Urine Screening for Marijuana Among Methadone-Maintained Patients

Saxon, Andrew J.; Calsyn, Donald A.; Greenberg, Diane; Blaes, Paul; Haver, Virginia M.; Stanton, Viki

doi:10.3109/10550499309113940

Cited by 18 publications

(37 citation statements)

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“…On the other hand, continuing to use an addictive drug, such as marijuana, could interfere with efforts to achieve abstinence from other drugs. Or it may have no effect (Budney et al, 1998; Hill et al, 2013; Church et al, 2001; Epstein and Preston, 2003; Nirenberg et al, 1996; Saxon et al, 1993; Alessi et al, 2011; Budney et al, 1996; Darke et al, 2006). Prior studies lend some support for each of these possibilities and hence findings among previously published studies are inconsistent.…”

Section: Discussionmentioning

confidence: 99%

“…But findings about marijuana’s effects on use of other substances and the need to address it during addiction treatment for other substances are not uniform (Hill et al, 2013; Wasserman et al, 1998; Church et al, 2001; Epstein and Preston, 2003; Nirenberg et al, 1996; Saxon et al, 1993; Aharonovich et al, 2005; Alessi et al, 2011; Budney et al, 1996; Kadden et al, 2009). Many find no association between marijuana use and outcome of addiction treatment for other substances (Budney et al, 1996; Church et al, 2001; Epstein and Preston, 2003; Hill et al, 2013; Nirenberg et al, 1996; Saxon et al, 1993) and one small study suggested that marijuana use helped crack cocaine addiction (Labigalini et al, 1999). Another small study, however, suggests that addressing marijuana use may lead to more use of alcohol (Peters and Hughes, 2010) and at least two prospective studies suggest that marijuana use is associated with worse addiction treatment outcomes (Aharonovich et al, 2005; Wasserman et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

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Marijuana use and achievement of abstinence from alcohol and other drugs among people with substance dependence: A prospective cohort study

Mojarrad

Samet

Cheng

et al. 2014

Drug and Alcohol Dependence

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Background Many with alcohol and other drug dependence have concurrent marijuana use, yet it is not clear how to address it during addiction treatment. This is partially due to the lack of clarity about whether marijuana use impacts one’s ability to achieve abstinence from the target of addiction treatment. We examined the association between marijuana use and abstinence from other substances among individuals with substance dependence. Methods A secondary analysis of the Addiction Health Evaluation And Disease management study, a randomized trial testing the effectiveness of chronic disease management. Individuals met criteria for drug or alcohol dependence and reported recent drug (i.e. opioid or stimulant) or heavy alcohol use. Recruitment occurred at an inpatient detoxification unit, and all participants were referred to primary medical care. The association between marijuana use and later abstinence from drug and heavy alcohol use was assessed using longitudinal multivariable models. Results Of 563 study participants, 98% completed at least one follow-up assessment and 535 (95%) had at least one pair of consecutive assessments and were included. In adjusted analyses, marijuana use was associated with a 27% reduction in the odds of abstinence from drug and heavy alcohol use (adjusted odds ratio 0.73 [95% CI, 0.56–0.97], P=0.03). Conclusions Marijuana use among individuals with alcohol or other drug dependence is associated with a lower odds of achieving abstinence from drug and heavy alcohol use. These findings add evidence that suggests concomitant marijuana use among patients with addiction to other drugs merits attention from clinicians.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Marijuana use and achievement of abstinence from alcohol and other drugs among people with substance dependence: A prospective cohort study

Mojarrad

Samet

Cheng

et al. 2014

Drug and Alcohol Dependence

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“…There were no significant correlations between cannabis use and the likelihood of testing positive for opioid, benzodiazepine or cocaine use in a group of buprenorphine-treated persons (Budney et al, 1998), or in methadone-maintained individuals (Saxon, 1993, Epstein and Preston, 2003, Scavone et al, 2013). Findings from a meta-analysis on predictors of substance use in treatment-seeking opioid dependent individuals found evidence for concurrent cannabis and opioid use during treatment, but no prospective effects of cannabis on increased opioid use following completion of treatment (Brewer et al, 1998).…”

Section: Potential Therapeutic Targets Of Cannabinoid-opioid Intermentioning

confidence: 94%

“…For example, Marammani observed within a cohort of 1090 heroin-dependent individuals presenting for methadone maintenance between 1994 and 2005, that 64.6% of men and 57.1% of females reported concurrent opioid and cannabis use when entering treatment (Maremmani et al, 2010). One study of 98 males on MMT found that 55.1% used cannabis during treatment (Saxon, 1993), while another study reported an even higher 79% rate of use (Nirenberg, 1996). Cannabis use was evaluated prior to and during treatment in a sample of 196 persons in an Israeli methadone maintenance program.…”

Section: Potential Therapeutic Targets Of Cannabinoid-opioid Intermentioning

confidence: 99%

“…Findings from a meta-analysis on predictors of substance use in treatment-seeking opioid dependent individuals found evidence for concurrent cannabis and opioid use during treatment, but no prospective effects of cannabis on increased opioid use following completion of treatment (Brewer et al, 1998). Several studies have demonstrated that retention in treatment for opioid dependence was unaffected by the use of cannabis either prior to or during treatment (Saxon, 1993, Budney et al, 1998, Epstein and Preston, 2003, Weizman et al, 2004). However the long-term nature of MMT often renders retention a poor indicator of overall treatment outcome.…”

Section: Potential Therapeutic Targets Of Cannabinoid-opioid Intermentioning

confidence: 99%

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Cannabinoid and opioid interactions: Implications for opiate dependence and withdrawal

2013

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Withdrawal from opiates, such as heroin or oral narcotics, is characterized by a host of aversive physical and emotional symptoms. High rates of relapse and limited treatment success rates for opiate addiction have prompted a search for new approaches. For many opiate addicts, achieving abstinence may be further complicated by poly-drug use and co-morbid mental disorders. Research over the past decade has shed light on the influence of endocannabinoids on the opioid system. Evidence from both animal and clinical studies point towards an interaction between these two systems, and suggest that targeting the endocannabinoid system may provide novel interventions for managing opiate dependence and withdrawal. This review will summarize the literature surrounding the molecular effects of cannabinoids and opioids system on the locus coeruleus-norepinephrine system, a key circuit implicated in the negative sequelae of opiate addiction. A consideration of the trends and effects of marijuana use in those seeking treatment to abstain from opiates in the clinical setting will also be presented. In summary, the present review details how cannabinoid-opioid interactions may inform novel interventions in management of opiate dependence and withdrawal.

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Association of cannabis use with opioid outcomes among opioid-dependent youth

Hill

Bennett

Griffin

et al. 2013

Drug and Alcohol Dependence

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Objective Cannabis use is common among opioid-dependent patients, but studies of its association with treatment outcome are mixed. In this secondary analysis, the association of cannabis use with opioid treatment outcome is assessed. Methods In the main study, participants (N=152) aged 15-21 years were randomized to receive psychosocial treatments and either a 12-week course of buprenorphine-naloxone with a dose taper to zero in weeks 9-12, or a 2-week detoxification with buprenorphine-naloxone. Drug use was assessed by self-report and urine drug screen at baseline and during study weeks 1-12. The association between cannabis and opioid use at weeks 4, 8, and 12 was examined using logistic regression models. Results Participants reported a median of 3.0 days (range=0-30) cannabis use in the past month; half (50.3%; n=77) reported occasional use, one-third reported no use (33.1%; n=50), and one-sixth reported daily cannabis use (16.6%; n=25). Median lifetime cannabis use was 4.0 years (range=0-11) and median age of initiation of use was 15.0 years (range 9-21). Neither past cannabis use (age of initiation and use in the month prior to baseline) nor concurrent use was associated with level of opioid use. Conclusions Overall, cannabis use had no association with opioid use over 12 weeks in this sample of opioid-dependent youth. While cannabis use remains potentially harmful, it was not a predictor of poor opioid treatment outcome.

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Urine Screening for Marijuana Among Methadone-Maintained Patients

Cited by 18 publications

References 0 publications

Marijuana use and achievement of abstinence from alcohol and other drugs among people with substance dependence: A prospective cohort study

Marijuana use and achievement of abstinence from alcohol and other drugs among people with substance dependence: A prospective cohort study

Cannabinoid and opioid interactions: Implications for opiate dependence and withdrawal

Association of cannabis use with opioid outcomes among opioid-dependent youth

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