British Columbia Centre on Substance Use, Vancouver, BC, Canada.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Addiction. 2018 Dec;113(12):2250-2258. doi: 10.1111/add.14398. Epub 2018 Sep 20.
Cannabis use is common among people on opioid agonist treatment (OAT), causing concern for some care providers. However, there is limited and conflicting evidence on the impact of cannabis use on OAT outcomes. Given the critical role of retention in OAT in reducing opioid-related morbidity and mortality, we aimed to estimate the association of at least daily cannabis use on the likelihood of retention in treatment among people initiating OAT. As a secondary aim we tested the impacts of less frequent cannabis use.
Data were drawn from two community-recruited prospective cohorts of people who use illicit drugs (PWUD). Participants were followed for a median of 81 months (interquartile range = 37-130).
Vancouver, Canada.
This study comprised a total of 820 PWUD (57.8% men, 59.4% of Caucasian ethnicity, 32.2% HIV-positive) initiating OAT between December 1996 and May 2016. The proportion of women was higher among HIV-negative participants, with no other significant differences.
The primary outcome was retention in OAT, defined as remaining in OAT (methadone or buprenorphine/naloxone-based) for two consecutive 6-month follow-up periods. The primary explanatory variable was cannabis use (at least daily versus less than daily) during the same 6-month period. Confounders assessed included: socio-demographic characteristics, substance use patterns and social-structural exposures.
In adjusted analysis, at least daily cannabis use was positively associated with retention in OAT [adjusted odds ratio (aOR) = 1.21, 95% confidence interval (CI) = 1.04-1.41]. Our secondary analysis showed that compared with non-cannabis users, at least daily users had increased odds of retention in OAT (aOR = 1.20, 95% CI = 1.02-1.43), but not less than daily users (aOR = 1.00, 95% CI = 0.87-1.14).
Among people who use illicit drugs initiating opioid agonist treatment in Vancouver, at least daily cannabis use was associated with approximately 21% greater odds of retention in treatment compared with less than daily consumption.
阿片类药物激动剂治疗（OAT）人群中大麻使用较为常见，这引起了部分医护人员的担忧。然而，关于大麻使用对 OAT 结果的影响，目前证据有限且存在冲突。鉴于保留 OAT 在降低阿片类药物相关发病率和死亡率方面的关键作用，我们旨在估计至少每日使用大麻与开始 OAT 治疗的人群保留治疗的可能性之间的关联。作为次要目标，我们测试了较少频率的大麻使用的影响。
数据来自两个社区招募的使用非法药物的人群（PWUD）前瞻性队列。参与者的中位随访时间为 81 个月（四分位距=37-130）。
加拿大温哥华。
这项研究共包括 820 名 PWUD（57.8%为男性，59.4%为白种人，32.2%为 HIV 阳性），他们于 1996 年 12 月至 2016 年 5 月期间开始 OAT。女性比例在 HIV 阴性参与者中更高，没有其他显著差异。
主要结局是 OAT 保留，定义为在连续两个 6 个月的随访期间保持 OAT（美沙酮或丁丙诺啡/纳洛酮为基础）。主要解释变量是同一 6 个月期间的大麻使用（至少每日与少于每日）。评估的混杂因素包括：社会人口统计学特征、物质使用模式和社会结构暴露。
在调整分析中，至少每日使用大麻与 OAT 保留呈正相关[调整后的优势比（aOR）=1.21，95%置信区间（CI）=1.04-1.41]。我们的二次分析表明，与非大麻使用者相比，至少每日使用者保留 OAT 的可能性增加（aOR=1.20，95%CI=1.02-1.43），但少于每日使用者则不然（aOR=1.00，95%CI=0.87-1.14）。
在温哥华开始阿片类药物激动剂治疗的使用非法药物的人群中，与每日少于一次使用大麻相比，至少每日使用大麻与保留治疗的可能性增加约 21%。
