AUTHOR=Naji Leen , Rosic Tea , Sanger Nitika , Dennis Brittany , Hillmer Alannah , Hudson Jacqueline , Worster Andrew , Paul James , Marsh David C. , Thabane Lehana , Samaan Zainab 

TITLE=Cannabis use and opioid relapse: An exploratory survival analysis of prospectively collected data

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.1046649

DOI=10.3389/fpsyt.2022.1046649

ISSN=1664-0640

ABSTRACT=Importance: It is known that only minority of patients with opioid use disorder (OUD) receive treatment, of which only a fraction successfully complete treatment as intended. Factors associated with poor treatment outcomes remain unclear, and there is emerging but conflicting evidence that cannabis use may mitigate opioid use. 

Objective: To analyze predictors of relapse amongst patients receiving buprenorphine-naloxone for OUD and identify the association between cannabis use and time to relapse

Design: Data were prospectively collected between May 2018 and October 2020, and patients were followed for 12 months.

Setting: Thirty-one outpatient opioid agonist treatment clinics across Ontario, Canada 

Participants:  All patients 16 years of age or older receiving buprenorphine-naloxone for OUD who had a urine toxicology screen negative for opioids at baseline were eligible for inclusion.  Of the 488 patients consecutively sampled, 466 were included.

Exposure: Cannabis use

Main outcome and measure: Relapse to opioid use assessed using urine toxicology screens. We employed a multivariable Cox-proportional hazard model for our analyses.

Results: We found that cannabis use was not protective against relapse (hazard ratio [HR]=1.03, 95% confidence interval [CI]: 0.78, 1.36, p=0.84). We found that participants who have been in treatment for at least two years had a 44% decrease in the hazard of relapse compared to those in treatment for less than a year (HR=0.56, 95% CI: 0.34, 0.92, p=0.021).  We also found that the hazard of relapse was 2.6 times higher for participants who were intravenous drug users (HR=2.61, 95% CI: 1.74, 3.91, p<0.001), and that for every 1mg increase in the participants’ buprenorphine-naloxone dose, the hazard of relapse is 2% greater (HR=1.02, 95% CI: 1.01, 1.03, p<0.001). 

Conclusion: Our analysis failed to show cannabis to be protective against relapse to opioid use in patients receiving buprenorphine-naloxone for OUD. We identified that individuals who inject drugs, are on higher doses of buprenorphine-naloxone, or have been in treatment for less than two years have a higher hazard for relapse. The presence of such factors may thus warrant closer patient follow-up and more stringent treatment protocols to mitigate risk of relapse and potential overdose.