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Friday, January 28, 2022

Factors Associated With Opioid Overdose After an Initial Opioid Prescription

Key Points

Question What factors are associated with an increased risk for opioid overdose after the initial opioid prescription to a previously opioid-naive individual?

Findings In this cohort study of 236 921 individuals who received a first opioid prescription, 667 experienced an incident opioid overdose. Patient risk factors included being aged 75 years or older, being male, receiving Medicaid or Medicare Advantage coverage, having a comorbid substance use disorder or depression, and having medical comorbidities. Prescription-related risk factors included an initial prescription of oxycodone or tramadol, concurrent use of benzodiazepines, and filling opioid prescriptions from 3 or more pharmacies.

Meaning Findings from this study suggest that several patient- and prescription-related risk factors are associated with opioid overdose; prescribers, researchers, policy makers, and insurers can apply this information to guide opioid counseling and monitoring, develop clinical decision-making tools, and provide additional opioid prevention and treatment resources to individuals who are at greatest risk for opioid overdose.

Abstract

Importance The opioid epidemic continues to be a public health crisis in the US.

Objective To assess the patient factors and early time-varying prescription-related factors associated with opioid-related fatal or nonfatal overdose.

Design, Setting, and Participants This cohort study evaluated opioid-naive adult patients in Oregon using data from the Oregon Comprehensive Opioid Risk Registry, which links all payer claims data to other health data sets in the state of Oregon. The observational, population-based sample filled a first (index) opioid prescription in 2015 and was followed up until December 31, 2018. Data analyses were performed from March 1, 2020, to June 15, 2021.

Exposures Overdose after the index opioid prescription.

Main Outcomes and Measures The outcome was an overdose event. The sample was followed up to identify fatal or nonfatal opioid overdoses. Patient and prescription characteristics were identified. Prescription characteristics in the first 6 months after the index prescription were modeled as cumulative, time-dependent measures that were updated monthly through the sixth month of follow-up. A time-dependent Cox proportional hazards regression model was used to assess patient and prescription characteristics that were associated with an increased risk for overdose events.

Results The cohort comprised 236 921 patients (133 839 women [56.5%]), of whom 667 (0.3%) experienced opioid overdose. Risk of overdose was highest among individuals 75 years or older (adjusted hazard ratio [aHR], 3.22; 95% CI, 1.94-5.36) compared with those aged 35 to 44 years; men (aHR, 1.29; 95% CI, 1.10-1.51); those who were dually eligible for Medicaid and Medicare Advantage (aHR, 4.37; 95% CI, 3.09-6.18), had Medicaid (aHR, 3.77; 95% CI, 2.97-4.80), or had Medicare Advantage (aHR, 2.18; 95% CI, 1.44-3.31) compared with those with commercial insurance; those with comorbid substance use disorder (aHR, 2.74; 95% CI, 2.15-3.50), with depression (aHR, 1.26; 95% CI, 1.03-1.55), or with 1 to 2 comorbidities (aHR, 1.32; 95% CI, 1.08-1.62) or 3 or more comorbidities (aHR, 1.90; 95% CI, 1.42-2.53) compared with none. Patients were at an increased overdose risk if they filled oxycodone (aHR, 1.70; 95% CI, 1.04-2.77) or tramadol (aHR, 2.80; 95% CI, 1.34-5.84) compared with codeine; used benzodiazepines (aHR, 1.06; 95% CI, 1.01-1.11); used concurrent opioids and benzodiazepines (aHR, 2.11; 95% CI, 1.70-2.62); or filled opioids from 3 or more pharmacies over 6 months (aHR, 1.38; 95% CI, 1.09-1.75).

Conclusions and Relevance This cohort study used a comprehensive data set to identify patient and prescription-related risk factors that were associated with opioid overdose. These findings may guide opioid counseling and monitoring, the development of clinical decision-making tools, and opioid prevention and treatment resources for individuals who are at greatest risk for opioid overdose.

Introduction

Opioid medications remain a mainstay of treatment of severe pain. In the setting of the modern opioid overdose and death epidemic, use of such medications has decreased, but there were still 168.9 million opioid prescriptions in the US in 2018.¹ Each prescription of an opioid to a previously opioid-naive patient creates the potential for the development of chronic opioid use and opioid use disorder.² For this reason, multiple entities and states have produced opioid prescribing guidelines, such as the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain in 2016 and the Oregon Acute Opioid Prescribing Guidelines in 2018.³^,4 The surgical literature has declared opioid dependence to be a never-event (along with use disorder and overdose)⁵ and as the most common surgical complication,⁶ affecting approximately 5% to 7% of patients who started a new episode of opioid use.⁷

An association exists between the characteristics of a patient’s first opioid prescription and long-term use. Shah et al⁸ discovered that the number of days’ supply of the initial prescription was directly associated with the development of long-term use. Deyo et al⁹ found that greater morphine milligram equivalents (MMEs) of the initial prescription were associated with increased likelihood of developing long-term use. Previous work with the Ohio prescription drug monitoring program (PDMP) database found that different prescriber specialties had different rates of long-term use by patients¹⁰ likely because the indications of opioid use and underlying patient factors create different risks for long-term use.

Although chronic opioid use is an undesirable outcome, the most substantial harms from a new episode of prescription opioid use are overdose and death. Unfortunately, the ability to link prescribing decisions to specific outcomes has been hampered by data source limitations. Prescription drug monitoring programs describe the prescription filling patterns of patients with long-term use but do not contain data about drug indications, comorbid conditions, the patient’s environment, or intervening outcomes, such as opioid use disorder or overdose. Administrative claim files are useful because they capture prescriptions that are covered by insurance but may be incomplete if the prescriptions are paid in cash or if patients change insurers. In addition, the most serious outcome of interest, opioid-related death, is often found not in PDMP or insurance data but in vital records.

To address data source limitations and provide a more comprehensive analysis of risk factors after the initiation of opioid therapy, we combined claims data with several public health data sets (including All Payer All Claims Data [APCD], vital records, PDMP, and hospital discharge data) to create the Oregon Comprehensive Opioid Risk Registry.¹¹ Using the Comprehensive Opioid Risk Registry, we constructed a retrospective cohort of opioid-naive patients who received an initial opioid prescription to assess the patient factors and early time-varying prescription-related factors associated with opioid-related fatal or nonfatal overdose. We hypothesized that some patient factors (eg, insurance type and high disease burden) and prescription factors in the first 6 months after opioid initiation (eg, high doses, and opioid and benzodiazepine overlap) are associated with increased risk of opioid overdose.

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Factors Associated With Opioid Overdose After an Initial Opioid Prescription | Addiction Medicine | JAMA Network Open | JAMA Network

Tuesday, April 11, 2023

Study shows patterns of opioid prescribing linked to suicide risk

Regions of the U. S. with the greatest decrease in opioid prescriptions found to have the greatest decline in suicide deaths

Peer-Reviewed Publication

COLUMBIA UNIVERSITY'S MAILMAN SCHOOL OF PUBLIC HEALTH

Controversy surrounds the effects of policies to reduce opioid prescriptions on suicide rates. There are concerns that rapid reductions in prescription opioids might provoke increased suicide risk among people who become desparate after they are taken off opioids. According to a new study at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center, however, changes in regional opioid prescribing and regional suicide rates tend to move in the same direction. This relationship held for rates of opioid prescribing, rates of high-dose prescribing and long-term prescribing, and having multiple opioid prescribers. Until now it was not known whether certain opioid prescribing patterns were associated with particularly elevated suicide risk.

Overall opioid prescribing declined for each of the measures during the 2009–2017 period and the overall rate of total suicide deaths increased from 13.80 to 16.36 per 100,000 persons. By evaluating regional changes, however, the researchers estimate that had opioid prescribing remained constant rather than decreased, the national rate of suicide would have risen even faster than it did.

The findings are published online in the American Journal of Psychiatry.

Alternately, having any opioid prescriptions and having three or more opioid prescribers were each negatively associated with unintentional opioid-related deaths in people in the age ranges of 10- to 24 and 25- to 44. For some opioid prescribing measures, negative associations were also observed with unintentional overdose deaths involving opioids among younger people.

“The relationship between opioid prescribing and suicide risk is a complex one. This is particularly the case when people have their opioids tapered,” said Mark Olfson, MD, MPH, professor of epidemiology at Columbia School of Public Health and Elizabeth K Dollard Professor of Psychiatry, Medicine and Law at Columbia University Irving Medical Center. ”People can become desperate if their pain is not well controlled. Yet opioids also pose a greater risk of overdose than any other drug class and approximately 40 percent of overdose suicide deaths in the U.S. involve opioids. At a population-level, the national decline in opioid prescribing over last several years appears to have reduced the number of people who died of suicide.”

Analyses were based on data from the 2009–2017 U.S. national IQVIA Longitudinal Prescription Database and National Center for Health Statistics mortality data. Information was based on opioid prescription, with high-dose prescriptions (>120 mg/day morphine equivalents), with long-term prescriptions (>60 consecutive days), and with prescriptions from three or more prescribers. For geographic aggregation, the researchers used states and commuting zones as defined by the U.S. Department of Agriculture.

The researchers looked at opioid prescribing measures for four age groups: 10–24, 25–44, 45–64, and 65 years or older, as well as males and females. Because length of opioid prescribing is strongly associated with persistent opioid use the researchers included a measure of percentage with opioid prescriptions for long-term opioid prescriptions measured at greater then or equal to 60 consecutive days. Also, because of the association between having multiple opioid prescribers and opioid overdose risk, Olfson and colleagues included a multiple prescriber measure as the percentage with three or more opioid prescribers during a year.

Among individuals in the 45- to 64-year age group, change in regional suicide deaths was positively associated with change in regional opioid prescriptions and change in percentage with at least one opioid prescription. Overall, the association with change in suicide deaths was significantly stronger in the West than in the East or the Midwest.

“If opioid prescribing per capita had held constant from 2009 to 2017, there would have been an estimated 10.5 percent more suicide deaths involving opioids in 2017,” noted Olfson. The corresponding estimated percentage increases in opioid-related suicide deaths were 15 percent, 9 percent, 9 percent, and 19 percent, respectively, for at least one opioid prescription, high-dose prescriptions, long-term prescriptions, and three or more opioid prescribers.

In the U.S., geographic regions with the greatest declines in people filling opioid prescriptions also tended to have the greatest declines in total suicide deaths. Had the national decline in opioid prescriptions between 2009 and 2017 not occurred, there would have been 3 percent more suicide deaths overall in the U.S. according to the research team. For four of five prescribing measures, decreasing regional opioid prescriptions were also related to declining total opioid-related overdose deaths.

“Although the present population-level research cannot establish that opioid prescriptions cause deaths by suicide, the results are consistent with the view that opioid prescription policies and practices should give careful attention to possible connections between prescription opioids and suicide risk,” noted Olfson.

Co-authors are Timothy Waidmann, and Vincent Pancini, Urban Institute, Health Policy Center, Washington, D.C.; Marissa King, University of Pennsylvania; and Michael Schoenbaum, NIMH, Bethesda.

The study was supported by the National Institute on Drug Abuse, grant 1R01DA044981.

The authors report no financial relationships with commercial interests.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.

JOURNAL

American Journal of Psychiatry

DOI

10.1176/appi.ajp.22020102

ARTICLE TITLE

A study of opioid prescriptions and mortality found population-level evidence linking opioid prescribing to suicide risk

ARTICLE PUBLICATION DATE

11-Apr-2023

New UK data system will help predict and prevent opioid overdoses in Kentucky

Grant and Award Announcement

UNIVERSITY OF KENTUCKY

New UK data system will help predict and prevent opioid overdoses in Kentucky — IMAGE: CO-LED BY SVETLA SLAVOVA AND JEFF TALBERT, RADOR-KY UTILIZE ARTIFICIAL INTELLIGENCE TO HELP PREDICT AND PREVENT OPIOID OVERDOSES. view more
CREDIT: ARDEN BARNES | UNIVERSITY OF KENTUCKY PHOTO.

LEXINGTON, Ky. (April 10, 2023) — University of Kentucky researchers are creating an innovative statewide surveillance system to inform prevention and response efforts aimed at reducing the burden of opioid use disorder in Kentucky.

The Rapid Actionable Data for Opioid Response in Kentucky (RADOR-KY) will use data from federal, state, and local sources to guide evidence-based practices aimed at preventing opioid overdoses in the Commonwealth. Phase one of the project is supported by a three-year $3.1 million grant from the National Institute on Drug Abuse (NIDA).

Driven by the COVID-19 pandemic and illegally manufactured fentanyl, drug overdose deaths in the U.S. increased to historic levels in 2021. Kentucky has been hit hard by the opioid epidemic. Overdose deaths reached an all-time high of 2,250, with 90% of those deaths involving an opioid.

Co-led by Svetla Slavova, Ph.D., associate professor in the College of Public Health, and Jeff Talbert, Ph.D., professor in the College of Medicine and College of Pharmacy, RADOR-KY will use a comprehensive set of data needed to effectively monitor and respond to the rapidly evolving opioid overdose crisis.

The system will use advanced algorithms to rapidly process data and help predict potential overdose surges using artificial intelligence.

“This unique, first-of-its-kind system will not only track and monitor overdose cases but use predictive analytics and dashboards for fast dissemination of analytical results to keep state agencies and local stakeholders on the frontlines of the opioid epidemic in Kentucky a step ahead,” said Slavova, who also serves as interim associate dean for research in the College of Public Health.

RADOR-KY will use data from multiple sources, including the Kentucky Office of Vital Statistics, syndromic surveillance, emergency medical services, prescription drug monitoring, Medicaid claims and drug seizure records. It will also track measures related to evidence-based practices such as treatment for opioid use disorder, overdose education and the distribution of naloxone, a life-saving medication that rapidly reverses an opioid overdose.

The project will leverage the expertise of UK research centers including the Kentucky Injury Prevention and Research Center, the Center on Drug and Alcohol Research, and the Institute for Biomedical Informatics. It also builds upon the expertise and experience gained from UK's work on the HEALing Communities Study (HCS).

“We’ve harnessed the power of our data processing capabilities at UK with the framework and experience gained from our work on the HEALing Communities Study, which has also shown that addressing this public health crisis requires working across disciplines,” said Talbert, who also directs the Institute for Biomedical Informatics.

“The HEALing Communities Study has been an exemplar of how a state and a university can work together and one of the deciding factors for receiving this award,” said HCS principal investigator Sharon Walsh, Ph.D., a professor in UK’s College of Medicine and College of Pharmacy and director for the Center on Drug and Alcohol Research.

Walsh leads the project’s substance use disorder team, which will advise on the content of evidence-based practices and state and local partners who are end users of the system.

Katherine Marks, Ph.D., a UK College of Medicine research assistant professor who serves as project director for the Kentucky Opioid Response Effort (KORE) within the Cabinet for Health and Family Services, is the project’s state government liaison.

Marks says RADOR-KY’s faster data processing, predictive analytics and inclusion of evidence-based practices will help the state take more strategic action.

“The opportunity for state and community partners to have readily available access to data so we can take action and evaluate how we’re doing in our response is a remarkable innovation,” said Marks. “This is a wonderful demonstration of the collaborative potential between the state and university expertise. It’s also yet another example of how UK is working as the University for Kentucky.”

An end-user advisory group, including partners in state government and local communities, will also guide the development of RADOR-KY. To advance the efforts to mitigate the opioid epidemic across the U.S. the team also plans to share programming code and algorithms in a public repository.

This project is supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA057605. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

As the state’s flagship, land-grant institution, the University of Kentucky exists to advance the Commonwealth. We do that by preparing the next generation of leaders — placing students at the heart of everything we do — and transforming the lives of Kentuckians through education, research and creative work, service and health care. We pride ourselves on being a catalyst for breakthroughs and a force for healing, a place where ingenuity unfolds. It's all made possible by our people — visionaries, disruptors and pioneers — who make up 200 academic programs, a $501 million research and development enterprise and a world-class medical center, all on one campus.

In 2022, UK was ranked by Forbes as one of the “Best Employers for New Grads” and named a “Diversity Champion” by INSIGHT into Diversity, a testament to our commitment to advance Kentucky and create a community of belonging for everyone. While our mission looks different in many ways than it did in 1865, the vision of service to our Commonwealth and the world remains the same. We are the University for Kentucky.

Tuesday, June 06, 2023

Your body naturally produces opioids without causing addiction or overdose – studying how this process works could help reduce the side effects of opioid drugs

The Conversation
June 5, 2023,

Opioid neurotransmitters (Shutterstock)

Opioid drugs such as morphine and fentanyl are like the two-faced Roman god Janus: The kindly face delivers pain relief to millions of sufferers, while the grim face drives an opioid abuse and overdose crisis that claimed nearly 70,000 lives in the U.S. in 2020 alone.

Scientists like me who study pain and opioids have been seeking a way to separate these two seemingly inseparable faces of opioids. Researchers are trying to design drugs that deliver effective pain relief without the risk of side effects, including addiction and overdose.

One possible path to achieving that goal lies in understanding the molecular pathways opioids use to carry out their effects in your body.

How do opioids work?

The opioid system in your body is a set of neurotransmitters your brain naturally produces that enable communication between neurons and activate protein receptors. These neurotransmitters include small proteinlike molecules like enkephalins and endorphins. These molecules regulate a tremendous number of functions in your body, including pain, pleasure, memory, the movements of your digestive system and more.

Opioid neurotransmitters activate receptors that are located in a lot of places in your body, including pain centers in your spinal cord and brain, reward and pleasure centers in your brain, and throughout the neurons in your gut. Normally, opioid neurotransmitters are released in only small quantities in these exact locations, so your body can use this system in a balanced way to regulate itself.

The opioids your body produces and opioid drugs bind to the same receptors.

The problem comes when you take an opioid drug like morphine or fentanyl, especially at high doses for a long time. These drugs travel through the bloodstream and can activate every opioid receptor in your body. You’ll get pain relief through the pain centers in your spinal cord and brain. But you’ll also get a euphoric high when those drugs hit your brain’s reward and pleasure centers, and that could lead to addiction with repeated use. When the drug hits your gut, you may develop constipation, along with other common opioid side effects.

Targeting opioid signal transduction

How can scientists design opioid drugs that won’t cause side effects?

One approach my research team and I take is to understand how cells respond when they receive the message from an opioid neurotransmitter. Neuroscientists call this process opioid receptor signal transduction. Just as neurotransmitters are a communication network within your brain, each neuron also has a communication network that connects receptors to proteins within the neuron. When these connections are made, they trigger specific effects like pain relief. So, after a natural opioid neurotransmitter or a synthetic opioid drug activates an opioid receptor, it activates proteins within the cell that carry out the effects of the neurotransmitter or the drug.

Cells communicate with one another in multiple ways.

Opioid signal transduction is complex, and scientists are just starting to figure out how it works. However, one thing is clear: Not every protein involved in this process does the same thing. Some are more important for pain relief, while some are more important for side effects like respiratory depression, or the decrease in breathing rate that makes overdoses fatal.

So what if we target the “good” signals like pain relief, and avoid the “bad” signals that lead to addiction and death? Researchers are tackling this idea in different ways. In fact, in 2020 the U.S. Food and Drug Administration approved the first opioid drug based on this idea, oliceridine, as a painkiller with fewer respiratory side effects.

However, relying on just one drug has downsides. That drug might not work well for all people or for all types of pain. It could also have other side effects that show up only later on. Plenty of options are needed to treat all patients in need.

This figure shows the structure of Hsp90.

Laguna Design/Science Photo Library via Getty Images

My research team is targeting a protein called Heat shock protein 90, or Hsp90, which has many functions inside each cell. Hsp90 has been a hot target in the cancer field for years, with researchers developing Hsp90 inhibitors as a treatment for many cancer types.

We’ve found that Hsp90 is also really important in regulating opioid signal transduction. Blocking Hsp90 in the brain blocked opioid pain relief. However, blocking Hsp90 in the spinal cord increased opioid pain relief. Our recently published work uncovered more details on exactly how inhibiting Hsp90 leads to increased pain relief in the spinal cord.

Our work shows that manipulating opioid signaling through Hsp90 offers a path forward to improve opioid drugs. Taking an Hsp90 inhibitor that targets the spinal cord along with an opioid drug could improve the pain relief the opioid provides while decreasing its side effects. With improved pain relief, you can take less opioid and reduce your risk of addiction. We are currently developing a new generation of Hsp90 inhibitors that could help realize this goal.

There may be many paths to developing an improved opioid drug without the burdensome side effects of current drugs like morphine and fentanyl. Separating the kindly and grim faces of the opioid Janus could help provide pain relief we need without addiction and overdose.

John Michael Streicher, Associate Professor of Pharmacology, University of Arizona Health Sciences

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Monday, January 15, 2024

Cannabis has no clear effect on treatment of opioid addiction, US study finds

Finding has significant implications for treatment programmes – with a growing number of states authorizing cannabis use to help opioid addiction

Peer-Reviewed Publication

TAYLOR & FRANCIS GROUP

Cannabis is not an effective treatment for opioid addiction, a new peer-reviewed study of thousands of people being treated for opioid use disorder suggests.

Experts, publishing their results today in The American Journal of Drug and Alcohol Abuse, have found that cannabis is having no significant effect on peoples’ use of opioids, taken outside of medical guidance.

The findings have substantial implications for U.S treatment programmes, some of which still require patients to abstain from cannabis before they qualify for potentially life-saving treatment. This is based on the belief they are more likely to use opioids non-medically if they are using cannabis.

The opposing, and increasingly popular, viewpoint, that cannabis can help wean people with opioid use disorder off opioids, is also called into question in this new study.

Opioids are effective painkillers, but they can also be addictive, and the U.S. remains in the grip of an opioid use disorder crisis.

Around 120 people die a day from drug overdoses involving opioids (prescription, such as oxycodone, and non-prescription, such as heroin) and opioid use disorder and related deaths cost the US economy more than $1 trillion a year.

As cannabis gains popularity among individuals with opioid use disorder in the U.S., its medicinal use is now legally recognized in thirty-seven states and Washington D.C. While pain remains the most common reason for medical cannabis authorization (i.e., “medical cannabis registration card”), an increasing number of states are adding “alternatives to opioids” or “opioid-treatable disorders” to their lists of approved conditions. In certain states, this includes treatment for opioid use disorder.

The study’s authors say this partly because the legalisation of the recreational use of cannabis in many states means the drug is being perceived as being less harmful than in the past. Some cannabis dispensaries have promoted medicinal cannabis as a treatment for opioid use disorder.

It isn’t clear, however, whether cannabis helps or hinders the treatment of opioid use disorder. Some studies have found it helps alleviate pain and opioid withdrawal, but others suggest it makes a return to opioids more likely.

“Clarifying how cannabis and opioids interact is crucial if we are to equip healthcare professionals to provide evidence-based addiction treatment, prevent overdose deaths and save lives,” says researcher Gabriel Costa, of University of Ribeirão Preto in Brazil.

Costa, under the mentorship of Dr. Joao P. De Aquino, of Yale University, and colleagues, carried out a systematic review and meta-analysis of existing research on the influence of cannabis on non-medical opioid use.

The meta-analysis combined the results of ten longitudinal studies involving 8,367 individuals who were receiving medication (buprenorphine, methadone or naltrexone) to treat their opioid use disorder.

As part of this, over the course of an average of 10 months, individuals were monitored for their non-medical opioid use – including the use of opioids not prescribed to them, taking more opioids than prescribed, or using opioids without a prescription.

The study compared the frequency of this use between individuals who used cannabis, typically obtained from non-regulated sources, and those who did not use cannabis.

Results showed there to be no link between cannabis use and rates of non-medical opioid use.

“Overall, we found no significant association between cannabis and non-medical opioid use among patients receiving pharmacotherapies for opioid use disorder,” states Costa.

“These findings neither confirm concerns about cannabis increasing non-medical opioid use in individuals being treated for opioid use disorder, nor do they endorse its efficacy in reducing non-medical opioid use.”

The implications for opioid use disorder treatment programmes are significant, adds Dr. De Aquino, who is a specialist in the treatment of persons with substance use disorders and co-occurring medical and psychiatric disorders.

He explains: “Our finding questions the ineffective practice of enforcing cannabis abstinence as a condition to offer life-saving medications for opioid use disorder.

“Our data suggests healthcare systems should instead adopt individualised treatment approaches which take into account each patient’s circumstances.

“This would include assessing cannabis use disorder, a problematic pattern cannabis use that affects a person’s wellbeing and ability to function, addressing pain management needs and treating co-occurring psychiatric conditions, such as depression and anxiety.”

Dr. De Aquino adds that there have been very few experimental studies into cannabis and its constituent cannabinoids’ ability to alleviate symptoms of opioid use disorder, and randomised placebo-controlled trials are needed to thoroughly assess its safety and effectiveness.

He says: “As high-potency synthetic opioids such fentanyl become increasingly available, it is of utmost importance that individuals with opioid use disorder have access to FDA-approved treatments.

“Methadone, buprenorphine, and extended-release intramuscular naltrexone – are known to be life-saving and are the cornerstone of opioid use disorder management.”

Limitations include a lack of consistency in how the studies in systematic review and meta-analysis were conducted. This includes differences in how cannabis and opioid use were measured and variations in baseline opioid use status.

In addition, although the results are applicable to general cannabis use, they may not apply to individuals with cannabis use disorder.