Among 100 men on long-term buprenorphine maintenance, those who used cannabis (35%) had comparable opioid cravings, withdrawal symptoms, employment, and quality of life to non-users, despite being on lower buprenorphine doses.
Read this if you use cannabis while on buprenorphine treatment and want to know if it affects your recovery.
Cannabis users on lower buprenorphine doses (7.9 vs 8.9 mg) with equivalent outcomes
What the researchers found
Researchers studied 100 randomly selected men who had been stable on buprenorphine maintenance for opioid use disorder for an average of 96 months. Compliance with buprenorphine was excellent across the group, with patients taking their medication on approximately 87 of every 90 days.
Thirty-five percent were currently using cannabis, and 77% had used it at some point in their lives. Current cannabis users were on significantly lower buprenorphine doses (7.9 mg vs 8.9 mg per day), yet showed no significant differences in opioid use, cravings, or withdrawal symptoms compared to non-users.
Employment rates, daily earnings, and quality of life scores across all domains were comparable between cannabis users and non-users. The findings suggest that concurrent cannabis use does not negatively impact the effectiveness of buprenorphine maintenance treatment for opioid use disorder.
Why it matters
Whether cannabis use undermines opioid treatment is a practical clinical question with real consequences. Some treatment programs prohibit cannabis use, potentially excluding patients who could benefit from opioid treatment. This study provides evidence that cannabis use may not warrant exclusion from buprenorphine treatment, especially given the lower buprenorphine doses among cannabis users.
The numbers in context
100 male patients studied. Average buprenorphine treatment duration: 96 months. Compliance: 86.92 days out of 90. 35% currently using cannabis. 77% lifetime cannabis use. Cannabis users on lower buprenorphine doses: 7.9 mg vs 8.9 mg (p = 0.04). No significant differences in opioid use, cravings, withdrawals, employment, or quality of life.
How the study worked
This was a cross-sectional study of 100 randomly selected adult male patients attending a community drug treatment clinic who had been stabilized on buprenorphine for more than 3 months. Measures included the WHO-ASSIST substance involvement screening tool and WHO Quality of Life-Brief assessment. Cannabis users and non-users were compared on buprenorphine dose, opioid outcomes, employment, and quality of life.
What this study cannot tell us
The sample was exclusively male, limiting generalizability to women. The cross-sectional design cannot determine causation. Patients were long-term stable patients (average 96 months), who may differ from those early in treatment. Cannabis use was self-reported. The study was conducted at a single community clinic in India, and findings may not generalize to other treatment settings.
How to read the evidence
This is a moderate-sized cross-sectional study with appropriate measures, but the observational design limits causal conclusions.
When this study was published
Published in 2018. The debate about cannabis use during opioid treatment continues with mixed findings.
The bigger picture
This study contributes to an ongoing debate about whether cannabis should be tolerated or prohibited during opioid agonist treatment. While some studies report cannabis use as a risk factor for poor treatment outcomes, this and other research suggests the relationship may be more nuanced, with cannabis potentially not interfering with, or possibly even supporting, opioid recovery.
Questions still open
- Could cannabis use actually support opioid recovery in some patients, as suggested by the lower buprenorphine doses among cannabis users? Would these findings hold in the early stages of buprenorphine treatment? Should opioid treatment programs reconsider policies that exclude cannabis users?
Common questions
Does cannabis interfere with buprenorphine treatment?
Should treatment programs test for cannabis?
Read the original research
Does Cannabis Use Influence Opioid Outcomes and Quality of Life Among Buprenorphine Maintained Patients? A Cross-sectional, Comparative Study.
Journal of addiction medicine, 12(4), 315-320
Citation
Bagra, Igam; Krishnan, Vijay; Rao, Ravindra; Agrawal, Alok. (2018). Does Cannabis Use Influence Opioid Outcomes and Quality of Life Among Buprenorphine Maintained Patients? A Cross-sectional, Comparative Study.. Journal of addiction medicine, 12(4), 315-320. https://doi.org/10.1097/ADM.0000000000000406
Explore the wider topic
- Physical vs Psychological Cannabis Dependence: What Science Actually Shows
- The Gap Between Cannabis Perception and Science: Why What We Believe Outpaces What We Know
- Cannabis Use Disorder: Am I Addicted? Self-Assessment Guide
- Cross-Addiction After Quitting Weed: When One Habit Replaces Another
- Is Weed Addictive? What the Research Actually Shows
- Is Cannabis Addictive? What the DSM-5 and Brain Science Say
- Quitting Weed and Alcohol Together: What to Know About Dual Cessation
- Is Rehab Necessary for Weed? An Honest Assessment
- Signs You May Have Cannabis Use Disorder: An Honest Self-Assessment
- Weed Vape Pen Addiction: Why Vaping Makes It Harder to Quit