being the most commonly used treatment (76.3 percent), followed by buprenorphine (21.3 percent) and intramuscular extended-release naltrexone (2.4 percent).
Only one study reported a significant, positive relationship between cannabis and non-medical opioid use.
The increasing popularity of cannabis, partly due to changing legalization trends, raises questions about its potential impact on OUD outcomes.
Some studies suggest cannabis could have opioid-sparing effects, reducing associated risks, while others suggest it may increase the risk of non-medical opioid use.
The researchers conducted another review involving nine studies with 1,190 patients. The studies were done in durations ranging from 3 to 18 months with an average monitoring period of 8 months.
Among the patients, 66 percent were on methadone, 25 percent on buprenorphine, and 9 percent on naltrexone. Only three studies found a significant connection between cannabis and non-medical opioid use, suggesting that cannabis may lead to opioid use in some cases.
Two retrospective studies suggested no significant changes in opioid use among cannabis users, while one study reported an association between daily cannabis use and non-medical opioid use.
“Our systematic review and meta-analysis of longitudinal studies did not find a significant association between cannabis use and subsequent non-medical opioid use among people receiving pharmacotherapies for OUD,” concluded researchers in the study.
Another study
published in November 2023, which tracked the relationship between cannabis
and cocaine, also had similar results. They couldn’t find enough proof to say for sure if using one of these substances makes a person more likely to use the other or if it works both ways.
The latest studywas published in the journalThe American Journal of Drug and Alcohol Abuse.
Study abstract:
Background:
The relationship between cannabis use and the risk of returning to using opioids non-medically during treatment for opioid use disorder (OUD) remains unclear.
Objective:
We sought to quantify the impact of cannabis use on the risk of non-medical opioid use among people receiving pharmacotherapies for OUD.
Methods:
A comprehensive search was performed using multiple databases from March 1 to April 5 of 2023. Eligible studies longitudinally assessed the association between cannabis use and non-medical opioid use among people with OUD receiving treatment with buprenorphine, methadone, or naltrexone. We utilized a random-effects model employing the restricted maximum likelihood method. A sensitivity analysis was conducted to understand potential differences between each OUD treatment modality.
Results:
A total of 10 studies were included in the final meta-analysis. There were 8,367 participants (38% female). The average follow-up time across these studies was 9.7 months (SD = 3.77), ranging from 4 to 15 months. The pharmacotherapies involved were methadone (76.3%) buprenorphine (21.3%), and naltrexone (2.4%). The pooled odds ratio did not indicate that cannabis use significantly influenced non-medical opioid use (OR: 1.00, 95% CI: 0.97–1.04, p = .98). There is evidence of moderate heterogeneity and publication bias.
Conclusion:
There was no significant association between cannabis use and non-medical opioid use among patients receiving pharmacotherapies for OUD. These findings neither confirm concerns about cannabis increasing non-medical opioid use during MOUD, nor do they endorse its efficacy in decreasing non-medical opioid use with MOUD. This indicates a need for individualized approaches for cannabis use and challenges the requirement of cannabis abstinence to maintain OUD pharmacotherapies.