Differential effect of cannabis use on opioid agonist treatment outcomes: Exploratory analyses from the OPTIMA study.
Elkrief et al.·Journal of substance use and addiction treatmentImpact 2.0
No benefit demonstratedGRADEModerate8 citations
Samplen = 272 Pat.
Duration24 weeks
ControlObserved intake of methadone, mean maximum…
EndpointOpioid use
Blindingoffen
DesignRCT
”Key finding
Cannabis use was not significantly associated with opioid use, craving or withdrawal symptoms.
Summary
Exploratory secondary analysis of an RCT (n=272 patients with opioid use disorder), randomized to buprenorphine/naloxone vs. methadone over 24 weeks. Cannabis use (mean 2,3 days/week) showed no significant association with opioid use (β±SE = -0,06±0,04; p=0,15), craving (β±SE = -0,05±0,08; p=0,49) or withdrawal symptoms (β±SE = 0,09±0,1; p=0,36). Bayes factors <0,3 supported the null hypothesis.
P
PopulationAdults with opioid use disorder (prescription type) under opioid agonist therapy, n=272
I
InterventionFlexible buprenorphine/naloxone (BUP/NX) take-home dosing (n=138), mean maximum dose 17,3 mg/day
C
ControlObserved intake of methadone (n=134), mean maximum dose 67,7 mg/day
O
OutcomeNo significant association between cannabis use (last week) and opioid use (β=-0,06, p=0,15), craving (β=-0,05, p=0,49) or withdrawal symptoms (β=0,09, p=0,36); Bayes factor <0,3 supports the null hypothesis
Confidence in the evidence
Very lowLowModerateHigh
Moderate
The third of four GRADE levels, the effect estimate is probably reliable.
Downgraded for
Risk of bias
Quality profile
Sample size★★★★★
BlindingOpen-label
Effect sizeNo benefit
Citations / year★★★★★
Authors
Elkrief L, Bastien G, McAnulty C, Bakouni H, Hebert FO, Socias ME, Le Foll B, Lim R, Ledjiar O, Marsan S
Introduction: Conflictual evidence exists regarding the effects of cannabis use on the outcomes of opioid agonist therapy (OAT). In this exploratory analysis, we examined the effect of recent cannabis use on opioid use, craving, and withdrawal symptoms, in individuals participating in a trial comparing flexible buprenorphine/naloxone (BUP/NX) take-home dosing model to witnessed ingestion of methadone.
Methods: We analyzed data from a multi-centric, pragmatic, 24-week, open label, randomized controlled trial in individuals with prescription-type opioid use disorder (n = 272), randomly assigned to BUP/NX (n = 138) or methadone (n = 134). The study measured last week cannabis and opioid use via timeline-follow back, recorded at baseline and every two weeks during the study. Craving symptoms were measured using the Brief Substance Craving Scale at baseline, and weeks 2, 6, 10, 14, 18 and 22. The study measured opioid withdrawal symptoms via Clinical Opiate Withdrawal Scale at treatment initiation and weeks 2, 4, and 6.
Results: The mean maximum dose taken during the study was 17.3 mg/day (range = 0.5-32 mg/day) for BUP/NX group and 67.7 mg/day (range = 10-170 mg/day) in the methadone group. Repeated measures generalized linear mixed models demonstrated that cannabis use in the last week (mean of 2.3 days) was not significantly associated with last week opioid use (abeta +/- standard error (SE) = -0.06 +/- 0.04; p = 0.15), craving (abeta +/- SE = -0.05 +/- 0.08, p = 0.49), or withdrawal symptoms (abeta +/- SE = 0.09 +/- 0.1, p = 0.36). Bayes factor (BF) for each of the tested models supported the null hypothesis (BF < 0.3).
Conclusions: The current study did not demonstrate a statistically significant effect of cannabis use on outcomes of interest in the context of a pragmatic randomized-controlled trial. These findings replicated previous results reporting no effect of cannabis use on opioid-related outcomes.