THC in Urine is Associated with Lower Opioid Concentrations In Pain Patients, Finds Study

According to a new study published in the journal Pain Management, the presence of THC metabolites in the urine of patients undergoing pain management is associated with lower levels of opioids.

For the study, researchers analyzed approximately 800,000 urine drug test results collected from pain management patients between the years 2016 and 2018.

The study states that “For each of the eight opioids monitored, lower mean concentrations were observed when THC-COOH [the primary metabolite of THC] was also present in the sample. The differences in opioid concentrations between the THC positive and THC negative groups were statistically significant … The largest shift was seen in codeine positive samples, followed by morphine, and fentanyl. … The buprenorphine positive group had the highest percentage of samples containing THC (20.8 percent), and hydrocodone had the lowest THC positive rate, 9.2 percent.”

While researchers acknowledged that the findings were “consistent with data from self-report surveys of medical cannabis patients” in which subjects frequently report substituting cannabis for opioids, they cautioned that the observational design of the study precluded them from “assigning causation” to their results, reports NORML.

They concluded: “Further studies will hopefully elucidate if cannabis can or should play a role in pain management through the anti-nociceptive properties of THC and any potential interaction with opioids. From the perspective of opioid addiction treatment, it is interesting that the highest rate of THC use was seen in buprenorphine-positive samples as buprenorphine is frequently utilized as a component of medication-assisted treatment for opioid dependence. Further studies are also needed to determine if THC/cannabis use alone or in combination with other medical treatments may help combat OUD (opioid use disorder).”

The full text of the study is titled “Reduced opioid levels from pain management patients associated with marijuana use”. The full abstract of the study can be found below:

Aim: Marijuana use has been postulated to modulate opioid use, dependence, and withdrawal. Broad target drug testing results provide a unique perspective to identify any potential interaction between marijuana use and opioid use. Materials & methods: Using a dataset of approximately 800,000 urine drug test results collected from pain management patients of time from of multiple years, creatinine corrected opioid levels were evaluated to determine if the presence of the primary marijuana marker 11-nor-carboxy-tetrahydrocannabinol (THC-COOH) was associated with statistical differences in excreted opioid concentrations. Results & conclusion: For each of the opioids investigated (codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, fentanyl and buprenorphine), marijuana use was associated with statistically significant lower urinary opiate levels than in samples without indicators of marijuana use.

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