Cannabis-positive urine tests predicted noncompliance with opioid addiction treatment | Research

The takeaway

Among veterans receiving buprenorphine for opioid addiction, positive urine tests for marijuana and benzodiazepines, being a smoker, and psychiatric comorbidity were all associated with treatment noncompliance.

Read this if you are in opioid addiction treatment and use cannabis and want to understand how they interact.

Cannabis-positive urines significantly predicted buprenorphine treatment noncompliance

What the researchers found

In a review of 69 veteran patients receiving buprenorphine maintenance for opioid use disorder, researchers found that positive urine drug screens for marijuana and benzodiazepines, along with being a cigarette smoker, were significantly associated with noncompliance (inaccurate pill counts).

Psychiatric comorbidity was also independently associated with noncompliance. However, despite noncompliance with pill counts, patients were generally still taking their prescribed buprenorphine (confirmed by positive urine tests) and had high rates of negative screens for opioids and cocaine.

Why it matters

Identifying risk factors for treatment noncompliance helps clinicians provide more targeted support. Cannabis use during buprenorphine treatment may indicate broader patterns of difficulty with treatment adherence.

The numbers in context

69 patients analyzed from 209 total. Cannabis, benzodiazepines, and smoking were significant predictors (F = 3.08, P = .03). Psychiatric comorbidity was independently significant (F = 4.88, P = .03).

How the study worked

Retrospective chart review of 69 patients (from 209 total) in a VA Medical Center buprenorphine maintenance program (2006-2013). Multiple linear regression identified predictors of noncompliance defined by inaccurate pill count callbacks.

What this study cannot tell us

Very small sample of 69 patients from a single VA center. Retrospective design with chart review limitations. Only 69 of 209 patients had pill count callbacks, introducing selection bias. Noncompliance was defined narrowly by pill count accuracy.

How to read the evidence

Small retrospective chart review at a single center. Identifies associations but cannot establish causation.

When this study was published

Published in 2014.

The bigger picture

The question of whether cannabis use should be tolerated during opioid addiction treatment is debated in clinical practice. This study suggests cannabis use is a marker for noncompliance, though it does not establish whether cannabis use itself causes the noncompliance or simply co-occurs with it.

Questions still open

Does cannabis use directly undermine opioid treatment adherence, or is it a marker for other factors? Should cannabis-positive urines trigger more intensive support rather than treatment consequences? Would addressing cannabis use improve buprenorphine treatment outcomes?

Common questions

Does marijuana use affect opioid addiction treatment?

In this study, veterans who tested positive for marijuana during buprenorphine treatment were more likely to be noncompliant with their medication regimen. However, the study could not determine whether cannabis directly caused the noncompliance.

Were patients still taking their buprenorphine despite noncompliance?

Yes. Despite inaccurate pill counts (the measure of noncompliance), patients generally had positive urine tests for buprenorphine, confirming they were still taking the medication, and had high rates of negative screens for opioids and cocaine.

Read the original research

Factors affecting noncompliance with buprenorphine maintenance treatment.

Journal of addiction medicine, 8(5), 345-50

View on PubMed ↗Publisher’s paper ↗

Citation

Fareed, Ayman; Eilender, Pamela; Ketchen, Bethany; Buchanan-Cummings, Ann Marie; Scheinberg, Kelly; Crampton, Kelli; Nash, Abigail; Shongo-Hiango, Hilaire; Drexler, Karen. (2014). Factors affecting noncompliance with buprenorphine maintenance treatment.. Journal of addiction medicine, 8(5), 345-50. https://doi.org/10.1097/ADM.0000000000000057