Patients who use cannabis while being medically treated for opioid use disorder (OUD) are not at greater risk of returning to non-medical opioid use, a new meta-analysis by Yale researchers reveals.
Researchers examined results from previously published longitudinal studies, including 8,000 patients who received methadone, buprenorphine, and extended-release intramuscular naltrexone for treatment of OUD. They were particularly interested in whether cannabis use might facilitate non-medical opioid use. Their findings suggest that cannabis use itself does not undermine OUD treatment, although they acknowledged problematic use may still pose risks.
“The primary takeaway from these analyses is that opioid treatment programs should continue to administer life-saving medications for opioid use disorder, irrespective of whether patients concurrently use cannabis,” said Joao P. De Aquino, MD, assistant professor of psychiatry and the paper’s senior author.
Researchers wrote that the findings, published in the American Journal of Drug and Alcohol Abuse, can be used to question “the ineffective practice of enforcing cannabis abstinence as a condition to offer life-saving medications for OUD, which still persists in parts of the (United States).”
“Instead, these data suggest healthcare systems should adopt individualized treatment approaches, considering each patient's unique circumstances: assessing cannabis use disorder, a problematic pattern cannabis use that affects the person’s ability to function; addressing pain management needs; and treating co-occurring psychiatric conditions, such as depression and anxiety,” they wrote.
The findings could challenge a requirement that patients remain abstinent from cannabis to qualify for life-saving opioid addiction treatment.
“Rather than blanket prohibitions, providers can consider individual factors and treat problematic cannabis use when warranted, while maintaining medications for OUD. This patient-centered approach can improve addiction care,” the researchers wrote.
The researchers say that clarifying how cannabis and opioids may interact “is critical to dispelling myths and equipping healthcare professionals to provide evidence-based addiction treatment — reducing opioid-related harm and shifting clinical decision-making and policy formation toward a more patient-centered approaches in treating OUD.”
Julio Nunes, MD, a second-year psychiatry resident, is a co-author of the paper. Gabriel Costa, final-year medical student from Brazil, currently affiliated with the University of Ribeirão Preto, is the paper’s first author. He was mentored by De Aquino.
The study was funded by the National Institute on Drug Abuse (NIDA).