People who inject drugs in Los Angeles reported using cannabis to help reduce their opioid use | Research

The takeaway

In qualitative interviews with 30 people who inject drugs in Los Angeles, participants described using cannabis to maintain opioid cessation, manage withdrawal symptoms, and reduce opioid use due to cannabis's easier accessibility.

Harm reduction program staff; addiction researchers studying cannabis substitution for opioid use reduction.

3 pathways identified for cannabis-facilitated opioid reduction

What the researchers found

Three themes emerged for how cannabis co-use facilitated reduced opioid use: (1) maintaining opioid cessation and treatment adherence by managing cessation-specific symptoms, (2) managing episodic opioid withdrawal symptoms, and (3) decreasing opioid use because cannabis was more easily accessible than opioids. Participants described cannabis as helping them "get over the hump" of opioid cravings and withdrawal.

Why it matters

With the fentanyl crisis driving unprecedented overdose deaths, understanding how people who inject drugs already use cannabis as a self-directed harm reduction strategy can inform formal intervention design and peer support programs.

The numbers in context

30 interviews conducted at 2 community sites. Three themes identified. Inclusion: injection drug use, opioid and cannabis use, age 18+, English-speaking.

How the study worked

Semi-structured qualitative interviews with 30 people who inject drugs at two community sites in Los Angeles (near a syringe service program and methadone clinic), July 2021 to April 2022. Constructivist grounded theory analysis.

What this study cannot tell us

Qualitative design with 30 participants cannot establish effectiveness. Self-selected, English-speaking sample from two sites in one city. No objective measures of opioid reduction. Participants were already using both substances, creating potential confirmation bias.

How to read the evidence

Qualitative study providing rich descriptive data but no quantitative outcomes or control group.

When this study was published

2024 study

The bigger picture

These findings suggest cannabis could complement medication-assisted treatment for opioid use disorder, either through peer distribution programs or integration into clinical settings. However, the current evidence is qualitative, and effectiveness outcomes remain unmeasured.

Questions still open

Does cannabis substitution actually reduce overdose risk in this population? Would formal integration of cannabis into MOUD programs improve retention and outcomes?

Common questions

Can cannabis replace opioid addiction treatment?

This study does not suggest cannabis as a replacement for proven treatments like methadone or buprenorphine. Participants described cannabis as a supplementary tool for managing symptoms, not a standalone treatment.

Is there a risk of developing cannabis dependence instead?

The study did not assess cannabis dependence. Trading one substance dependence for another is a legitimate concern, though cannabis carries far lower overdose and mortality risk than opioids.

Read the original research

"Smoking weed it gets you over the hump": Cannabis co-use as a facilitator of decreased opioid use among people who inject drugs in Los Angeles, California.

Drug and alcohol dependence reports, 12, 100257

View on PubMed ↗Publisher’s paper ↗

Citation

Ganesh, Siddhi S; Gould, Erin E; Conner, Bradley T; Huh, Jimi; Ceasar, Rachel Carmen; Bluthenthal, Ricky N. (2024). "Smoking weed it gets you over the hump": Cannabis co-use as a facilitator of decreased opioid use among people who inject drugs in Los Angeles, California.. Drug and alcohol dependence reports, 12, 100257. https://doi.org/10.1016/j.dadr.2024.100257