A new study suggests that cannabis may help some people reduce or stop their opioid use.

The study, conducted by researchers at the University of Southern California and published this week in Drug and Alcohol Dependence Reports, was funded by the National Institute on Drug Abuse (NIDA).

Using qualitative data and paying particular attention to the actual experiences of drug users, researchers found that cannabis can help people overcome some of the most difficult phases of reducing or stopping their opioid use.

Participants reported using cannabis to relieve withdrawal symptoms and to manage cravings and anxiety during the post-withdrawal period.

Opioid overdose mortality has risen sharply in recent years, largely due to fentanyl. Drug overdose deaths increased from 2019 to 2022, reaching 107,941 deaths in 2022. The majority of these deaths involved synthetic opioids, primarily fentanyl, which was responsible for 73,838 of overdose deaths that year, according to NIDA.

Cannabis use is medically legal in 38 U.S. states and territories, but its role in opioid-using populations remains poorly understood, although there are new studies on the topic. In addition, the Food and Drug Administration approved a 2022 application to study CBD as a potential adjunct treatment for opioid use disorder.

This study, based on 30 interviews with drug users in Los Angeles, shows that co-occurring cannabis helps reduce opioid use by alleviating withdrawal symptoms, supporting opioid cessation, and providing accessible alternatives. The findings suggest that distributing cannabis through peer programs and integrating it into opioid use disorder treatment could improve harm reduction and treatment outcomes for PWID.

Patients with opioid use disorder often face significant barriers to accessing life-saving treatments such as Suboxone, methadone, and naloxone. Barriers to broader access to life-saving medications for opioid use disorder include stigma, inadequate specialized training, and difficulties connecting patients to treatment options. These issues are exacerbated by fragmented delivery systems, regulatory and legal hurdles, and inadequate insurance coverage and reimbursement policies that do not support effective treatment for opioid use disorder.

Participants in this study used cannabis to manage anxiety and cravings after stopping opioid use, which helped them maintain opioid abstinence. Cannabis also provided rapid relief from withdrawal symptoms, which reduced the frequency of opioid use.

The study suggests that the legalization and greater availability of cannabis has promoted its use among PWID as a harm reduction approach.

Participants used cannabis to stay opioid-free by relieving anxiety and cravings after stopping opioids. One participant highlighted the role of cannabis in relieving anxiety during opioid withdrawal, stating that “cannabis is a lifesaver.”

Cannabis also quickly relieved opioid withdrawal symptoms and helped reduce cravings, according to some interviews. For example, one participant explained how cannabis helped overcome opioid cravings: “If you’re addicted and you have a habit, you have to take opiates. But if you don’t have a habit and you don’t get sick every day when you smoke weed, it helps you get over the hump and overcomes the cravings of getting high for the first time. And that’s the thing about weed.” Another noted how cannabis eased withdrawal pain.

Participants reported that increased availability of cannabis led to behavioral changes, such as a reduction in fentanyl use.

The authors of this study argue that easy access to cannabis through pharmacies has also contributed to a decline in opioid use. However, there are several limitations to this study.

First, the study was conducted in California, where cannabis is legal, potentially limiting generalizability to states with different legal statuses. Second, during the study period, illicit opioids switched from heroin to fentanyl. However, because the study examines general opioid use, the researchers believe this change does not affect how they interpret their findings on cannabis and opioid use. Third, although participants used cannabis to reduce and quit opioid use, the study focused on co-use, suggesting that quitting was likely episodic. Finally, recruitment from methadone and needle exchange sites may have resulted in an overrepresentation of individuals who were already motivated or able to adopt safer patterns of use.

Despite these limitations, the study authors state that the research provides valuable insights for guiding interventions and evaluating cannabis as a means of modulating and cessation of opioid use.

However, to fully assess the effectiveness of cannabis for treating opioid use disorder, large-scale clinical trials are needed to provide comprehensive data on the effectiveness of cannabis in treating the disorder, as well as its potential benefits and risks.