Impact of Cannabis Use during Stabilization on Methadone Maintenance Treatment

Abstract

Background and Objectives Illicit drug use, particularly of cannabis, is common among opiate-dependent individuals, and has the potential to impact treatment in a negative manner. Methods To examine this, patterns of cannabis use prior to and during methadone maintenance treatment (MMT) were examined to assess possible cannabis-related effects on MMT, particularly during methadone stabilization. Retrospective chart analysis was used to examine outpatient records of patients undergoing MMT (n=91), focusing specifically on past and present cannabis use and its association with opiate abstinence, methadone dose stabilization, and treatment compliance. Results Objective rates of cannabis use were high during methadone induction, dropping significantly following dose stabilization. History of cannabis use correlated with cannabis use during MMT, but did not negatively impact the methadone induction process. Pilot data also suggested that objective ratings of opiate withdrawal decrease in MMT patients using cannabis during stabilization. Conclusions and Scientific Significance The present findings may point to novel interventions to be employed during treatment for opiate dependence that specifically target cannabinoid-opioid system interactions.

The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone

“…The finding of diminished opioid withdrawal with dronabinol is consistent with preclinical studies (Frederickson et al, 1976; Lichtman et al, 2001; Vela et al, 1995; Yamaguchi et al, 2001) and smoked marijuana also appeared to diminish opioid withdrawal in patients undergoing stabilization on methadone (Scavone et al, 2013b). In the present trial, participants were also receiving other medications during the detoxification, so it is not clear if dronabinol by itself would be sufficient to produce clinically significant reduction of opioid withdrawal.…”

Variations in Cannabis Use Level and Correlates in Opiate-Users on Methadone Maintenance Treatment: A French Prospective Study

“…A recent study in a sample of individuals seeking care for opioid dependence showed high rates for cannabis use during MMT induction, with these rates decreasing significantly after dose stabilization to remain similar to pre-treatment values (Scavone, Sterling, Weinstein, & Van Bockstaele, 2013). This study also observed less severe opiate withdrawal symptoms during induction period among cannabis users.…”

Gender-Specific Predictors of Retention and Opioid Abstinence During Methadone Maintenance Treatment

“…Notably, cannabinoid-positive UDS during the first month of MMT predicted b 1-year retention for both males and females, but was unrelated to opioid abstinence rate for males or females; i.e., there were no gender differences in outcomes for this predictor. Previous research has generated mixed results on whether cannabis use is associated with negative treatment outcomes, with the majority finding no link between cannabis use and treatment retention or heroin abstinence (Aharonovich et al, 2005;Epstein & Preston, 2003;Scavone, Sterling, Weinstein, & Van Bockstaele, 2013;Weizman, Gelkopf, Melamed, Adelson, & Bleich, 2004), whereas one study found cannabis use predicted increased risk of heroin relapse (Wasserman, Weinstein, Havassy, & Hall, 1998). For some patients, cannabinoid-positive UDS during the first month of treatment could partly reflect carryover from pre-MMT cannabis use; the present study cannot address this limitation.…”