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Cannabis use may increase risk for opioid abuse

Mark Olfson

Adults who used cannabis were significantly more likely to use nonmedical prescription opioids, according to recent findings.

“In the wake of rising rates of nonmedical prescription opioid use, there has been increased public and professional interest in the possibility that cannabis might help to curb or prevent opioid use disorder,” Mark Olfson, MD, MPH, of Columbia University Medical Center, New York, and colleagues wrote. “Support comes from two widely publicized ecological analyses indicating that compared with states that do not permit medical marijuana, annual death rates due to opioid overdoses were nearly one-quarter lower in states that do permit medical marijuana. Significant reductions in opioid prescribing have also been reported following passage of medical marijuana laws.”

To assess associations between cannabis use and change in risk for incident nonmedical prescription opioid use and opioid use disorder at 3 years, researchers analyzed data from wave 1 (2001-2002) and wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions.

Logistic regression models indicated cannabis use at wave 1 was associated with increased incident nonmedical prescription opioid use (OR = 5.78; 95% CI, 4.23-7.9) and opioid use disorder (OR = 7.76; 95% CI, 4.95-12.16) at wave 2.

Adjustment for background characteristics did not impact the statistical significance of these associations.

Among participants with pain at wave 1, cannabis use was significantly associated with increased incident nonmedical opioid use at wave 2 (adjusted OR = 2.99; 95% CI, 1.63-5.47) and increased incident prescription opioid use disorder, although this association failed to reach statistical significance.

Cannabis use was also associated with increased nonmedical opioid use (aOR = 3.13; 95% CI, 1.19-8.23) among participants with nonmedical opioid use at wave 1.

“We report that cannabis use, even among adults with moderate to severe pain, was associated with a substantially increased risk of nonmedical prescription opioid use at 3-year follow-up,” the researchers wrote. “Although the great majority of adults who used cannabis did not go on to initiate or increase their nonmedical opioid use, a strong prospective association between cannabis and opioid use disorder should nevertheless sound a note of caution in ongoing policy discussions concerning cannabis and in clinical debate over authorization of medical marijuana to reduce nonmedical use of prescription opioids and fatal opioid overdoses.” – by Amanda Oldt

Disclosures: Olfson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.