Cannabis Use Is Associated With Suicidal Ideation Among Individuals With Opioid Use Disorder Receiving Opioid Agonist Therapy

Cannabis use is associated with suicidal behavior in the general population. This Canadian study investigated the association between cannabis use and suicidal ideation in cohort of participants aged 16 or older with opioid use disorder who were receiving opioid agonist therapy. Suicidal ideation was assessed by self-report as part of the Maudsley Addiction Profile (MAP), which also includes a 10-item psychological health scale. Participants were also asked about cannabis use and frequency.

• Of the 2335 participants, approximately half reported current cannabis use. Among those with cannabis use, 24% reported suicidal ideation in the last 30 days compared with 17% of those without.
• In multivariable analyses, suicidal ideation was associated with cannabis use (odds ratio [OR], 1.4), male sex (OR, 1.8), and symptoms of anxiety and depression on the MAP (OR, 1.2 for every 1-point increase). The following factors were not associated with suicidal ideation: current tobacco or alcohol use, or being employed or married.
• Frequency of cannabis use was not significantly associated with suicidal ideation.

Comments: This study raises concerns about the potential effect of cannabis on the psychological health of individuals with opioid use disorder. This is particularly important in the context of legalization of cannabis in Canada and many US states. However, this is far from demonstrating a cause and effect relationship, especially given that the observed association was modest and there did not appear to be a dose-response effect.

Darius A. Rastegar, MD

Reference: Naji L, Rosic T, Sanger N, et al. The role of cannabis use in suicidal ideation among patients with opioid use disorder. J Addict Med. [Epub ahead of print] 2020. doi:10.1097/ADM.0000000000000781.