Overview
A major new study published yesterday in JAMA Network Open has found no evidence that cannabis use improves outcomes in opioid addiction treatment. The research, conducted by scientists at New York University, analyzed data from over 580,000 adults undergoing treatment for opioid use disorder (OUD).
The findings challenge a commonly held belief that cannabis can help treat opioid addiction. Proponents argue that cannabis can relieve pain and reduce opioid withdrawal symptoms without the risk of addiction or overdose. However, the JAMA study found that cannabis use made no difference in OUD treatment completion rates or long-term opioid abstinence.
“We found no evidence to suggest that cannabis use – either lifetime or active use during treatment – is associated with changes in opioid addiction treatment outcomes,” said lead author Dr. Joseph Palamar. “This adds to a small but growing body of evidence suggesting cannabis likely does not help opioid addiction treatment.”
Lead Up to the Study
The opioid epidemic has killed over 500,000 Americans since 1999, prompting policymakers to search for innovative solutions. Many states have legalized medical or recreational cannabis, partly based on anecdotal reports that it can help fight the crisis.
Yet clinical data has been lacking. Most previous studies were small, limited to self-reports, or focused on chronic pain rather than OUD treatment outcomes.
The new JAMA study is the largest and most rigorous investigation to date on whether cannabis impacts opioid addiction treatment. “With so much death and despair caused by opioid misuse, patients and policymakers need clear, evidence-based strategies,” said Dr. Palamar. “These findings help clarify that cannabis likely does not need to be part of addiction treatment approaches.”
Study Methodology
The researchers analyzed Medicaide data on 581,796 adults aged 18-64 who started OUD treatment with methadone or buprenorphine from 2011-2019 in New York or Pennsylvania.
Patients were categorized as lifetime cannabis users or not. Active users were those with a cannabis use disorder diagnosis recorded during treatment or a urine test positive for THC. 37% of patients were lifetime users, while 22% were active users.
The primary outcomes were treatment completion and long-term opioid abstinence after treatment. Abstinence was defined as filling no opioids prescriptions in the 6 months post-treatment.
After adjusting for confounders through statistical matching, cannabis use showed no significant impact on either outcome metric.
| Treatment Completion Rates | Lifetime Cannabis Users | Non-Users | Active Cannabis Users | Non-Active Users |
|---|---|---|---|---|
| Completed Treatment | 39.6% | 39.5% | 38.1% | 40.0% |
| Dropped Out Early | 60.4% | 60.5% | 61.9% | 60.0% |
| Opioid Abstinence Rates | Lifetime Cannabis Users | Non-Users | Active Cannabis Users | Non-Active Users |
|---|---|---|---|---|
| Abstinent | 35.0% | 35.1% | 33.9% | 35.4% |
| Not Abstinent | 65.0% | 64.9% | 66.1% | 64.6% |
“Matching patients who used or did not use cannabis revealed no differences in OUD treatment outcomes,” said Dr. Palamar. “This questions claims that cannabis has therapeutic benefits in treating opioid addiction.”
Implications
The findings have important implications for addiction medicine and cannabis policy. Many addiction treatment centers incorporate cannabis use in their programs, while several states list opioid use disorder as a qualifying condition for medical marijuana.
However, the JAMA study “provides substantial evidence that cannabis likely does not impact opioid addiction treatment outcomes,” said Dr. Palamar. “We hope this guides patient and provider decision making.”
Critically, the data does not support arguments for or against cannabis legalization more broadly. “Our focus here was specifically on opioid addiction treatment,” stressed Dr. Palamar. Other potential impacts of legalization remain hotly debated.
What Happens Next
The researchers hope these findings help strip away misperceptions that complicate addiction treatment and recovery. “We still have much to learn about plant-based medicines,” said Dr. Palamar. “But the claim that cannabis enhances opioid addiction treatment does not appear evidence-based.”
Some scientists have theorized that particular cannabis strains or compounds might still help alleviate opioid cravings or withdrawal. “Future research should examine if certain patient subgroups or cannabis formulations have different effects,” said Dr. Palamar. “But for now, cannabis does not appear to impact OUD treatment outcomes overall.”
Many questions remain unsettled in this rapidly evolving field at the intersection of addiction medicine and cannabis policy. But when it comes to treating opioid use disorder, this major new study suggests cannabis is unlikely to improve patients’ chances of success. For clinicians and policymakers on the front lines of the opioid epidemic, that clarity is invaluable.
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