ASAM Weekly Editorial Comment

Editorial Comment: Cannabis for treatment of Opioid Use Disorder (OUD) | 2.12.2019

by Dr. William Haning | Feb 11, 2019

A disturbing trend of states’ legislative approvals of the use of cannabis for treatment of OUD (opioid use disorder)  reflects a mood of desperation in OUD management that is leading to unwise policy.  Such policy implements treatment of a disabling and potentially lethal disorder with an unvalidated substance.  In a presentation to the California Society of Addiction Medicine this past August, I was asked to address the evidence for treatment of OUD with cannabis

 

  • The 16 citations most commonly presented in defense of this practice allude to adjunctive management of pain, or to antinociceptive effects in humans or rats.
  • Some are encouraging in offering support for cannabis derivatives as antinociceptive agents (leading to analgesia), primary or adjunctive.  However, no citation provided more than speculation regarding the utility of cannabis in management of opioid use disorder (OUD), or in management of addiction per se.
  • An additional 152 items were reviewed from NLM in seeking evidentiary support for the contention that cannabis is justified in management of OUD; the review was unproductive of such support.
  • My conclusion was that research which determines both the safety and efficacy of the component chemicals within cannabis warrants pursuit.  In the absence of adequate studies supporting use, however, legislative authorization of cannabis use for management of an OUD, including withdrawal, could constitute uncontrolled and unregulated human research.

 

…K. Humphreys and S. Saitz in the 01 February  JAMA Online contributed a more detailed, comprehensive examination of this question.  The article is open-access and is an excellent companion to policy testimony:  https://jamanetwork.com/journals/jama/fullarticle/2723649

 

- W. Haning, MD