Among 244 urine drug screens from chronic opioid therapy patients, 9.8% tested positive for THC, with inconsistent clinical documentation and response to positive results.
Pain management clinicians, primary care providers prescribing opioids, addiction medicine specialists
What the researchers found
Of 244 urine drug screens from patients receiving chronic opioid therapy for pain at a single academic center (2024), 24 (9.8%) tested positive for THC. Provider responses to positive results varied widely: some documented patient counseling, others did not acknowledge the result. In a small subset, positive THC led to opioid therapy changes including tapering or discontinuation.
Why it matters
Nearly 10% of chronic opioid patients are concurrently using cannabis, often without their provider's knowledge. The inconsistent clinical response to positive THC screens highlights a need for standardized, non-punitive approaches to concurrent cannabis use in pain management.
The numbers in context
244 urine screens; 24 (9.8%) THC-positive; variable provider documentation and response; some opioid therapy changes in small subset
How the study worked
Retrospective review of 244 urine drug screen results from chronic opioid therapy patients at a single academic institution (January-December 2024). Assessed THC positivity prevalence and documented provider responses.
What this study cannot tell us
Single institution with small sample. Retrospective review cannot capture provider reasoning. Cannot determine whether THC use was medical or recreational. 2024 data from a single year. Provider response documentation may not reflect actual conversations.
How to read the evidence
Preliminary: small single-site retrospective review without comparison group or outcome assessment.
When this study was published
2025 publication using 2024 data
The bigger picture
As cannabis legalization expands, the intersection of cannabis use and opioid prescribing requires clearer clinical guidelines. Punitive responses (stopping opioids) may drive patients to hide cannabis use, while ignoring positive screens misses an opportunity for risk assessment.
Questions still open
- Should concurrent cannabis use change opioid prescribing decisions?
- Would standardized protocols for positive THC screens in opioid patients improve care consistency?
Read the original research
Prevalence of THC-Positive Urine Drug Screens in Patients Receiving Chronic Opioid Therapy: A Retrospective Review.
Psychopharmacology bulletin, 55(4), 36-42
Citation
Hasoon, Jamal; Viswanath, Omar; Urits, Ivan; Abd-Elsayed, Alaa; Kaye, Alan D. (2025). Prevalence of THC-Positive Urine Drug Screens in Patients Receiving Chronic Opioid Therapy: A Retrospective Review.. Psychopharmacology bulletin, 55(4), 36-42. https://doi.org/10.64719/pb.4549
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