When Veterans Stopped Using Opioids, They Were Also More Likely to Stop Using Cannabis and Cocaine and Report Less Pain and Anxiety | Research

The takeaway

Among 2,473 veterans who reported opioid use, those who stopped were nearly twice as likely to also stop using cannabis (aOR=1.82) and cocaine (aOR=1.93), and more likely to report improvements in pain (aOR=1.53) and anxiety (aOR=1.56).

Addiction clinicians, pain management specialists, harm reduction advocates, VA healthcare providers.

Stopping opioids was linked to 82% higher odds of also stopping cannabis use

What the researchers found

Ceasing opioid use was associated with no longer reporting cannabis use (aOR=1.82, 95% CI: 1.10-3.03), cessation of cocaine use (aOR=1.93, 95% CI: 1.16-3.20), improvements in pain (aOR=1.53, 95% CI: 1.05-2.24), and improvements in anxiety (aOR=1.56, 95% CI: 1.01-2.41). Among 2,473 participants, 872 stopped reporting opioid use at first follow-up.

Why it matters

This challenges the common narrative that people need cannabis or other substances to manage pain and anxiety when reducing opioids. The data suggest that stopping opioids may lead to broader substance reduction and symptom improvement rather than substitution.

The numbers in context

N=2,473 veterans with opioid use. 872 stopped by year 1. Cannabis cessation aOR=1.82. Cocaine cessation aOR=1.93. Pain improvement aOR=1.53. Anxiety improvement aOR=1.56.

How the study worked

Target trial emulation using Veterans Aging Cohort Study survey data (2003-2012). Compared participants who stopped reporting opioid use at first follow-up (~1 year) with those who continued. Logistic regression models estimated associations with changes at second follow-up (~2 years).

What this study cannot tell us

Observational study, even with target trial emulation. Self-reported substance use and symptoms. Veterans may not represent broader populations. 35% missing data at first follow-up. Cannot determine whether improvements were caused by opioid cessation or other factors.

How to read the evidence

Target trial emulation using longitudinal cohort data. Stronger than standard observational studies but still limited by self-report and missing data.

When this study was published

Published in 2023 using VACS data from 2003-2012.

The bigger picture

The finding that opioid cessation was associated with cannabis cessation (rather than substitution) adds complexity to the cannabis-as-opioid-substitute narrative. For some people, reducing one substance may catalyze broader recovery rather than a shift to alternative substances.

Questions still open

Why did stopping opioids lead to less cannabis use rather than substitution?
Would these patterns hold in non-veteran populations?

Common questions

Do people switch to cannabis when they stop opioids?

In this veteran study, the opposite happened. Those who stopped opioids were nearly twice as likely to also stop using cannabis, suggesting recovery may be broader than just one substance.

Did stopping opioids improve pain?

Yes. Veterans who stopped opioid use were 53% more likely to report pain improvement and 56% more likely to report anxiety improvement at follow-up.

Read the original research

Cessation of self-reported opioid use and impacts on co-occurring health conditions.

Drug and alcohol dependence, 242, 109712

View on PubMed ↗Publisher’s paper ↗

Citation

Scheidell, Joy D; Townsend, Tarlise; Ban, Kaoon Francois; Caniglia, Ellen C; Charles, Dyanna; Edelman, E Jennifer; Marshall, Brandon D L; Gordon, Adam J; Justice, Amy C; Braithwaite, R Scott; Khan, Maria R. (2023). Cessation of self-reported opioid use and impacts on co-occurring health conditions.. Drug and alcohol dependence, 242, 109712. https://doi.org/10.1016/j.drugalcdep.2022.109712