Bagra, Igam, MD; Krishnan, Vijay, MD; Rao, Ravindra, MD; Agrawal, Alok, MD

Objectives: Use of various psychoactive substances can influence outcomes of patients on opioid agonist treatment (OAT). While use of alcohol and cocaine has shown to adversely affect OAT results, associated cannabis use shows mixed results. This study aimed to assess the pattern of cannabis use among opioid-dependent patients maintained on buprenorphine. Additionally, the study compared the dose of buprenorphine, opioid-related craving and withdrawals, productivity, and also quality of life between those with and without recent (past 90-day) cannabis use.

Methods: We collected data on demographic and drug use details in 100 randomly selected adult male patients attending a community drug treatment clinic, who were stabilized on buprenorphine for more than 3 months. Other measures included scores on World Health Organization (WHO)-Alcohol, Smoking and Substance Involvement Screening Tool and WHO-Quality of Life-Brief (WHOQOL-Bref) version.

Results: The average duration of maintenance treatment with buprenorphine was 96 months, with excellent compliance for buprenorphine (86.92 ± 9.58 days in 90 days). Thirty-five per cent had used cannabis in past 90 days, with lifetime use of cannabis in 77%. Participants using cannabis currently were on lower doses of buprenorphine (mean dose per day: 7.9 mg vs 8.9 mg; P = 0.04). Yet, there was no significant difference in the rates of opioid use or opioid withdrawals and craving between the 2 groups. Compliance to OAT, number of days of employment, daily earning, and WHOQOL-Bref scores in all domains were comparable between those with and without cannabis use. Duration of cannabis use, current use of alcohol, and dose of buprenorphine predicted current cannabis use in multivariable logistic regression analysis.

Conclusions: Cannabis use does not negatively influence opioid outcomes among patients receiving buprenorphine maintenance treatment. There is no difference in productivity and quality of life between individuals maintained on buprenorphine with and without current cannabis use.


I find this information counterintuitive to the effect that good recovery in a 12-step program has and the necessity to stop mind-altering substances, yet with the exception of Medication Assisted Treatment of addiction such as Buprenorphine.  I also recognize that since BUP is a mixed agonist/antagonist as it’s mechanism of action.  I’m surprised that the cannabinoid system has an apparently neutral effect.  Knowing that some cannabinoids have opposite effects of others, I wonder if it would be possible to tease out a group of cannabinoids that would be helpful to the process.  I confess that my own bias is still strongly in favor of the spiritual nature of the disease and recovery with the 12-step programs.

Dr. Raymond Oenbrink