Lack of Association of Cannabis Use with Opioid Outcomes among Opioid-Dependent YouthKevin P. Hill, M.D., M.H.S.a,b, Heather E. Bennett, B.A.a, Margaret L. Griffin, Ph.D.a,b,, Hilary S. Connery, M.D., Ph.D.a,b,

Garrett M. Fitzmaurice, Sc. D.a,b, Geetha Subramaniam, M.D.c, George E. Woody, M.D.d, Roger D. Weiss, M.D.a,b

a Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MAb Harvard Medical School, Boston, MA

c Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MDd Department of Psychiatry, Treatment Research Institute, University of Pennsylvania, Philadelphia, PA

• Cannabis use is common among opioid-dependent patients, but studies of its association with treatment outcome are mixed (Budney et al. 1998, Dupont and Saylor 1989).

• In this secondary data analysis, we assessed the association of cannabis use with opioid treatment outcome.

• 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 as measured by opioid urine drug screens in our sample.

This was a secondary data analysis from National Drug Abuse Treatment Clinical Trials Network Study CTN-0010, “Buprenorphine/Naloxone-Facilitated Rehabilitation for Opioid Dependent Adolescents/Young Adults” (Woody et al. 2008).

• Opioid-dependent participants (n = 152) aged 15-21 years received psychosocial treatments and were randomized to one of two treatment conditions:

• 2 week detox with buprenorphine/naloxone • 12 week course of buprenorphine/naloxone

• Assessment of drug use by self-report and urine drug screen occurred during the screening, baseline, and treatment phase of the study (weeks 1-12).

• Multivariate analyses were conducted to investigate the relationship between cannabis use and opioid use, adjusting for treatment condition.

Background and Aim Results

Method

Results Conclusions

Table 1. Odds ratio (OR), and 95% confidence interval (CI), from logistic regression analysis of opioid use (throughout treatment) on cannabis use. Cannabis OR 95% CI p Age of initiation, years .96 .86-1.08 .53Days used at baseline1 .99 .96-1.01 .34Concurrent use2 1.56 .86-2.80 .141 Past 30 days, by self-report2 Urine screen

Supported by grants K99 DA029115 (KPH), K24 DA022288 (RDW), and CTN U10 DA15831 (RDW, HSC) from the National Institute on Drug Abuse, as well as the Adam Corneel Young Investigator Fellowship from McLean Hospital to Dr. Hill.

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Figure 1. Distribution of frequency of cannabis use in past month

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• 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) (FIGURE 1).

• 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) (FIGURE 2).

• Participants were able to significantly reduce opioid use after initiating treatment before their level of opioid use stabilized; however, cannabis use was constant throughout.

• 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 (TABLE 1).

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Figure 2. Distribution of years of cannabis use

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ReferencesBudney, A.J., Radonovich, K.J., Higgins, S.T., Wong, C. J., 1998. Adults seeking treatment for marijuana dependence: A comparison with cocaine- dependent treatment seekers. Exp. Clin. Psychopharmacology 6, 419-426.

DuPont, R.L., Saylor, K.E., 1989. Marijuana and benzodiazepine in patients receiving methadone maintenance treatment. JAMA 261, 3409.

Woody, G.E., Poole, S.A., Subramaniam, G., Dugosh, K., Bogenschutz, M., Abbott, P., Patkar, A., Publicker, M., McCain, K., Potter, J.S., Forman, R., Vetter, V., McNicholas, L., Blaine, J., Lynch, K.G., Fudala, P., 2008. Extended vs. short-term buprenorphine-naloxone for treatment of opioid-addicted youth. JAMA 300, 2003-2011.