Synthetic Cannabinoid Use Made Opioid Withdrawal Last Significantly Longer | Research

The takeaway

Opioid-dependent patients who also used synthetic cannabinoids had significantly longer withdrawal and craving symptoms during detoxification, with higher doses and longer use histories predicting worse outcomes.

Readers interested in how synthetic cannabinoid use interacts with opioid dependence and recovery.

Synthetic cannabinoid users had significantly longer opioid withdrawal symptoms (p < 0.001)

What the researchers found

Among 193 patients with opioid use disorder undergoing detoxification in Kazakhstan, the 47 who also regularly used synthetic cannabinoids (SCs) experienced significantly longer withdrawal and craving symptoms compared to those who did not use SCs (p < 0.001).

The study identified a dose-response relationship: higher SC intake in the past 30 days (p = 0.045), more recent SC use (p = 0.033), longer total duration of SC use (p < 0.001), and higher SC doses (p < 0.001) were all independently associated with longer symptom duration.

This was the first prospective study to examine how synthetic cannabinoid use affects the course of opioid withdrawal, revealing that polysubstance use involving SCs creates a more difficult detoxification process.

Why it matters

Synthetic cannabinoids are increasingly used alongside opioids in many parts of the world. Understanding that SC use complicates opioid detoxification has practical implications for treatment planning: patients with concurrent SC use may need longer treatment stays and different management protocols.

The numbers in context

193 total patients. 47 (24.4%) used synthetic cannabinoids. SC users had significantly longer withdrawal (p < 0.001) and craving (p < 0.001). Dose-response relationships confirmed for SC intake (p = 0.045), recency (p = 0.033), duration (p < 0.001), and dosage (p < 0.001).

How the study worked

Prospective case-control study at addiction clinics in Kazakhstan. 193 patients with opioid use disorder underwent integrated detoxification. 47 were regular SC users. Opioid withdrawal was measured using the Clinical Opiate Withdrawal Scale and craving was assessed with a visual analogue scale at multiple time points.

What this study cannot tell us

Conducted at addiction clinics in Kazakhstan, which may limit generalizability to other populations and treatment settings. The synthetic cannabinoids used were not chemically identified, and SC products vary widely in composition and potency. The study did not account for other substances of use beyond SCs and opioids.

How to read the evidence

Moderate evidence from a prospective study with appropriate controls and dose-response analysis.

When this study was published

Published in 2017. First prospective study on SC-opioid withdrawal interaction.

The bigger picture

This study provides clinical evidence for the molecular cross-talk between cannabinoid and opioid systems that has been demonstrated in basic science research. The endocannabinoid and endogenous opioid systems share neuroanatomical overlap and functional interactions, and disrupting both simultaneously through polysubstance use appears to make recovery from either substance more difficult.

Questions still open

Do natural cannabis and synthetic cannabinoids have different effects on opioid withdrawal? Should detoxification protocols be modified for patients with concurrent SC use? Would cannabinoid receptor modulation during opioid detox improve or worsen outcomes?

Common questions

Do synthetic cannabinoids make opioid withdrawal worse?

This study found that regular synthetic cannabinoid use was associated with significantly longer opioid withdrawal and craving symptoms during detoxification. Higher doses and longer histories of SC use predicted worse outcomes.

Would natural marijuana have the same effect on opioid withdrawal?

This study only examined synthetic cannabinoids, which are typically much more potent at cannabinoid receptors than natural cannabis. Whether natural marijuana would have the same effect on opioid withdrawal duration is unknown and was not studied here.

Read the original research

Impact of synthetic cannabinoids on the duration of opioid-related withdrawal and craving among patients of addiction clinics in Kazakhstan: A prospective case-control study.

Human psychopharmacology, 32(3)

View on PubMed ↗Publisher’s paper ↗

Citation

Prilutskaya, Mariya; Bersani, Francesco Saverio; Corazza, Ornella; Molchanov, Sergey. (2017). Impact of synthetic cannabinoids on the duration of opioid-related withdrawal and craving among patients of addiction clinics in Kazakhstan: A prospective case-control study.. Human psychopharmacology, 32(3). https://doi.org/10.1002/hup.2618