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Mixing opioids, cannabis tied to greater anxiety, depression symptoms

Andrew Rogers

Evidence published in Journal of Addiction Medicine showed that combined use of opioid and cannabis was linked to greater symptoms of anxiety, depression and substance use problems compared with opioid use alone in adults with chronic pain.

"Given the continued rise in opioid-involved deaths, as well as the increase in popularity to treat pain-related conditions with cannabis, it was important to look at the effects of the combination of these two substances to potentially identify patients that may be additionally vulnerable," Andrew H. Rogers, MA, from the department of psychology, University of Houston, told Healio Psychiatry.

In their study, researchers compared mental health, pain and substance use outcomes in 450 adults with chronic pain who used opioids alone to those who combined use of opioid and cannabis. They used:

• Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to measure risk for alcohol, cannabis, cocaine and other substance misuse;
• Patient Health Questionnaire-4 (PHQ-4) to measure depression and anxiety;
• Current Opioid Misuse Measure (COMM) to identify behaviors of opioid misuse;
• Severity of Dependence Scale (SDS) to determine opioid dependence severity; and
• Graded Chronic Pain Scale (GCPS) to assess pain intensity and disability.

Analysis indicated that combined use of opioids and cannabis compared with opioid use alone was associated with more mental health symptoms and substance use issues, but not pain experience.

For mental health outcomes, Rogers and colleagues found that co-use of opioids and cannabis was linked to significantly greater anxiety total scores (estimated marginal mean = 2.33 vs. 1.56), and that people reporting cannabis co-use reported significantly higher depression total scores than those reporting opioid only use (estimated marginal mean = 2.5 vs. 1.8).

Co-use of opioids and cannabis was associated with significantly greater opioid misuse total scores than opioid only use (estimated marginal mean = 23.97 vs. 13.88), the study revealed. In addition, those that co-use cannabis reported significantly greater opioid dependence severity compared with those that only used opioids (estimated marginal mean = 5.41 vs. 3.61). People who co-used opioids and cannabis also had greater ASSIST scores on tobacco, alcohol and cocaine involvement than those that only used opioids (estimated marginal mean = 15.98 vs. 9.07 for tobacco; 13.01 vs. 5.99 for alcohol; and 7.63 vs. 0.91 for cocaine).

However, there was no difference in pain intensity scores and pain disability scores between participants who reported opioid use only and those who reported co-use of opioids and cannabis, according to the results.

"While these findings are preliminary, it may be important for clinicians to assess concurrent substance use when prescribing pain medication to reduce risk of negative outcomes," Rogers told Healio Psychiatry. – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.