Backmund Markus, Zámbó Greta G, Schöfl Susanne, Soyka Michael
Ludwig-Maximilians-University Munich, Munich, Germany.
P3 Clinic, Tutzing, Germany.
Brain Sci. 2025 Jun 29;15(7):699. doi: 10.3390/brainsci15070699.
Opioid maintenance therapy (OMT) is the first-line treatment for opioid use disorder (OUD), reducing opioid use and mortality while improving physical and mental health. However, concomitant substance use remains common, with cannabis being the most frequently used substance. This study assessed the prevalence and clinical correlates of cannabis use in OMT patients, as well as individual motivations.
In this cross-sectional, single-center study, 128 OUD patients (96 male, 32 female) receiving OMT were assessed using standardized questionnaires: the Marijuana Smoking History Questionnaire (MSHQ), Cannabis Problems Questionnaire (CPQ) and the Severity of Dependence Scale (SDS). Cannabis users and non-users were compared regarding type (methadone vs. buprenorphine) and dosage of maintenance medication.
Cannabis use was reported by 41% of patients, 73% met criteria for cannabis dependence, 30% of the full sample. Of the patients, 85% reported cannabis-related legal issues. Common reasons for use included recreational motives (mood change, enhancement) and reduction in cravings for other substances. Cannabis dependence was significantly more common in patients receiving buprenorphine than methadone. Higher methadone doses were also associated with increased cannabis use. These results suggest a clinically relevant pattern.
Cannabis use is highly prevalent and appears to be influenced by type and dosage of substitution medication. These findings highlight a complex interaction between opioid treatment and cannabis use, possibly involving behavioral coping or regulatory processes. Further longitudinal and placebo-controlled trials are needed to investigate the clinical and pharmacological interactions between cannabis and OMT, including effects on craving, withdrawal, and overall treatment outcomes.
阿片类药物维持治疗（OMT）是阿片类药物使用障碍（OUD）的一线治疗方法，可减少阿片类药物使用和死亡率，同时改善身心健康。然而，同时使用其他物质的情况仍然很常见，大麻是最常使用的物质。本研究评估了接受OMT治疗的患者中使用大麻的患病率、临床相关性以及个人动机。
在这项横断面单中心研究中，使用标准化问卷对128名接受OMT治疗的OUD患者（96名男性，32名女性）进行评估：大麻使用历史问卷（MSHQ）、大麻问题问卷（CPQ）和依赖严重程度量表（SDS）。比较了大麻使用者和非使用者在维持药物类型（美沙酮与丁丙诺啡）和剂量方面的差异。
41%的患者报告使用过大麻，73%符合大麻依赖标准，占全部样本的30%。在这些患者中，85%报告了与大麻相关的法律问题。使用大麻的常见原因包括娱乐动机（情绪改变、增强）以及减少对其他物质的渴望。接受丁丙诺啡治疗的患者中，大麻依赖明显比接受美沙酮治疗的患者更常见。较高的美沙酮剂量也与大麻使用增加有关。这些结果表明存在一种具有临床相关性的模式。
大麻使用非常普遍，并且似乎受到替代药物的类型和剂量的影响。这些发现突出了阿片类药物治疗与大麻使用之间的复杂相互作用，可能涉及行为应对或调节过程。需要进一步进行纵向和安慰剂对照试验，以研究大麻与OMT之间的临床和药理学相互作用，包括对渴望、戒断和总体治疗结果的影响。
