Multiple groups have reported synergy between cannabinoids and opiates when administered concurrently 10, 37– 40. Based on findings from experimental models of opiate dependence, it is hypothesized that the use of cannabinoids, via its interaction with the opioid system, may impact opioid signaling in the brain 29– 36. The present study sought to examine the trends in cannabis use of individuals during the early phases of MMT initiation in order to test the hypothesis that cannabis use may impact illicit drug use, and subsequently methadone stabilization. However, very limited research has focused specifically on the impact of cannabis exposure during the process of methadone dose titration (referred to herein as methadone induction) and the early stabilization phase. Several groups have investigated the impact of cannabis use on various measures of treatment outcome and success, such as retention in treatment or compliance 16, 23– 28.
In several studies of non-opiate illicit drug use in opiate-dependent individuals, rates of cannabis use were shown to remain high during treatment for opiate dependence 15, 22– 25. There is a limited amount of research focused on the impact of continued non-opiate substance use on methadone dose titration and overall treatment compliance.Ĭannabis (marijuana) is commonly used in combination with heroin or oral opiates, in addition to other substances such as cocaine and benzodiazepines 19– 21. Non-opiate illicit drug use often persists during the early phases of treatment for opiate dependence 11– 18, promoted at least in part by the experience of withdrawal and craving. The initial period of methadone dose stabilization is one of particular vulnerability to relapse due to the persistence of low-moderate grade opiate withdrawal and associated stress during dose titration 6– 10. Dose titration proceeds through initiation, induction, and stabilization phases prior to reaching a maintenance phase 3– 5. Initiation on methadone maintenance treatment is a federally regulated process that requires slow and careful titration of methadone dosing to avoid risk of overmedication. Methadone maintenance treatment (MMT) is an opiate agonist pharmacotherapy prescribed for opiate-dependent individuals as a means of extinguishing illicit opiate use and reducing associated risk behaviors 1, 2.
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