Kitchen Chenai, Socias Eugenia, Sayre Eric C, Hayashi Kanna, DeBeck Kora, Milloy M-J, Kerr Thomas, Reddon Hudson
British Columbia Centre on Substance Use, Vancouver, Canada.
Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.
Drug Alcohol Rev. 2025 Mar;44(3):799-810. doi: 10.1111/dar.14014. Epub 2025 Feb 26.
Amidst the opioid overdose crisis, there is interest in cannabis use for pain management and harm reduction. We investigated the relationship between cannabis use and cessation of unregulated opioid use among people who use drugs (PWUD) living with chronic pain.
Data for analyses were collected from three prospective cohort studies in Vancouver, Canada. All cohort participants who completed at least two study visits and reported both pain and unregulated opioid use in the past 6 months were included in the present study. We analysed the association between cannabis use frequency and opioid cessation rates using extended Cox regression models with time-updated covariates.
Between June 2014 and May 2022, 2340 PWUD were initially recruited and of those 1242 PWUD reported chronic pain, use of unregulated opioids and completed at least two follow-up visits. Of these 1242 participants, 764 experienced a cessation event over 1038.2 person-years resulting in a cessation rate of 28.5 per 100 person-years (95% confidence interval [CI] 25.4-31.9). Daily cannabis use was positively associated with opioid cessation (adjusted hazard ratio 1.40, 95% CI 1.08-1.81; p = 0.011). In the sex-stratified sub-analyses, daily cannabis use was significantly associated with increased rates of opioid cessation among males (adjusted hazard ratio 1.50, 95% CI 1.09-2.08; p = 0.014).
Participants reporting daily cannabis use exhibited higher rates of cessation compared to less frequent users or non-users. Observed sex-specific differences in cannabis use and opioid cessation suggest potential differences in cannabis use behaviours and effects. Our findings add to the growing evidence supporting the potential benefits of cannabis use among PWUD, underlining the need for further research.
在阿片类药物过量危机中，人们对使用大麻进行疼痛管理和减少伤害产生了兴趣。我们调查了患有慢性疼痛的吸毒者（PWUD）中大麻使用与停止使用不受管制的阿片类药物之间的关系。
分析数据来自加拿大温哥华的三项前瞻性队列研究。本研究纳入了所有完成至少两次研究访视且在过去6个月内报告有疼痛和使用不受管制的阿片类药物的队列参与者。我们使用具有时间更新协变量的扩展Cox回归模型分析大麻使用频率与阿片类药物戒断率之间的关联。
2014年6月至2022年5月期间，最初招募了2340名PWUD，其中1242名PWUD报告有慢性疼痛、使用不受管制的阿片类药物并完成了至少两次随访。在这1242名参与者中，764人在1038.2人年期间经历了戒断事件，戒断率为每100人年28.5例（95%置信区间[CI]25.4 - 31.9）。每日使用大麻与阿片类药物戒断呈正相关（调整后的风险比为1.40，95%CI为1.08 - 1.81；p = 0.011）。在按性别分层的亚分析中，每日使用大麻与男性阿片类药物戒断率增加显著相关（调整后的风险比为1.50，95%CI为1.09 - 2.08；p = 0.014）。
与使用频率较低或不使用大麻的参与者相比，报告每日使用大麻的参与者戒断率更高。观察到的大麻使用和阿片类药物戒断中的性别差异表明大麻使用行为和效果可能存在差异。我们的研究结果进一步证明了支持PWUD使用大麻可能有益的证据不断增加，强调了进一步研究的必要性。
