Cannabis use did not reduce opioid withdrawal symptoms during a methadone taper | Research

The takeaway

Among 116 patients undergoing methadone dose reduction, cannabis use did not reduce opioid withdrawal symptoms, moving the evidence slightly closer to negative for this claimed benefit.

Read this if you use cannabis to manage opioid withdrawal and want to know what the evidence shows.

No evidence cannabis reduced opioid withdrawal during methadone taper

What the researchers found

Researchers analyzed data from 116 outpatient heroin and cocaine users undergoing a 10-week methadone taper, of whom 46 also used cannabis. Opioid withdrawal symptom scores did not differ overall between cannabis users and non-users.

A temporal analysis found a slight, non-significant suggestion that higher withdrawal symptoms preceded cannabis use (suggesting self-medication attempts), but cannabis use in one week did not predict lower withdrawal symptoms the following week. Both findings were robust across 17 different sensitivity analyses controlling for potential confounders.

The authors concluded that these findings move the evidence for smoked cannabis as a reducer of opioid withdrawal symptoms from "inconclusive" closer to negative, at least in the context of a methadone taper. They noted this finding does not preclude other potential uses of cannabinoids in addiction treatment.

Why it matters

Claims that cannabis helps with opioid withdrawal are common among patients and some advocates. This study provides controlled evidence that in a clinical setting, cannabis did not demonstrably reduce withdrawal symptoms, which is important for setting realistic treatment expectations.

The numbers in context

116 patients in methadone taper. 46 were cannabis users. No significant difference in withdrawal scores between users and non-users. Temporal analysis effect sizes near zero (r = .01 for cannabis reducing withdrawal). Controlled for 17 confounders.

How the study worked

Secondary analysis of a clinical trial with 116 outpatient heroin and cocaine users who completed a 10-week methadone taper. Weekly urine screens for cannabinoids and biweekly withdrawal assessments were analyzed using lagged temporal analyses. Sensitivity analyses controlled for 17 potential confounders.

What this study cannot tell us

Secondary analysis not designed to test this specific hypothesis. Cannabis use was self-directed, not controlled. The methadone taper context may not generalize to other opioid withdrawal settings. Only 46 cannabis users in the analytic sample. Urine screening may not capture all cannabis use patterns.

How to read the evidence

Secondary analysis of clinical trial data with multiple sensitivity analyses. Well-controlled but observational regarding cannabis use.

When this study was published

Published in 2015. Cannabinoid-opioid interaction research has continued.

The bigger picture

While some laboratory studies have shown cannabinoids can modulate aspects of opioid withdrawal, real-world evidence from this clinical context does not support the practice of using smoked cannabis to ease methadone tapering. Other cannabinoid-based approaches (synthetic, targeted dosing) may still have potential.

Questions still open

Would controlled cannabinoid administration (rather than self-directed smoking) show different results? Does the form of opioid withdrawal (rapid vs. gradual) matter? Could specific cannabinoids like CBD help even if smoked cannabis does not?

Common questions

Does cannabis help with opioid withdrawal?

In this study of 116 patients undergoing methadone tapering, cannabis use did not reduce withdrawal symptoms. The authors described the evidence as moving closer to negative for this specific claim.

Why do some people believe cannabis helps with opioid withdrawal?

Some laboratory studies have shown cannabinoid-opioid system interactions, and individual testimonials report benefit. However, this controlled clinical analysis did not find evidence of withdrawal reduction from self-directed cannabis use.

Read the original research

No evidence for reduction of opioid-withdrawal symptoms by cannabis smoking during a methadone dose taper.

The American journal on addictions, 24(4), 323-8

View on PubMed ↗Publisher’s paper ↗

Citation

Epstein, David H; Preston, Kenzie L. (2015). No evidence for reduction of opioid-withdrawal symptoms by cannabis smoking during a methadone dose taper.. The American journal on addictions, 24(4), 323-8. https://doi.org/10.1111/ajad.12183