43-53% of Pregnant Women with Opioid or Alcohol Problems Also Used Marijuana | Research

The takeaway

Among 251 pregnant women with opioid use disorder and/or alcohol use, marijuana co-use was remarkably common at 43-53%, with younger age and polysubstance use as the strongest predictors.

Obstetricians managing high-risk pregnancies; addiction medicine specialists; prenatal care researchers.

52.6% marijuana use in pregnant women with combined OUD and alcohol problems

What the researchers found

Marijuana prevalence was 43.2% in the OUD group, 52.6% in the combined OUD+Alcohol group, and 46.4% in the Alcohol group. Weekly or daily use ranged from 19-25%. Women on buprenorphine had higher marijuana use than those on methadone. Younger age and polysubstance use were independent predictors.

Why it matters

Prenatal substance exposure research typically focuses on single substances, but these data show marijuana co-use is extremely common among pregnant women already dealing with opioid or alcohol problems. This means fetal exposure is often multi-substance, complicating risk assessment.

The numbers in context

Marijuana prevalence: OUD 43.2%, OUD+Alcohol 52.6%, Alcohol 46.4%. Weekly/daily use: 19.4%, 21.0%, 24.6% respectively. Buprenorphine patients had higher use than methadone patients (45.8% vs 37.5% in OUD; 58.3% vs 42.9% in OUD+Alcohol). Age: aOR 0.61 per 5-year increment. Polysubstance use: aOR 2.02.

How the study worked

Prospective cohort study (ENRICH-1) of 251 pregnant women classified into OUD (n=125), Alcohol (n=69), and OUD+Alcohol (n=57) groups. Substance use was assessed by self-report and biomarkers. Multivariable logistic regression identified correlates of marijuana use.

What this study cannot tell us

The sample was recruited from specific clinical settings and may not represent all pregnant women with substance use issues. Self-report of marijuana use may underestimate true prevalence. The study was not designed to assess fetal outcomes from marijuana co-exposure.

How to read the evidence

Moderate: well-characterized prospective cohort with both self-report and biomarker data, though from specific clinical settings.

When this study was published

Published in 2022.

The bigger picture

The high rates of marijuana co-use highlight a gap in prenatal care: most screening and treatment programs focus on the primary substance of concern (opioids or alcohol) but may not adequately address marijuana. The buprenorphine-methadone difference is intriguing and warrants investigation.

Questions still open

Does marijuana co-use affect the efficacy of methadone or buprenorphine treatment during pregnancy? Are fetal outcomes worse with combined exposures than with single-substance exposure? Why do buprenorphine patients have higher marijuana use rates?

Common questions

Why is marijuana use so common in pregnant women with other substance problems?

Polysubstance use is common in people with substance use disorders. Marijuana may be perceived as less harmful than opioids or alcohol, and some women may use it to manage symptoms like nausea, anxiety, or pain during pregnancy.

Does marijuana use during pregnancy add risk on top of opioids or alcohol?

This study did not assess fetal outcomes, but the high co-use rates highlight that many fetuses are exposed to multiple substances simultaneously. Other research suggests combined exposures may pose greater risks than individual substances alone.

Read the original research

Prevalence of marijuana use in pregnant women with concurrent opioid use disorder or alcohol use in pregnancy.

Addiction science & clinical practice, 17(1), 3

View on PubMed ↗Publisher’s paper ↗

Citation

Page, Kimberly; Murray-Krezan, Cristina; Leeman, Lawrence; Carmody, Mary; Stephen, Julia M; Bakhireva, Ludmila N. (2022). Prevalence of marijuana use in pregnant women with concurrent opioid use disorder or alcohol use in pregnancy.. Addiction science & clinical practice, 17(1), 3. https://doi.org/10.1186/s13722-021-00285-z