Suboxone and Marijuana: To puff or pass … Can you smoke weed if you are taking Suboxone?
As more and more states legalize or decriminalize marijuana, people in recovery from opioid addiction are wondering what that means for them. Is it okay to partake if you’re on buprenorphine? Ultimately, only you can answer that question for yourself. The landscape of recovery is immensely various, and what one person considers fine might be another person’s relapse. Unfortunately, because of marijuana’s regulatory status and contentious history in the United States, there is not a lot of scientific data on the topic, either. But there is some. And it points to marijuana use being okay while in recovery—at least, if you say it is for you.
Studies of people using cannabis while receiving buprenorphine
A 2018 study published in the Journal of Addiction Medicine found that marijuana use did not negatively affect buprenorphine therapy outcomes. It appeared to have some correlation to a lower dose, but did not affect cravings, opioid use, or duration of treatment. A 2020 study found that using cannabis had an effect on how buprenorphine was metabolized, leading patients to require higher dosages of buprenorphine to avoid withdrawal symptoms. This makes it especially important that people who use both buprenorphine and marijuana discuss any symptoms with their providers, who may need to monitor them more closely or adjust their medication.
Interestingly, a retrospective study of pregnant buprenorphine-maintained women who used marijuana during the third trimester of pregnancy did not find that the use was associated with significant complications either—except for a slightly heightened risk for requiring pharmacological intervention for neonatal abstinence syndrome. That seems like it would merit further study, especially to rule out bias. Were hospital staff more inclined to medicate infants they knew had been exposed to both buprenorphine and marijuana, for example? But if it were me, I would abstain from marijuana during pregnancy just to be safe. Not pregnant and on bupe? Now that looks to be more of a personal choice, with the emerging science concluding that even if it won’t help, it also won’t hurt.
Cannabis as treatment
Some physicians now claim that cannabis has therapeutic value for opioid addiction. The state of Pennsylvania has approved the use of medical marijuana for opioid use disorder, and advocates in other states are working hard to get OUD added as a medical marijuana qualifying condition. In Philadelphia, Joe Schrank runs a cannabis-based recovery center called High Society. Although he uses an abstinence based model for his own recovery, he acknowledges that some clients aren’t ready to stop experiencing some form of intoxication. For those people, marijuana is a harm reduction strategy, as it poses a less harmful and addicting alternative to heroin or other illegally obtained opioids.
During an interview for an article I wrote for The Fix, Schrank told me, “[Cannabis forms] a great therapeutic alliance from the get-go. Like, we’re here with compassion, we’re not here to punish you, we want to make this as comfortable as we possibly can, and the doctor says you can have this [marijuana]. I think it’s better than the message of ‘you’re a drug addict and you’re a piece of shit and you’re going to puke.'”
Cannabis to get off Suboxone (buprenorphine/naloxone)
Although many people choose to stay on buprenorphine long-term or for life—which research supports as a strategy—some people decide to get off the medication after a short period of time. Others find themselves unable to continue to pay for the medication, and are therefore forced to taper or discontinue use prematurely. (I experienced this, myself.) Hopefully, everyone who has to come off a stable dose of buprenorphine gets to taper in a controlled manner, but whether someone jumps off a high dose or tapers slowly, experiencing some withdrawal symptoms is to be expected. During that taper or detoxification period, some people find cannabis to be extremely therapeutic. For example, Stephanie Bertrand, whom I also interviewed for the article I wrote last year for The Fix, used marijuana to navigate the heightened anxiety and physical discomfort associated with her buprenorphine taper. She was able to drop by 2mg at a time using cannabis as an aid.
The verdict? It’s complicated, and it’s personal.
Views on recovery vary. Some people feel that if they’re experiencing intoxication in any form, they are not truly in recovery. Others define recovery as a healthier way of living; one which may include moderate marijuana or alcohol consumption. How you define your recovery is up to you. I can’t tell you whether it’s okay to use marijuana while also taking buprenorphine or otherwise in recovery from an opioid use disorder—only you can decide that for yourself. If you decide to give it a try, check in with yourself frequently and watch for signs of addictive behavior around your cannabis use. That means compulsive use, like smoking when you didn’t really want to or hadn’t planned to, or using when doing so will lead to negative consequences.
If you are concerned cannabis is getting in the way of your recovery or your life, there are a variety of screening tools available to help you determine if your use is a problem.
Does Suboxone interact with cannabis?
Based on research, cannabis has been shown to raise the levels of buprenorphine in the blood. It is known that Suboxone and marijuana are depressant drugs, which means there could be a negative nervous system response to this combination.
Workit Health operates in a harm-reduction principle. This means that controlled cannabis use that does not impede daily activity and is done in a safe manner will not result in dismissal from our opioid use disorder program. It is important to note that everyone reacts to cannabis differently. Always discuss cannabis use with a healthcare provider. Workit Health does not use cannabis as a treatment for opioid use disorder. If you find yourself concerned about your cannabis use, please contact your Care Team.