Cannabis and Opioid-Addiction. Part I

The cultural perception of cannabis as a recreational narcotic is one reason many patients are not open to the option of cannabis treatment. As more states begin to offer medicinal cannabis, this cultural perception has largely reversed and enabled genuine research around the benefits of cannabis use.  However, many doctors are still asking cannabis consumers who have found medical benefits, to abstain from cannabis.  Underpinning this type of recommendation is the way marijuana use is classified in addiction rehabilitation centers; many make mandatory rules for those seeking treatment in their facilities to cease all cannabis consumption. These physicians base the decision on the reasoning that even if research has confirmed that cannabis use is safe and effective for controlling some health conditions, cannabis might still interfere with recovery from other addictions or otherwise play a harmful role. As it turns out, new research is showing that the reverse is possible. Many addicts are using cannabis to attenuate the effects of withdrawal and help recovery. However, for the focus of this article, we’ll first focus on a Rhode Island study that asked the question, “Does concurrent marijuana use present additional treatment needs or affect outcomes?”

In this study, doctors at an opioid addiction rehabilitation clinic collected frequent drug tests during their rehabilitation program to track both cannabis use and the success of 107 patients in abstaining from opioid use.  They were then able to compare the groups of cannabis users and non-users to analyze whether one group had greater success in opioid addiction recovery. In this program, as in most, drug therapy was used to reduce addicts’ cravings. Doctors administered buprenorphine in amounts specific to each addict to block cravings, then reduced the dose weekly over the course of the recovery program. Readers might be more familiar with methadone, which has historically been more commonly used to block opioid craving in addicts.  More recent programs tend to adopt buprenorphine, which is just as effective and has almost identical risk for adverse side effects, but unlike methadone, is only a partial opioid receptor agonist.  This means that it its effect on respiratory depression has a ceiling or limit. Since the majority of deaths from overdose occur from loss of breathing, using buprenorphine has proven much safer and more abuse-resistant. However, it is likely the conclusions of this study would apply equally to methadone treatment programs due to the almost identical nature of drug therapy.

Rehabilitation, however, requires more than simply adjusting the body to operate healthily again without constant opioid use. Without measures taken to change the patient’s lifestyle, it’s common to revert back to using opioids, especially in socio-economic brackets where opioids are readily available and the underlying condition causing drug-seeking behavior has not been addressed. Therefore, almost all treatment plans include counseling approaches and social services programs, which are designed to give the patient tools and structure to prevent relapse. This particular program tested three different counseling strategies, but found that no differences existed in terms of the comparison between cannabis users and non-users, which allowed data to be grouped afterwards into one cohesive study. Cannabis users were defined as those who consumed cannabis at any time during the study, to make sure that the data of non-users would not be muddled with users. Users were not encouraged to use cannabis or to sustain their use but were observed throughout the entire program. Success in treatment was quantified in several ways: retention, opioid abstinence, and Addiction Severity Index (ASI) score changes.  All three are important metrics for recovery: retention measures how long patients stay within the program, abstinence measures the highest number of continuous weeks without opioid use, and the ASI is a metric commonly used to rate addiction.  Researchers then summarized the data in the following table:













As seen, results showed no correlation between cannabis use and addiction recovery or treatment.  Retention and abstinence were virtually equal. Additionally, cannabis users were less likely to use other substances during recovery. This could be because users are seeking symptom treatment in other substances as substitutes. Researchers then took data one more step to ask how marijuana use associated with other socioeconomic variables.  In multivariate regressions, cannabis use was shown to have no correlation with marital status, intravenous drug use, or financial difficulties when controlling for the factors of alcohol use, needle sharing, and dealing of drugs.

One caveat to this study is that 107 patients, with roughly 2/3rds cannabis users, is considered a small study within the field of medicine.  However, other similar studies exist with the same conclusion, duplicating the findings here. Another caveat would be that the study is merely program retrospective and does not look at maintenance of recovery for long lengths of time afterwards.  Further testing should center on long-term recovery. However, this study was enough for the rehabilitation program to formally decide to stop focusing on patients’ cannabis use and to make the recommendation for other programs to cease that recommendation as well.  Similar studies have suggested that cannabis use does not affect stimulant recovery programs either, which continues to support the characterization of cannabis as being a relatively inert medicine.

But why is this important? Studies show that close to two thirds of opioid addicts are also cannabis users. This means that most patients seeking recovery from opioid addiction are affected by recommendations about cannabis. Asking those patients to shed use leaves them in the situation of either going without medication or else to have to seek treatment through other substances. More importantly, it continues to list marijuana on the side of unregulated narcotic, purely out of cultural bias.

Our next article on the topic will explore the use of cannabis to attenuate addiction withdrawal symptoms for other substances.














Alan J. Budney, Warren Bickel. & Leslie Amass (1998) Marijuana use and treatment outcome among opioid-dependent patients, Addiction, 93:4, 493-503.

Image: Ruben Lammerink