Methadone patients had lower cannabis use than buprenorphine patients in opioid treatment trial
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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).
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- OR 0.47 for THC-positive urine with methadone
- Evidence Grade:
- Secondary analysis of a pragmatic RCT provides moderate evidence, but was not designed to study non-opioid substance use as a primary outcome.
- Study Age:
- 2024 secondary analysis of the pan-Canadian OPTIMA trial
- Original Title:
- 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.
- Published In:
- Canadian journal of psychiatry. Revue canadienne de psychiatrie, 69(4), 252-263 (2024)
- Authors:
- Bakouni, Hamzah(3), Sharafi, Heidar, Drouin, Sarah(2), Fortin, Raphaelle, Marsan, Stéphanie, Brissette, Suzanne, Socias, Maria Eugenia, Le Foll, Bernard, Lim, Ron, Jutras-Aswad, Didier
- Database ID:
- RTHC-05106
Evidence Hierarchy
Frequently Asked Questions
Does cannabis use during opioid treatment affect outcomes?
In this study, no. Cannabis-positive urine screens were not associated with opioid use or treatment retention, suggesting cannabis use during OAT does not undermine treatment success.
Why might methadone patients use less cannabis?
The study found methadone was associated with 53% lower odds of cannabis-positive urine compared to buprenorphine, possibly related to pharmacological differences, stronger sedation, or different clinic attendance patterns, but the mechanism was not determined.
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Cite This Study
https://rethinkthc.com/research/RTHC-05106APA
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
MLA
Bakouni, Hamzah, et al. "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, 2024. https://doi.org/10.1177/07067437231210796
RethinkTHC
RethinkTHC Research Database. "Associations Between Buprenorphine\Naloxone and Methadone Tr..." RTHC-05106. Retrieved from https://rethinkthc.com/research/bakouni-2024-associations-between-buprenorphinenaloxone-and
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.