Tea Rosic1,2, Raveena Kapoor3, Balpreet Panesar4, Leen Naji2,5, Darren B Chai6, Nitika Sanger7, David C Marsh8,9,10,11, Andrew Worster2,12, Lehana Thabane2,13,14, Zainab Samaan15,16. 1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th St, Hamilton, ON, L8N 3K7, Canada. 2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 3. Bachelor of Health Sciences, McMaster University, Hamilton, ON, Canada. 4. Neurosciences Graduate Program, McMaster University, Hamilton, ON, Canada. 5. Department of Family Medicine, McMaster University, Hamilton, ON, Canada. 6. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. 7. Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada. 8. Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada. 9. Canadian Addiction Treatment Centres, 175 Commerce Valley Drive West, Suite 300, Markham, ON, L3T 7P6, Canada. 10. ICES North, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. 11. Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada. 12. Department of Medicine, McMaster University, Hamilton, ON, Canada. 13. Biostatistics Unit, Research Institute at St Joseph's Healthcare, Hamilton, ON, Canada. 14. Departments of Pediatrics/Anesthesia, McMaster University, Hamilton, ON, Canada. 15. Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th St, Hamilton, ON, L8N 3K7, Canada. samaanz@mcmaster.ca. 16. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. samaanz@mcmaster.ca.
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.
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.
Entities:
Keywords:
Cannabis; Harm reduction; Marijuana; Opioid; Polysubstance use
Authors: Adam Bisaga; Maria A Sullivan; Andrew Glass; Kaitlyn Mishlen; Martina Pavlicova; Margaret Haney; Wilfrid N Raby; Frances R Levin; Kenneth M Carpenter; John J Mariani; Edward V Nunes Journal: Drug Alcohol Depend Date: 2015-07-08 Impact factor: 4.492