6 in 10 Opioid Treatment Patients Used Cannabis, Most as a Harm Reduction Strategy
Among 118 German opioid maintenance patients, 60% used cannabis, and 72% of those used it deliberately to reduce their intake of more dangerous drugs like heroin and benzodiazepines.
Quick Facts
What This Study Found
Sixty percent of opioid maintenance patients reported cannabis use. Of those, 72% used cannabis as a substitution strategy for other substances. Cannabis was most commonly used to replace heroin (44.8%) and benzodiazepines (16.4%). When asked to rate how well cannabis substituted for heroin (German school grades 1-6), the average was 2.6. Forty-seven percent used cannabis to reduce pain.
Key Numbers
118 patients surveyed. 60% used cannabis. 72% of users employed it as substitution. Heroin substitution: 44.8%. Benzodiazepine substitution: 16.4%. Heroin substitution rated 2.6/6. Pain management: 47%.
How They Did This
Cross-sectional survey of 118 German opioid maintenance treatment patients using a questionnaire about cannabis use patterns, substitution motivations, self-medication purposes, and negative consequences.
Why This Research Matters
Rather than treating cannabis use in opioid patients as purely problematic, this study suggests many use it strategically as harm reduction, choosing a less dangerous substance over heroin or benzodiazepines.
The Bigger Picture
The harm reduction framing of cannabis use among opioid patients challenges the assumption that all concurrent substance use during treatment is negative. If cannabis helps patients reduce use of more lethal substances, it may have a net positive effect.
What This Study Doesn't Tell Us
Small single-center sample in Germany. Self-reported data. Cross-sectional design cannot confirm that cannabis actually reduced other drug use. No comparison group of non-cannabis-using patients.
Questions This Raises
- ?Does cannabis use actually improve opioid treatment outcomes?
- ?Should clinicians encourage or discourage this substitution strategy?
- ?Would formal cannabis-assisted treatment programs be more effective?
Trust & Context
- Key Stat:
- 72% of cannabis-using opioid patients used it to replace more dangerous drugs
- Evidence Grade:
- Preliminary: small single-center cross-sectional survey with self-reported data
- Study Age:
- Published in 2025
- Original Title:
- Does cannabis use substitute for opioids? A preliminary exploratory survey in opioid maintenance patients.
- Published In:
- European archives of psychiatry and clinical neuroscience, 275(2), 565-572 (2025)
- Authors:
- Bekier, Nina Kim, Frischknecht, Ulrich, Eidenmueller, Katharina, Grimm, Franz, Bach, Patrick, Stenger, Manuel, Kiefer, Falk, Hermann, Derik
- Database ID:
- RTHC-06036
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Why do opioid patients use cannabis?
The most common reasons were to substitute for more dangerous drugs (especially heroin at 44.8% and benzodiazepines at 16.4%) and for pain management (47%). Most framed cannabis as a deliberate harm reduction strategy.
Does this mean cannabis should be part of opioid treatment?
This study suggests cannabis use in opioid patients is often strategic rather than random, but it cannot prove cannabis improves outcomes. The authors recommend viewing it as a potential harm reduction tool rather than automatically treating it as a problem.
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Cite This Study
https://rethinkthc.com/research/RTHC-06036APA
Bekier, Nina Kim; Frischknecht, Ulrich; Eidenmueller, Katharina; Grimm, Franz; Bach, Patrick; Stenger, Manuel; Kiefer, Falk; Hermann, Derik. (2025). Does cannabis use substitute for opioids? A preliminary exploratory survey in opioid maintenance patients.. European archives of psychiatry and clinical neuroscience, 275(2), 565-572. https://doi.org/10.1007/s00406-023-01718-3
MLA
Bekier, Nina Kim, et al. "Does cannabis use substitute for opioids? A preliminary exploratory survey in opioid maintenance patients.." European archives of psychiatry and clinical neuroscience, 2025. https://doi.org/10.1007/s00406-023-01718-3
RethinkTHC
RethinkTHC Research Database. "Does cannabis use substitute for opioids? A preliminary expl..." RTHC-06036. Retrieved from https://rethinkthc.com/research/bekier-2025-does-cannabis-use-substitute
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.