Leaving the situation of OTPs and methadone for a moment, let’s consider buprenorphine. It’s not only OTPs, which mainly dispense methadone, that are interested in helping patients by allowing cannabis.
These problems began when only medical marijuana was permitted. With the advent of recreational marijuana in 2012, life for OTP patients — and providers — got even more complicated.
What Federal Rules Say—And Don’t
For people who use drugs and start opioid agonist treatment, daily cannabis use was associated with a 21 percent greater odds of treatment retention compared with less-than-daily cannabis use.
Massachusetts, by way of contrast, is another state that, like Colorado, requires THC testing in its OTPs.
Among many studies on this issue, there have been these findings showing the benefits or lack of harms of cannabis for OTP patients:
Further, unlike its sister cannabinoid, delta-9-tetrahydrocannabinol (THC), CBD is largely non-intoxicating and therefore is thought to be non-addictive. It also appears to be relatively safe to use. It’s no wonder CBD has garnered so much excitement and positive attention.
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Medicinal uses of cannabidiol
Crucially, this means that we need many more studies and funded research to fully understand exactly how CBD might play a role in the treatment of opioid use disorder.
Opioid agonist treatments are particularly helpful for the mitigation of opioid cravings and withdrawal. Another therapeutic effect of opioid agonist treatments is that they help people in recovery maintain some level of tolerance to opioids, which is helpful for preventing overdose in the event of relapse.
Further, to suggest that CBD is an effective treatment for opioid use disorder is misleading and harmful, as this misinformation could be used to justify not initiating, or discontinuing, opioid agonist medications.
Many patients and their families don’t disclose the use of natural medicines such as CBD and other cannabis products to their healthcare providers. It’s important to discuss the use of all cannabis-derived products with patients and their families. Healthcare providers should ask directly about CBD use and be aware of its potential drug interactions.
A 13-year-old patient with chronic cancer pain who was previously stabilized on methadone 7.5 mg twice daily was admitted to the ER with opioid-related side effects. These side effects started 5 days prior to the ER visit, which occurred about 2 weeks after her parents increased her dose of CBD oil 4-fold. After stopping CBD, the side effects resolved. CBD may increase methadone levels by inhibiting the cytochrome P450 3A4 (CYP3A4) and CYP2C19 enzymes, which metabolize methadone. This is the first case report suggesting there is an interaction between CBD and methadone. The interaction appears to be dose-dependent – in this case, it occurred with a very high dose of CBD but not with a much lower dose. More evidence is needed to verify this interaction and to determine the CBD dose threshold at which it might occur.
A new report suggests that taking cannabidiol (CBD) might increase methadone levels and increase its side effects. This is especially concerning in chronic pain settings such as cancer.
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