a National Drug and Alcohol Research Centre , UNSW Sydney , Sydney , Australia.
b Centre for Youth Substance Abuse Research , University of Queensland , Brisbane , Australia.
Int Rev Psychiatry. 2018 Oct;30(5):91-106. doi: 10.1080/09540261.2018.1509842. Epub 2018 Dec 6.
Pre-clinical research supports that cannabinoids reduce opioid dose requirements, but few studies have tested this in humans. This review evaluates ecological and epidemiological studies that have been cited as evidence that medical cannabis use may reduce opioid use and opioid-related harms. Medline and Embase were searched for relevant articles. Data were extracted on study setting, analyses approach, covariates, and outcomes. Eleven ecological and 14 epidemiological studies were found. In ecological studies, states that allow medical cannabis laws have reported a slower rate of increase in opioid overdose deaths compared with states without such laws. These differences have increased over time and persisted after controlling for state sociodemographic characteristics and use of prescription monitoring programmes. Few studies have controlled for other potential confounders such as opioid dependence treatment and imprisonment rates. Some epidemiological studies provide evidence that cannabis availability may reduce opioid use, but are limited by selection bias, cross-sectional designs, and self-reported assessments of the opioid-sparing effects of cannabis. Some epidemiological and ecological studies suggest that cannabis may reduce opioid use and harms, although important methodological weaknesses were identified. Well-designed clinical studies may provide more conclusive evidence on whether cannabinoids can reduce opioid use and related harm.
临床前研究支持大麻素可减少阿片类药物的剂量需求，但很少有研究在人类中对此进行测试。本综述评估了被引为医学大麻使用可能减少阿片类药物使用和阿片类药物相关危害的证据的生态学和流行病学研究。检索了 Medline 和 Embase 中的相关文章。提取了研究设置、分析方法、协变量和结果的数据。发现了 11 项生态学研究和 14 项流行病学研究。在生态学研究中，允许医用大麻法律的州报告称，与没有此类法律的州相比，阿片类药物过量死亡的增长率较慢。这些差异随着时间的推移而增加，并在控制了州社会人口特征和处方监测计划的使用后仍然存在。很少有研究控制了其他潜在的混杂因素，如阿片类药物依赖治疗和监禁率。一些流行病学研究提供了大麻供应可能减少阿片类药物使用的证据，但受到选择偏差、横断面设计和大麻对阿片类药物的节省作用的自我报告评估的限制。一些流行病学和生态学研究表明，大麻可能会减少阿片类药物的使用和危害，尽管发现了重要的方法学弱点。精心设计的临床研究可能会提供更确凿的证据，证明大麻素是否可以减少阿片类药物的使用和相关危害。
