Buprenorphine Treatment for Opioid Disorder Linked to Less Cannabis Use Than Naltrexone

Participants receiving buprenorphine-naloxone were 39% less likely to use cannabis than those receiving extended-release naltrexone across all timepoints (p = 0.0499). No significant mediation was found between treatment assignment and opioid use on cannabis outcomes, or vice versa.

Secondary analysis of the CTN-0051 X:BOT randomized clinical trial comparing extended-release naltrexone (n=283) versus buprenorphine-naloxone (n=287) for opioid use disorder. Mixed-effects logistic regression modeled cannabis use odds. Cross-lagged mediation models explored whether cannabis and opioid use mediated each other.

Cannabis use is highly prevalent among people with opioid use disorder, but it has been unclear whether the type of medication treatment affects cannabis use patterns. This finding suggests buprenorphine may have differential effects on cannabis use compared to naltrexone.

This is a secondary analysis, meaning the trial was not designed to test this question. The borderline significance (p = 0.0499) warrants cautious interpretation. However, the finding raises interesting questions about whether opioid receptor pharmacology differently modulates cannabis use behavior.

Secondary analysis of a trial not designed for this outcome. Borderline statistical significance. Cannabis use was self-reported. Mechanisms for the differential effect are unknown. May not generalize to all people with opioid use disorder.