The effects of alcohol, cannabis, and cigarette use on the initiation, reinitiation and persistence of non-medical use of opioids, sedatives, and tranquilizers in adults

Marijuana and Prescription Pain Reliever Use among Cigarette Smokers

“…Our findings align with those of Lucas et al (2013), who determined that among Canadian medical marijuana users, there was no association between frequency of marijuana use and illicit drug substitution, though this finding is attenuated because their analysis was not stratified by cigarette use status. On the other hand, our findings contrast with those of Arterberry et al (2016), who reported that frequency of marijuana and cigarette use was predictive of opioid use among an adult sample in the NESARC. This dissimilarity may be due to differences in study design.…”

“…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.…”

“…Like marijuana, nicotine is involved in anti-nociception via endogenous opioid system mediation, suggesting that nicotine is used for the self-medication of pain (Kishioka et al 2014; Ditre et al 2016); and in fact, nicotine heightens the anti-nociceptive effects of both opioids and marijuana (Kohut 2017). Several studies have documented common use patterns among tobacco, marijuana, and opioids/PPRs (Arterberry et al 2016; Abrahamsson & Hakansson 2015; Fiellin et al 2013). For example, a prospective study of NESARC data demonstrated that early-onset of smoking cigarettes increased the odds of beginning opioid use and that frequency of both cigarette and marijuana use increased the odds of beginning opioid use, re-initiating opioid use after previously stopping, and continuing opioid use among current users (Arterberry et al 2016).…”

“…Several studies have documented common use patterns among tobacco, marijuana, and opioids/PPRs (Arterberry et al 2016; Abrahamsson & Hakansson 2015; Fiellin et al 2013). For example, a prospective study of NESARC data demonstrated that early-onset of smoking cigarettes increased the odds of beginning opioid use and that frequency of both cigarette and marijuana use increased the odds of beginning opioid use, re-initiating opioid use after previously stopping, and continuing opioid use among current users (Arterberry et al 2016). Thus, the three substances share anti-nociceptive actions mediated by the endogenous opioid system, and evidence indicates that marijuana and nicotine use predict opioid use among adults.…”

“…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.…”