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Rogan M, Nunes JC, Xie CZ, Sofuoglu M, Pittman B, De Aquino JP. Brief report: The influence of childhood trauma on the effects of delta-9-tetrahydrocannabinol in persons with opioid use disorder. Am J Addict 2024; 33:343-346. [PMID: 38059660 PMCID: PMC11032222 DOI: 10.1111/ajad.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/21/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Childhood trauma (CT) increases addiction vulnerability. We examined CT's impact on delta-9-tetrahydrocannabinol (THC) effects. METHODS This is a post-hoc analysis of a randomized, placebo-controlled, crossover trial investigating the effects of oral THC (10, 20 mg) among 25 persons receiving methadone for opioid use disorder (OUD). RESULTS Greater CT was associated with lower aversive effects from higher THC doses (20 mg) (p = .006). DISCUSSION AND CONCLUSIONS CT may reduce the subjective aversive effects of THC, potentially leading to greater cannabis use in individuals with OUD. SCIENTIFIC SIGNIFICANCE These findings offer insights into THC's risks versus benefits in OUD subgroups and emphasize assessing CT in OUD treatment and research.
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Affiliation(s)
- Michael Rogan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VISN-1 Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VISN-1 Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Catherine Z Xie
- Department of Counseling and Developmental Psychology, Boston College, Chestnut Hill, Massachusetts, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VISN-1 Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VISN-1 Mental Illness Research Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Connecticut, USA
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Costa GPA, Nunes JC, Heringer DL, Anand A, De Aquino JP. The impact of cannabis on non-medical opioid use among individuals receiving pharmacotherapies for opioid use disorder: a systematic review and meta-analysis of longitudinal studies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:12-26. [PMID: 38225727 DOI: 10.1080/00952990.2023.2287406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/20/2023] [Indexed: 01/17/2024]
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.
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Affiliation(s)
- Gabriel P A Costa
- Faculty of Medicine, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel L Heringer
- Faculty of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Akhil Anand
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH, USA
- Department of Psychiatry, University Hospitals Medical Center, Cleveland, OH, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Castillo F, Hu MC, Liu Y, Balise RR, Weiss RD, Rotrosen J, Nunes EV, Saxon AJ, Feaster DJ, Luo SX. Risks of returning to opioid use at treatment entry and early in opioid use disorder treatment: Role of non-opioid substances. Drug Alcohol Depend 2023; 251:110926. [PMID: 37604012 DOI: 10.1016/j.drugalcdep.2023.110926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Patients in treatment with medications for opioid use disorder (MOUD) often report use of other substances in addition to opioids. Few studies exist that examine the relationship between use at treatment entry and early non-opioid use in opioid treatment outcome. METHODOLOGY We combined and harmonized three randomized, controlled MOUD clinical trials from the National Institutes of Drug Abuse (NIDA) Clinical Trials Network (CTN) (N=2197) and investigated the association of non-opioid substance use at treatment entry and during early treatment with a return to opioid use. The trials compared MOUD treatment (buprenorphine, methadone, extended-release naltrexone) in populations with opioid use disorder (OUD). Non-opioid substances were identified through harmonizing self-reported use. The primary outcomes were markers of return to opioid use by 12 weeks. RESULTS When treatment cohorts were adjusted, no association between self-reported treatment entry use of non-opioid substances and week-12 opioid use was detected. During the first month of treatment, higher use of cocaine (OR 1.41 [1.18-1.69]) and amphetamine (OR 1.70 [1.27-2.26]) was found to be associated with higher likelihood of illicit opioid use by week 12. Exploratory analyses of potential treatment cohort-by-predictor interactions showed that those with heavier cocaine use had a lower rate of returning to opioid use in the extended-release naltrexone group than in the methadone group. CONCLUSION Substance use other than opioids at treatment entry is not associated with relapse. Use of cocaine or amphetamines during the first few weeks of MOUD treatment may signal a worse outcome, suggesting a need for additional interventions.
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Affiliation(s)
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University, USA
| | - Ying Liu
- Department of Psychiatry, Columbia University, USA
| | - Raymond R Balise
- Division of Biostatistics, Department of Public Health Sciences, University of Miami, USA
| | - Roger D Weiss
- Department of Psychiatry, Harvard Medical School, Boston, and McLean Hospital, 115 Mill St., Belmont, MA, USA
| | - John Rotrosen
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington, USA
| | - Daniel J Feaster
- Department of Psychiatry, Harvard Medical School, Boston, and McLean Hospital, 115 Mill St., Belmont, MA, USA
| | - Sean X Luo
- Department of Psychiatry, Columbia University, USA
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4
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Hillmer A, Chawar C, Lamri A, Hudson J, Kapczinski F, Minuzzi L, Marsh DC, Thabane L, Paterson AD, Samaan Z. Genetics of cannabis use in opioid use disorder: A genome-wide association and polygenic risk score study. PLoS One 2023; 18:e0289059. [PMID: 37494403 PMCID: PMC10370765 DOI: 10.1371/journal.pone.0289059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Individuals with an Opioid Use Disorder (OUD) have increased rates of cannabis use in comparison to the general population. Research on the short- and long-term impacts of cannabis use in OUD patients has been inconclusive. A genetic component may contribute to cannabis cravings. AIMS Identify genetic variants associated with cannabis use through Genome-wide Association Study (GWAS) methods and investigate a Polygenic Risk Score (PRS). In addition, we aim to identify any sex differences in effect size for genetic variants reaching or nearing genome-wide significance in the GWAS. METHODS The study outcomes of interest were: regular cannabis use (yes/no) (n = 2616), heaviness of cannabis use (n = 1293) and cannabis cravings (n = 836). Logistic and linear regressions were preformed, respectively, to test the association between genetic variants and each outcome, regular cannabis use and heaviness of cannabis use. GWAS summary statistics from a recent large meta-GWAS investigating cannabis use disorder were used to conduct PRS's. Findings are limited to a European ancestry sample. RESULTS No genome-wide significant associations were found. Rs1813412 (chromosome 17) for regular cannabis use and rs62378502 (chromosome 5) for heaviness of cannabis use were approaching genome-wide significance. Both these SNPs were nominally significant (p<0.05) within males and females, however sex did not modify the association. The PRS identified statistically significant association with cannabis cravings. The variance explained by all PRSs were less than 1.02x10-2. CONCLUSION This study provides promising results in understanding the genetic contribution to cannabis use in individuals living with OUD.
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Affiliation(s)
- Alannah Hillmer
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Caroul Chawar
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Amel Lamri
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jacqueline Hudson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Flavio Kapczinski
- McMaster University, Hamilton, ON, Canada
- Universidade Federal do Rio Grande do Sol, Porto Alegre, Brazil
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | | | - Lehana Thabane
- Department of Health Research Method, Evidence & Impact, Hamilton, ON, Canada
| | - Andrew D Paterson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Divisions of Biostatistics and Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Elkrief L, Bastien G, McAnulty C, Bakouni H, Hébert FO, Socias ME, Le Foll B, Lim R, Ledjiar O, Marsan S, Brissette S, Jutras-Aswad D. Differential effect of cannabis use on opioid agonist treatment outcomes: Exploratory analyses from the OPTIMA study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209031. [PMID: 37003540 DOI: 10.1016/j.josat.2023.209031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/09/2022] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Conflictual evidence exists regarding the effects of cannabis use on the outcomes of opioid agonist therapy (OAT). In this exploratory analysis, we examined the effect of recent cannabis use on opioid use, craving, and withdrawal symptoms, in individuals participating in a trial comparing flexible buprenorphine/naloxone (BUP/NX) take-home dosing model to witnessed ingestion of methadone. METHODS We analyzed data from a multi-centric, pragmatic, 24-week, open label, randomized controlled trial in individuals with prescription-type opioid use disorder (n = 272), randomly assigned to BUP/NX (n = 138) or methadone (n = 134). The study measured last week cannabis and opioid use via timeline-follow back, recorded at baseline and every two weeks during the study. Craving symptoms were measured using the Brief Substance Craving Scale at baseline, and weeks 2, 6, 10, 14, 18 and 22. The study measured opioid withdrawal symptoms via Clinical Opiate Withdrawal Scale at treatment initiation and weeks 2, 4, and 6. RESULTS The mean maximum dose taken during the study was 17.3 mg/day (range = 0.5-32 mg/day) for BUP/NX group and 67.7 mg/day (range = 10-170 mg/day) in the methadone group. Repeated measures generalized linear mixed models demonstrated that cannabis use in the last week (mean of 2.3 days) was not significantly associated with last week opioid use (aβ ± standard error (SE) = -0.06 ± 0.04; p = 0.15), craving (aβ ± SE = -0.05 ± 0.08, p = 0.49), or withdrawal symptoms (aβ ± SE = 0.09 ± 0.1, p = 0.36). Bayes factor (BF) for each of the tested models supported the null hypothesis (BF < 0.3). CONCLUSIONS The current study did not demonstrate a statistically significant effect of cannabis use on outcomes of interest in the context of a pragmatic randomized-controlled trial. These findings replicated previous results reporting no effect of cannabis use on opioid-related outcomes.
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Affiliation(s)
- Laurent Elkrief
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Christina McAnulty
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Hamzah Bakouni
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - François-Olivier Hébert
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, Ontario M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, Ontario L9M 1G3, Canada
| | - Ron Lim
- Department of Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Omar Ledjiar
- Unité de recherche clinique appliquée, Centre hospitalier universitaire Ste-Justine, 3175 chemin de la Côte Ste-Catherine, Montréal, Québec H3T 1C5, Canada
| | - Stéphanie Marsan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada
| | - Suzanne Brissette
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
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Suzuki J, Martin B, Prostko S, Chai PR, Weiss RD. Cannabidiol Effect on Cue-Induced Craving for Individuals with Opioid Use Disorder Treated with Buprenorphine: A Small Proof-of-Concept Open-Label Study. INTEGRATIVE MEDICINE REPORTS 2022; 1:157-163. [PMID: 36105269 PMCID: PMC9462449 DOI: 10.1089/imr.2022.0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 12/02/2022]
Abstract
Background: Opioid use disorder (OUD) remains a major public health concern. Despite the use of medications for OUD such as buprenorphine, the current gold-standard treatment, relapse in the context of increased craving remains common. Cannabidiol (CBD) has been shown to reduce cue-induced craving in individuals with OUD, but among those who were not receiving any buprenorphine treatment. This small proof-of-concept open-label study sought to evaluate the effect of CBD on cue-induced craving among individuals with OUD who were being actively treated with buprenorphine. Methods: Participants (n = 5) received CBD (Epidiolex®) 600 mg once daily for 3 consecutive days in an open-label manner. Primary outcome was cue-induced craving measured on a visual analog scale of 0 to 10, calculated as the difference in craving in response to drug-related versus neutral cues. The cue-reactivity paradigm was performed at baseline before CBD administration, and was repeated after 3 days of CBD. Secondary outcomes included scores on depression, anxiety, pain, opioid withdrawal, and side effects. Results: All participants were actively taking buprenorphine for an average of 37.8 months (range 1–120 months). Cue-induced craving was significantly lower after CBD dosing compared with baseline (0.4 vs. 3.2, paired t-test, p = 0.0046). No significant changes in scores for depression, anxiety, pain, or opioid withdrawal were noted. CBD was well tolerated, although one participant experienced moderate sedation; otherwise, no other adverse effects were reported. Conclusions: Given the high risk for bias in a small uncontrolled open label study such as this, results must be interpreted with caution. A larger adequately powered trial with a suitable control group is needed to confirm the finding that CBD may help to reduce cue-induced craving among individuals with OUD currently on buprenorphine treatment. Research should further evaluate whether adjunctive use of CBD can improve clinical outcomes for individuals with OUD maintained on buprenorphine. ClinicalTrials.gov (NCT04192370).
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Bianca Martin
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Sara Prostko
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter R. Chai
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - Roger D. Weiss
- Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
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Meacham MC, Nobles AL, Tompkins DA, Thrul J. "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. PLoS One 2022; 17:e0263583. [PMID: 35134074 PMCID: PMC8824349 DOI: 10.1371/journal.pone.0263583] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
A growing body of research has reported on the potential opioid-sparing effects of cannabis and cannabinoids, but less is known about specific mechanisms. The present research examines cannabis-related posts in two large online communities on the Reddit platform (“subreddits”) to compare mentions of naturalistic cannabis use by persons self-identifying as actively using opioids versus persons in recovery. We extracted all posts mentioning cannabis-related keywords (e.g., “weed”, “cannabis”, “marijuana”) from December 2015 through August 2019 from an opioid use subreddit and an opioid recovery subreddit. To investigate how cannabis is discussed at-scale, we identified and compared the most frequent phrases in cannabis-related posts in each subreddit using term-frequency-inverse document frequency (TF-IDF) weighting. To contextualize these findings, we also conducted a qualitative content analysis of 200 random posts (100 from each subreddit). Cannabis-related posts were about twice as prevalent in the recovery subreddit (n = 908; 5.4% of 16,791 posts) than in the active opioid use subreddit (n = 4,224; 2.6% of 159,994 posts, p < .001). The most frequent phrases from the recovery subreddit referred to time without using opioids and the possibility of using cannabis as a “treatment.” The most frequent phrases from the opioid subreddit referred to concurrent use of cannabis and opioids. The most common motivations for using cannabis were to manage opioid withdrawal symptoms in the recovery subreddit, often in conjunction with anti-anxiety and GI-distress “comfort meds,” and to enhance the “high” when used in combination with opioids in the opioid subreddit. Despite limitations in generalizability from pseudonymous online posts, this examination of reports of naturalistic cannabis use in relation to opioid use identified withdrawal symptom management as a common motivation. Future research is warranted with more structured assessments that examines the role of cannabis and cannabinoids in addressing both somatic and affective symptoms of opioid withdrawal.
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Affiliation(s)
- Meredith C. Meacham
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - Alicia L. Nobles
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - D. Andrew Tompkins
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States of America
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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8
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Ngarachu EW, Kiburi SK, Owiti FR, Kangethe R. The prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya. Subst Abuse Treat Prev Policy 2022; 17:12. [PMID: 35168646 PMCID: PMC8845270 DOI: 10.1186/s13011-022-00437-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cannabis use during methadone treatment may negatively impact treatment outcomes. The aim of this study was to determine the prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya. METHODS This was a retrospective study of 874 patients on methadone therapy at a methadone maintenance treatment clinic in Nairobi, Kenya from December 2014 to November 2018. Data on sociodemographic characteristics and drug use patterns based on urine drug screens was collected from patient files. Data was analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 23.0. RESULTS Point prevalence of cannabis use was 85.8% (95% CI, 83.3 - 88.0) at baseline and 62.7% (95% CI, 59.5 - 65.8) during follow-up. A pattern of polysubstance use was observed where opioids, cannabis and benzodiazepines were the most commonly used drugs. The mean age of the patients was 35.3 (SD 9.0) years with the majority being male, unemployed (76%), (51.4%) had reached primary level of education, and (48.5%) were divorced or separated. University education was associated with reduced risk for cannabis use OR = 0.1 (95% CI, 0.02-0.8, p = 0.031). CONCLUSION Cannabis use is prevalent among patients attending a methadone treatment clinic in Kenya, suggesting need for targeted interventions to address the problem of cannabis use during methadone treatment.
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Affiliation(s)
| | | | | | - Rachel Kangethe
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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9
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A cohort study examining the relationship among housing status, patient characteristics, and retention among individuals enrolled in low-barrier-to-treatment-access methadone maintenance treatment. J Subst Abuse Treat 2022; 138:108753. [DOI: 10.1016/j.jsat.2022.108753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
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10
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Naji L, Rosic T, Sanger N, Dennis B, Hillmer A, Hudson J, Worster A, Paul J, Marsh DC, Thabane L, Samaan Z. Cannabis use and opioid relapse: An exploratory survival analysis of prospectively collected data. Front Psychiatry 2022; 13:1046649. [PMID: 36465312 PMCID: PMC9708870 DOI: 10.3389/fpsyt.2022.1046649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE It is known that only minority of patients with opioid use disorder (OUD) receive treatment, of which only a fraction successfully complete treatment as intended. Factors associated with poor treatment outcomes remain unclear, and there is emerging but conflicting evidence that cannabis use may mitigate opioid use. OBJECTIVE To analyze predictors of relapse amongst patients receiving buprenorphine-naloxone for OUD and identify the association between cannabis use and time to relapse. DESIGN Data were prospectively collected between May 2018 and October 2020, and patients were followed for 12 months. SETTING Thirty-one outpatient opioid agonist treatment clinics across Ontario, Canada. PARTICIPANTS All patients 16 years of age or older receiving buprenorphine-naloxone for OUD who had a urine toxicology screen negative for opioids at baseline were eligible for inclusion. Of the 488 patients consecutively sampled, 466 were included. EXPOSURE Cannabis use. MAIN OUTCOME AND MEASURE Relapse to opioid use assessed using urine toxicology screens. We employed a multivariable Cox-proportional hazard model for our analyses. RESULTS We found that cannabis use was not protective against relapse [hazard ratio (HR) = 1.03, 95% confidence interval (CI): 0.78, 1.36, p = 0.84]. We found that participants who have been in treatment for at least two years had a 44% decrease in the hazard of relapse compared to those in treatment for less than a year (HR = 0.56, 95% CI: 0.34, 0.92, p = 0.021). We also found that the hazard of relapse was 2.6 times higher for participants who were intravenous drug users (HR = 2.61, 95% CI: 1.74, 3.91, p < 0.001), and that for every 1mg increase in the participants' buprenorphine-naloxone dose, the hazard of relapse is 2% greater (HR = 1.02, 95% CI: 1.01, 1.03, p < 0.001). CONCLUSION Our analysis failed to show cannabis to be protective against relapse to opioid use in patients receiving buprenorphine-naloxone for OUD. We identified that individuals who inject drugs, are on higher doses of buprenorphine-naloxone, or have been in treatment for less than two years have a higher hazard for relapse. The presence of such factors may thus warrant closer patient follow-up and more stringent treatment protocols to mitigate risk of relapse and potential overdose.
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Affiliation(s)
- Leen Naji
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tea Rosic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Nitika Sanger
- Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Brittany Dennis
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alannah Hillmer
- Neuroscience Graduate Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jacqueline Hudson
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Research Institute at St Joseph's Healthcare, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
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11
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Namba MD, Leyrer-Jackson JM, Nagy EK, Olive MF, Neisewander JL. Neuroimmune Mechanisms as Novel Treatment Targets for Substance Use Disorders and Associated Comorbidities. Front Neurosci 2021; 15:650785. [PMID: 33935636 PMCID: PMC8082184 DOI: 10.3389/fnins.2021.650785] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
Recent studies examining the neurobiology of substance abuse have revealed a significant role of neuroimmune signaling as a mechanism through which drugs of abuse induce aberrant changes in synaptic plasticity and contribute to substance abuse-related behaviors. Immune signaling within the brain and the periphery critically regulates homeostasis of the nervous system. Perturbations in immune signaling can induce neuroinflammation or immunosuppression, which dysregulate nervous system function including neural processes associated with substance use disorders (SUDs). In this review, we discuss the literature that demonstrates a role of neuroimmune signaling in regulating learning, memory, and synaptic plasticity, emphasizing specific cytokine signaling within the central nervous system. We then highlight recent preclinical studies, within the last 5 years when possible, that have identified immune mechanisms within the brain and the periphery associated with addiction-related behaviors. Findings thus far underscore the need for future investigations into the clinical potential of immunopharmacology as a novel approach toward treating SUDs. Considering the high prevalence rate of comorbidities among those with SUDs, we also discuss neuroimmune mechanisms of common comorbidities associated with SUDs and highlight potentially novel treatment targets for these comorbid conditions. We argue that immunopharmacology represents a novel frontier in the development of new pharmacotherapies that promote long-term abstinence from drug use and minimize the detrimental impact of SUD comorbidities on patient health and treatment outcomes.
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Affiliation(s)
- Mark D. Namba
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | | | - Erin K. Nagy
- Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - M. Foster Olive
- Department of Psychology, Arizona State University, Tempe, AZ, United States
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12
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Rosic T, Sanger N, Panesar B, Foster G, Marsh DC, Rieb L, Thabane L, Worster A, Samaan Z. Cannabis use in patients treated for opioid use disorder pre- and post-recreational cannabis legalization in Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:34. [PMID: 33849580 PMCID: PMC8045320 DOI: 10.1186/s13011-021-00372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 11/28/2022]
Abstract
Background As the legalization of recreational cannabis becomes more widespread, its impact on individuals with substance use disorders must be studied. Amidst an ongoing opioid crisis, Canada’s legalization of recreational cannabis in October 2018 provides an important setting for investigation. We examined changes to cannabis use patterns in patients receiving medication-assisted treatment (MAT) for opioid use disorder (OUD) following legalization. Methods This study includes cross-sectional data from 602 participants recruited 6 months pre-legalization and 788 participants recruited 6 months post-legalization, providing information on cannabis use. Regression analysis was used to estimate the association between legalization and cannabis use patterns. We collected longitudinal urine drug screens (UDSs) detecting cannabis-metabolites for 199 participants recruited pre-legalization and followed prospectively post-legalization. Conditional logistic regression was used to assess the association between legalization and UDS results. Results Past-month cannabis use was self-reported by 54.8 and 52.3% of participants recruited pre- and post-legalization, respectively. Legalization was not associated with changes in any measured cannabis characteristics: cannabis use (OR 0.91, 95% CI 0.73–1.13), days of use/month (B -0.42, 95% CI - 2.05-1.21), money spent, or cannabis source. There was no association between legalization and prevalence of cannabis use on UDS (OR 1.67, 95% CI 0.93–2.99) or percentage of cannabis-positive UDSs (OR 1.00, 95% CI 0.99–1.01). Participants overwhelmingly reported that legalization would have no impact on their cannabis use (85.7%). Conclusions Amongst patients treated for OUD, no significant change in cannabis use was observed following legalization; however, high rates of cannabis use are noted.
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Affiliation(s)
- Tea Rosic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Nitika Sanger
- Medical Sciences Graduate Program, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Balpreet Panesar
- Neurosciences Graduate Program, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Gary Foster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Biostatistics Unit, Research Institute at St Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada.,Canadian Addiction Treatment Centres, 175 Commerce Valley Drive West, Suite 300, Markham, Ontario, L3T 7P6, Canada.,ICES North, 41 Ramsey Lake Road Sudbury, Sudbury, ON, P3E 5J1, Canada
| | - Launette Rieb
- Department of Family Practice, University of British Columbia and St. Paul's Hospital, 1081 Burrard St, Hornby site, Vancouver, BC, V6Z 1Y6, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Biostatistics Unit, Research Institute at St Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
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13
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Abstract
With the growing public interest in the potential therapeutic benefits of cannabis and cannabinoids in the treatment of opioid use disorder (OUD), some states have now either added or proposed to add OUD as an indication for their state's medical marijuana program. However, these initiatives are based on weak evidence which at present do not support the listing of cannabis or cannabinoids as a treatment for OUD. Nevertheless, studying the potential therapeutic applications of carefully chosen components of cannabis or cannabinoids to treat specific aspects of OUD is not without scientific merit. Given the high rates of treatment discontinuation among those taking medications for OUD, interventions that further improve clinical outcomes are especially needed. The potential therapeutic applications of cannabis and cannabinoids in the treatment of OUD are worthy of further study, but it should be conducted with the same rigor that we expect of all pharmaceutical products. Until we have more research to show their efficacy, policy makers and clinicians should refrain from portraying cannabis and cannabinoids as evidence-based treatments for OUD.
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115
- Harvard Medical School, Boston 02115, MA
| | - Roger D. Weiss
- Harvard Medical School, Boston 02115, MA
- Division of Drug and Alcohol Abuse, McLean Hospital, 115 Mill St, Belmont, MA 02478
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14
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Rosic T, Kapoor R, Panesar B, Naji L, Chai DB, Sanger N, Marsh DC, Worster A, Thabane L, Samaan Z. The association between cannabis use and outcome in pharmacological treatment for opioid use disorder. Harm Reduct J 2021; 18:24. [PMID: 33622351 PMCID: PMC7903683 DOI: 10.1186/s12954-021-00468-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Tea Rosic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th St, Hamilton, ON, L8N 3K7, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Raveena Kapoor
- Bachelor of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Balpreet Panesar
- Neurosciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Leen Naji
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Darren B Chai
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nitika Sanger
- Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada
- Canadian Addiction Treatment Centres, 175 Commerce Valley Drive West, Suite 300, Markham, ON, L3T 7P6, Canada
- ICES North, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada
- Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Research Institute at St Joseph's Healthcare, Hamilton, ON, Canada
- Departments of Pediatrics/Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th St, Hamilton, ON, L8N 3K7, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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15
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Adelson M, Smith D, Peles E. Trend differences over 20 years between two methadone maintenance clinics, one with and one without cannabis legalization. J Addict Dis 2021; 39:226-233. [PMID: 33559536 DOI: 10.1080/10550887.2020.1848248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although methadone maintenance treatment (MMT) guidelines are well established, patients' characteristics and outcome change over time may be affected by the legality of cannabis. OBJECTIVE To study trend changes between two clinics over 20 years from Las Vegas (LV) and 27 years from Tel Aviv (TA). METHODS Patients' characteristics at admission, including drugs in urine at first and 13th month were obtained from their medical charts. Changes by year of admission and cumulative retention were analyzed. RESULTS The LV MMT clinic (1724 patients) had a lower one-year retention rate compared to the TA MMT clinic (1014 patients) (46.4% vs. 74.4%, respectively, p < 0.0005), and a higher rate of opioid stop after one year (75.9% vs. 68.8%, respectively, p = 0.003). The age at MMT admission and the retention rates decreased in LV and increased in TA. The prevalence of cannabis and benzodiazepine misuse on MMT admission increased in LV with no change recorded in TA. Cocaine on MMT admission decreased in LV and increased in TA, while amphetamine use increased in LV and decreased in TA. Cox models multivariate analyses found cannabis on admission to predict shorter retention in LV (as younger age male and amphetamines), and cannabis after one year in TA (as did cocaine and opiates after one year and BDZ on admission). CONCLUSION Although cannabis prevalence increased only in LV where it was legalized, it was associated with poor outcomes in both clinics. Younger age, a known poor outcome predictor, may be related to decreased retention in LV.
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Affiliation(s)
- Miriam Adelson
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse Treatment & Research, Las Vegas, NV, USA.,Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dinita Smith
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse Treatment & Research, Las Vegas, NV, USA
| | - Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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16
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Socías ME, Choi J, Lake S, Wood E, Valleriani J, Hayashi K, Kerr T, Milloy MJ. Cannabis use is associated with reduced risk of exposure to fentanyl among people on opioid agonist therapy during a community-wide overdose crisis. Drug Alcohol Depend 2021; 219:108420. [PMID: 33342591 PMCID: PMC8006801 DOI: 10.1016/j.drugalcdep.2020.108420] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/14/2020] [Accepted: 10/31/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The ongoing opioid overdose crisis is driven largely by exposure to illicitly-manufactured fentanyl. Preliminary observational and experimental research suggests that cannabis could potentially play a role in reducing use of prescription opioids among individuals with chronic pain. However, there is limited data on the effects of cannabis on illicit opioid consumption, particularly fentanyl, especially among individuals on opioid agonist therapy (OAT). We sought to assess the longitudinal association between cannabis use and exposure to fentanyl among people on OAT. METHODS Data were drawn from two community-recruited prospective cohorts of people who use drugs in Vancouver, Canada. We used generalized linear mixed-effects modeling, adjusted by relevant confounders, to investigate the relationship between cannabis use and recent fentanyl exposure (both assessed by urine drug testing) among participants on OAT between 2016 and 2018. RESULTS Among the 819 participants on OAT who contributed 1989 observations over the study period, fentanyl exposure was common. At the baseline interview, fentanyl was detected in a majority of participants (431, 53 %), with lower prevalence among individuals with urine drug tests positive for tetrahydrocannabinol (47 vs. 56 %, p = 0.028). Over all study interviews, cannabis use was independently associated with reduced likelihood of being recently exposed to fentanyl (Adjusted Prevalence Ratio = 0.91, 95 % Confidence Interval: 0.83 - 0.99). CONCLUSIONS Participants on OAT using cannabis had significantly lower risk of being exposed to fentanyl. Our findings reinforce the need for experimental trials to investigate the potential benefits and risks of controlled cannabinoid administration for people on OAT.
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Affiliation(s)
- M Eugenia Socías
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - JinCheol Choi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Stephanie Lake
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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17
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Abstract
OBJECTIVES Cannabis use is associated with suicide risk in the general population; however, it is unknown if this association is also present in patients with opioid use disorder (OUD). The purpose of this study is to investigate the association between cannabis use and suicidal ideation in patients with OUD. METHODS We conducted a multivariable logistic regression analysis to assess the association between cannabis use and suicidal ideation, amongst a large cohort of patients with OUD. Current cannabis use and suicidal ideation over the past 30 days were obtained by self-report. RESULTS Cross-sectional data from 2335 participants with OUD were included in the analysis, of whom 51% report current cannabis use. We found a positive association between cannabis use and suicidal ideation (OR = 1.41, 95% CI 1.11, 1.80, P = 0.005). We found that men (OR = 1.84, 95% CI 1.44, 2.35, P < 0.001), younger individuals (OR = 1.02, 95% CI 1.01, 1.03), P = 0.004), and that those with more symptoms of anxiety or depression (OR = 1.16, 95% CI 1.15, 1.18, P < 0.001) were more likely to report suicidal ideation. CONCLUSIONS Cannabis use is associated with a heightened propensity for suicidal ideation amongst patients with OUD, who are already a high-risk population. Further research into the potential harms of cannabis use in this population is required given the prevalence of its use and potential benefits in mitigating opioid withdrawal.
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18
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Frank D. "That's No Longer Tolerated": Policing Patients' Use of Non-opioid Substances in Methadone Maintenance Treatment. J Psychoactive Drugs 2020; 53:10-17. [PMID: 32996399 DOI: 10.1080/02791072.2020.1824046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current overdose crisis in the United States emphasizes the importance of providing substance use treatment programs that are not only effective but tailored to meet the specific needs of the populations they serve. While Methadone Maintenance Treatment (MMT) is considered to be among the best strategies for reducing rates of opioid-involved overdose, its ability to attract and maintain patients may be hindered by a recent focus on policing the non-opioid substance use of people on the program. This paper uses interview data from treatment providers to examine how clinicians conceptualize and organize MMT in regards to patients' use of non-opioid drugs. Responses demonstrate that some treatment providers are increasingly monitoring their patients' use of non-opioid substances and punishing them for infractions, up to and including discharge from treatment. This approach will likely result in increasing rates of patient dropout and a lack of new admissions among people who use non-opioid substances. This article argues that including non-opioid substances in MMT's mandate restricts its ability to improve public health, including by preventing overdoses, and recommends instead that MMT adopt a more individualized approach, shaped by the needs and goals of the patient rather than those of the clinician.
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Affiliation(s)
- David Frank
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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19
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Woo JJ, van Reekum EA, Rosic T, Samaan Z. Children and Youth Who Use Cannabis for Pain Relief: Benefits, Risks, and Perceptions. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2020; 11:53-61. [PMID: 32547283 PMCID: PMC7247732 DOI: 10.2147/ahmt.s254264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022]
Abstract
We provide up-to-date perspectives on the benefits and risks of medical cannabis for pain management in children and youth. To date, only two studies (a case report and a small observational study) have examined the effects of medical cannabis on pain in children and youth. No controlled trial has commented on long-term safety of medical cannabis. Findings from the recreational cannabis literature reveal significant potential short- and long-term risks of regular cannabis use, including impaired driving, depression, suicidality, psychosis, and tolerance. Despite this, many children and youth are self-medicating with cannabis, and perceive regular cannabis use to be safe. There is a need for better education and counselling of patients regarding the benefits and risks of medical cannabis use.
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Affiliation(s)
- Julia J Woo
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Tea Rosic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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