Cannabis Use Among Individuals Treated with Medication for Opioid Use Disorder: Correlates, Patterns, and Motivations for Use

BACKGROUND Cannabis use is prevalent among patients receiving medication for opioid use disorder (MOUD). However, little is known about factors associated with frequent cannabis use.

OBJECTIVE To describe correlates, patterns, and motivations for cannabis use among individuals treated with MOUD.

METHODS Participants from a randomized trial (n = 303) investigating a mind-body intervention adjunct to MOUD were compared based on frequent cannabis use (≥3 days/week) versus less frequent or no use, assessing demographic and clinical characteristics. Individuals with frequent cannabis use were invited to participate in a telephone survey exploring reasons for cannabis use, cannabis usage in treating symptoms/conditions, route, tetrahydrocannabinol/cannabidiol content, and cannabis use disorder screening.

RESULTS 47.5% of participants (n = 144) endorsed cannabis use, and 27% used cannabis frequently (≥3 days/week). Frequent cannabis use was associated with anxiety (P = .04), nausea/vomiting (P < .001), and lower employment (P = .03). Employment was associated with less frequent cannabis use (OR = 0.54, 95% CI = 0.29-0.99, P = .049), and higher interoceptive awareness was associated with lower odds of frequent cannabis use (OR = 0.64, 95% CI = 0.43-0.96, P = .03). In a subsample (n = 27) of individuals with frequent cannabis use, 56% used cannabis for both recreation and symptom management, 30% for symptom management only, and 15% for recreation only. Participants who reported medical use of cannabis used it to manage a variety of conditions, including stress (100%), anxiety (83%), insomnia (79%), pain (75%), depression (75%), and posttraumatic stress disorder (n = 67%). Fifty-two percent wanted to cut down.

CONCLUSIONS Frequent cannabis use among individuals on MOUD was associated with anxiety, nausea, and lower employment, with no significant differences in key MOUD outcomes including substance use and retention. Individuals with frequent cannabis use reported treating stress, pain, and mental health conditions with cannabis. More attention to screening and treatment of these conditions is warranted.