Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States

Abstract

Objective To determine whether cannabis use is associated with a change in the risk of incident nonmedical prescription opioid use and opioid use disorder at 3 year follow-up. Methods We used logistic regression models to assess prospective associations between cannabis use at Wave 1 (2001–2002) and nonmedical opioid use and prescription opioid use disorder at Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Corresponding analyses were performed among adults with moderate or more severe pain and with nonmedical opioid use at Wave 1. Cannabis and prescription opioid use were measured with a structured interview (AUDADIS-IV). Other covariates included age, sex, race/ethnicity, anxiety or mood disorders, family history of drug, alcohol, and behavioral problems, and in opioid use disorder analyses, nonmedical opioid use. Results In logistic regression models, Wave 1 cannabis use was associated with increased incident non-medical prescription opioid use (OR=5.78, 95%CI=4.23–7.90) and opioid use disorder (OR=7.76, 95%CI=4.95–12.16) at Wave 2. These associations remained significant following adjustment for background characteristics (non-medical opioid use: AOR=2.26, 95%CI=1.86–3.69; opioid use disorder: AOR=2.18, 95%CI=1.14–4.14). Among adults with pain at Wave 1, cannabis use was also associated with increased incident non-medical opioid use (AOR=2.99, 95%CI=1.63–5.47) and approached significance with incident prescription opioid use disorder (AOR=2.14, 95%CI=0.95–4.83). Among adults with nonmedical opioid use at Wave 1, cannabis use was also associated with an increase in non-medical opioid use (AOR=3.13, 95%CI=1.19–8.23). Conclusions Cannabis use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.

It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis

“…A recent analysis of two waves of the US National Epidemiologic Survey on Alcohol and Related Conditions found that people who reported cannabis use at baseline were more (not less) likely to have an opioid use disorder 3 years later. This was also true among cannabis users who reported moderate to severe pain and opioid use at baseline [12].…”

“…A recent analysis of two waves of the US National Epidemiologic Survey on Alcohol and Related Conditions found that people who reported cannabis use at baseline were more (not less) likely to have an opioid use disorder 3 years later. This was also true among cannabis users who reported moderate to severe pain and opioid use at baseline [12].Given these limitations of the evidence, it is premature to recommend the expansion of access to medical cannabis as a policy to reduce opioid overdose risks in the United States and Canada. The premature adoption of this could displace policies for which there is far better evidence of effectiveness in reducing opioid overdose deaths; namely, increasing access to methadone-and buprenorphine-assisted treatment for opioid dependence; reducing rates of imprisonment for opioid possession and low-level dealing; and distributing naloxone to users and family members to reverse opioid overdoses.…”

Marijuana and Prescription Pain Reliever Use among Cigarette Smokers

“…Novak, Peiper, and Zarkin (2016) analyzed NSDUH data in 2003 and 2013 and found that greater marijuana use was associated with more frequent PPR use. An analysis of NESARC data found higher levels of marijuana and cigarette use predicted initiation, re-initiation, and sustained opioid use (Arterberry et al 2016); and another study using NESARC data determined that marijuana use was associated with an elevated risk of using nonmedical prescription opioids three years later (Olfson et al 2018). Two Swedish teams found similar results.…”

“…In another study, researchers focused on individuals who were prescribed long-term opioid therapy and found that those who also used medical marijuana presented with greater risk of misusing prescription opioids. (Nugent et al 2018) Additionally, a prospective cohort study using the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) data determined that use of marijuana was associated with a greater risk of using nonmedical prescription opioids three years later (Olfson et al 2018). However, in these studies, researchers did not analyze how co-use of other substances would impact the direction and/or strength of the relationship between marijuana and opioids/PPRs.…”

“…Given the national trend toward marijuana legalization, co-use is likely to increase. Cigarette smokers and marijuana users are a crucial population to study, as nicotine and marijuana share mechanisms of action with each other and with opioids, and use of each substance has been shown to be associated with use of opioids/PPRs (Arterberry et al 2016, Abrahamsson and Hakansson 2015, Fiellin et al 2013, Olfson et al 2018, Nugent et al 2018). However, whether there is an association between prevalence of marijuana and PPR use among current smokers has not been determined.…”