In a clinical trial for prescription opioid use disorder, methadone treatment was associated with lower odds of cannabis-positive and benzodiazepine-positive urine screens compared to buprenorphine/naloxone, though non-opioid substance use did not affect treatment outcomes.
People in opioid treatment who use cannabis, addiction medicine providers, treatment program designers
OR 0.47 for THC-positive urine with methadone
What the researchers found
Methadone was associated with lower odds of THC-positive urine (OR 0.47, 95% CI 0.28-0.77) and benzodiazepine-positive urine (OR 0.63, 95% CI 0.40-0.98) compared to buprenorphine/naloxone. No difference in stimulant use. Non-opioid substance use did not predict opioid use or treatment retention.
Why it matters
Understanding how different opioid agonist treatments affect cannabis and other substance use can help clinicians choose optimal treatment and counsel patients about expected patterns of substance use during recovery.
The numbers in context
THC-positive UDS: methadone OR 0.47 (95% CI 0.28-0.77). Benzodiazepine-positive: OR 0.63 (0.40-0.98). Stimulant-positive: OR 1.29 (0.78-2.16, not significant). No association between non-opioid substance use and treatment outcomes.
How the study worked
Secondary analysis of the OPTIMA trial, an open-label, pragmatic, pan-Canadian, multicenter RCT comparing methadone and flexible take-home buprenorphine/naloxone for prescription-type opioid use disorder. Non-opioid substance use assessed by urine drug screens (weeks 2-24).
What this study cannot tell us
Open-label trial design. Secondary analysis not powered for substance use outcomes. Prescription-type OUD may differ from illicit opioid use disorder. UDS detection windows vary by substance. Canadian healthcare context.
How to read the evidence
Secondary analysis of a pragmatic RCT provides moderate evidence, but was not designed to study non-opioid substance use as a primary outcome.
When this study was published
2024 secondary analysis of the pan-Canadian OPTIMA trial
The bigger picture
The finding that non-opioid substance use (including cannabis) did not affect opioid treatment outcomes is reassuring. It suggests clinicians should not withhold OAT based on continued cannabis use, as it does not appear to undermine treatment.
Questions still open
- Why does methadone reduce cannabis use more than buprenorphine? Is it related to stronger sedation, more clinic contact, or pharmacological differences? Should cannabis use during OAT be treated differently for prescription vs. illicit OUD?
Common questions
Does cannabis use during opioid treatment affect outcomes?
Why might methadone patients use less cannabis?
Read the original research
Associations Between Buprenorphine\Naloxone and Methadone Treatment and non-Opioid Substance Use in Prescription-Type Opioid Use Disorder: Secondary Analyses From the OPTIMA Study: Associations entre le traitement avec la buprénorphine/naloxone et avec la méthadone et l'utilisation de substances non opioïdes dans le trouble lié à l'usage d'opioïdes de type sur ordonnance : analyses secondaires de l'étude OPTIMA.
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 69(4), 252-263
Citation
Bakouni, Hamzah; Sharafi, Heidar; Drouin, Sarah; Fortin, Raphaelle; Marsan, Stéphanie; Brissette, Suzanne; Socias, Maria Eugenia; Le Foll, Bernard; Lim, Ron; Jutras-Aswad, Didier. (2024). Associations Between Buprenorphine\Naloxone and Methadone Treatment and non-Opioid Substance Use in Prescription-Type Opioid Use Disorder: Secondary Analyses From the OPTIMA Study: Associations entre le traitement avec la buprénorphine/naloxone et avec la méthadone et l'utilisation de substances non opioïdes dans le trouble lié à l'usage d'opioïdes de type sur ordonnance : analyses secondaires de l'étude OPTIMA.. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 69(4), 252-263. https://doi.org/10.1177/07067437231210796
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