Cannabis Use During Methadone Stabilization Did Not Worsen Treatment and May Have Eased Opiate Withdrawal | Research

The takeaway

Cannabis use was common during methadone induction but dropped after dose stabilization, and pilot data suggested cannabis users experienced less opiate withdrawal during the stabilization process.

Read this if you are in methadone treatment and use cannabis, or if you work in addiction medicine.

Cannabis use during methadone did not impair treatment and may have reduced withdrawal

What the researchers found

A retrospective chart analysis of 91 methadone maintenance patients examined cannabis use patterns during treatment. Cannabis use was high during methadone induction (the initial dose-stabilization period) and dropped significantly after stable dosing was achieved. History of cannabis use predicted cannabis use during treatment.

Critically, cannabis use during MMT did not negatively impact the methadone induction process (dose stabilization, treatment compliance, opiate abstinence). Pilot data suggested that patients who used cannabis during stabilization actually had lower objective ratings of opiate withdrawal symptoms.

Why it matters

Many methadone clinics penalize or discharge patients for cannabis use, based on the assumption it impairs treatment. This study suggests the opposite: cannabis use during methadone stabilization was not harmful and may have reduced withdrawal symptoms. This has implications for treatment policies.

The numbers in context

91 patients. Cannabis use: high during induction, dropped after stabilization. No negative impact on: dose stabilization, compliance, opiate abstinence. Pilot data: lower opiate withdrawal ratings in cannabis users during stabilization.

How the study worked

Retrospective chart analysis of 91 outpatient MMT records. Cannabis use patterns before and during treatment. Association with opiate abstinence, methadone dose stabilization, and treatment compliance. Objective withdrawal ratings.

What this study cannot tell us

Retrospective chart review with inherent limitations. Small sample (91 patients). The withdrawal finding was described as "pilot data" requiring confirmation. Cannabis use was objective (urine testing) but patterns were inferred from testing schedules. Selection bias: patients who stayed in treatment long enough for analysis.

How to read the evidence

Retrospective chart analysis with pilot withdrawal data; preliminary evidence against cannabis harming MMT.

When this study was published

Published in 2013. The question of cannabis policies in opioid treatment has become increasingly debated.

The bigger picture

This study contributed to the growing evidence that cannabis use during opioid agonist therapy may not be the clinical concern it is often treated as. Some methadone programs have since reconsidered strict cannabis policies, focusing instead on the primary goal of opioid abstinence.

Questions still open

Should methadone clinics change their cannabis policies based on this evidence? Does cannabis specifically reduce opiate withdrawal through cannabinoid-opioid interactions? Would prospective trials confirm the withdrawal benefit?

Common questions

Should methadone patients stop using cannabis?

This study suggests cannabis use during methadone treatment does not worsen outcomes. Cannabis use dropped naturally after methadone stabilization, and pilot data suggested it may have actually eased opiate withdrawal during the induction period. However, this is preliminary evidence and individual circumstances vary. The primary goal of MMT is opiate abstinence.

Why might cannabis help with opiate withdrawal?

The endocannabinoid and opioid systems interact extensively in the brain. Cannabis may ease some withdrawal symptoms like anxiety, insomnia, muscle pain, and nausea through its effects on cannabinoid receptors that overlap functionally with opioid receptors. However, this mechanism has not been rigorously tested in human studies.

Read the original research

Impact of cannabis use during stabilization on methadone maintenance treatment.

The American journal on addictions, 22(4), 344-51

View on PubMed ↗Publisher’s paper ↗

Citation

Scavone, Jillian L; Sterling, Robert C; Weinstein, Stephen P; Van Bockstaele, Elisabeth J. (2013). Impact of cannabis use during stabilization on methadone maintenance treatment.. The American journal on addictions, 22(4), 344-51. https://doi.org/10.1111/j.1521-0391.2013.12044.x