Cannabis Use Associated With Aberrant Drug Behaviors

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Patients who were THC-positive at baseline were more likely to be men and to have a history of substance use disorder.
Patients who were THC-positive at baseline were more likely to be men and to have a history of substance use disorder.

Cannabis use was associated with aberrant drug behaviors in patients referred to a medication management program, according to the results of a recent study published in Pain Medicine.

In a retrospective cohort study, chronic opioid users enrolled in a medication management program were screened for cannabis use with urine drug testing during evaluation for the program and categorized as Δ9-tetrahydrocannabinol (THC)-negative (n=165) or THC-positive (n=44). Patients who were THC-positive agreed to discontinue cannabis use to enroll in the program.

Subsequent urine drug testing was used to compare aberrant drug behaviors between the 2 groups. Inconsistent urinary drug tests associated with aberrant drug behaviors included the presence of an opioid medication not currently prescribed, the absence of a prescribed opioid medication, or the presence of an illicit substance, including cannabis or alcohol.

Patients who were THC-positive at baseline were more likely to be men (P =.047), to have a history of substance use disorder (P =.013), and to be enrolled in a higher level of clinical monitoring of opioid medication use (P =.008) compared with patients who were THC-negative.

Patients with inconsistent urinary drug tests were more likely to be baseline THC-positive compared with those with consistent urinary drug tests (35.4% vs 8.8%; P <.001). According to the generalized estimating equation analysis, baseline THC-positive results were associated with an increased risk for inconsistent urinary drug test occurrence (odds ratio [OR], 7.26; P <.001).

When the presence of THC in subsequent urinary drug tests was considered consistent vs inconsistent, the occurrence of inconsistent drug tests among THC-positive and THC-negative patients was not significantly different according to a chi-square analysis (P =.221), but was significant according to the generalized estimating equation analysis (OR, 2.50; P <.001).

In an interview with Clinical Pain Advisor, Kelly Wawrzyniak, PsyD, clinical psychologist and director of Clinical Research Development at Boston PainCare Center in Massachusetts and senior author on the study, concluded that the legalization of medical cannabis will lead to "a continued increase in the concurrent use of cannabis and opioid analgesics." As such, she noted that "clinicians should inquire and periodically drug test for the use of cannabis and illicit substances in patients receiving or being considered for opioid treatment."

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Reference

DiBenedetto DJ, Weed VF, Wawrzyniak KM, et al. The association between cannabis use and aberrant behaviors during chronic opioid therapy for chronic pain [published online October 9, 2017]. Pain Medicine. doi: 10.1093/pm/pnx222

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