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

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.

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).

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 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.

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.