Among 2,335 patients with opioid use disorder, current cannabis use was associated with 41% higher odds of suicidal ideation over the past 30 days, even after adjusting for depression and anxiety.
Addiction medicine specialists, psychiatrists treating OUD patients, and researchers studying cannabis in the context of opioid harm reduction.
41% higher odds of suicidal ideation with cannabis use in OUD patients
What the researchers found
Current cannabis use was associated with suicidal ideation (OR 1.41, 95% CI 1.11-1.80, P = 0.005) in multivariable analysis. Male sex (OR 1.84), younger age (OR 1.02 per year), and more anxiety/depression symptoms (OR 1.16) also predicted suicidal ideation. 51% of OUD patients reported current cannabis use.
Why it matters
Patients with opioid use disorder are already at high suicide risk. Finding that concurrent cannabis use further increases suicidal ideation in this population is clinically important, especially as cannabis is sometimes promoted for harm reduction in opioid dependence.
The numbers in context
2,335 OUD patients; 51% current cannabis use; cannabis-suicidal ideation OR 1.41; male sex OR 1.84; anxiety/depression OR 1.16
How the study worked
Cross-sectional multivariable logistic regression analysis of 2,335 participants with opioid use disorder from a large cohort. Self-reported current cannabis use and 30-day suicidal ideation were the primary variables.
What this study cannot tell us
Cross-sectional design cannot determine causation. Self-reported cannabis use and suicidal ideation. Cannot control for all confounders. Direction of association unclear.
How to read the evidence
Large cohort with multivariable adjustment, though cross-sectional design limits causal inference.
When this study was published
Published in 2021.
The bigger picture
This creates a tension with studies showing cannabis may help reduce opioid use: if cannabis increases suicidal ideation in OUD patients, the harm reduction calculus becomes more complex.
Questions still open
- Does cannabis cause suicidal ideation in OUD patients, or do those with more severe mental health issues use both cannabis and have suicidal thoughts? Would specific cannabinoid profiles (high CBD, low THC) have a different association? Should OUD treatment programs screen for cannabis use as a suicide risk factor?
Common questions
Does cannabis increase suicide risk in opioid-dependent people?
How common was cannabis use among opioid patients?
Read the original research
The Role of Cannabis Use in Suicidal Ideation Among Patients With Opioid Use Disorder.
Journal of addiction medicine, 15(5), 370-375
Citation
Naji, Leen; Rosic, Tea; Sanger, Nitika; Dennis, Brittany; Worster, Andrew; Paul, James; Thabane, Lehana; Samaan, Zainab. (2021). The Role of Cannabis Use in Suicidal Ideation Among Patients With Opioid Use Disorder.. Journal of addiction medicine, 15(5), 370-375. https://doi.org/10.1097/ADM.0000000000000781
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