Suboxone and marijuana: Can you smoke weed or take a gummy if you’re taking Suboxone for opioid addiction?
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 varied, and what feels safe and moderate to one person 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 suggests that marijuana use may be okay while in recovery from opioids—at least, if you feel it is okay for you.
Using cannabis while in Suboxone treatment: The research
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 could have an effect on the way buprenorphine was metabolized in the body, leading some 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.
A 2020 literature review looked at 41 studies addressing cannabis and medication for opioid use disorder (including buprenorphine, methadone, and naltrexone). They found that most studies found that cannabis use had no significant effect on treatment outcomes (opioid use, adherence, retention)—neither good nor bad.
Can cannabis be used to treat opioid use disorder?
Some physicians claim that cannabis has therapeutic value for opioid addiction, but the evidence for this is considered weak. 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. Researchers and clinicians have not seen sufficient evidence to support using marijuana to treat opioid use disorder. Cannabis is not generally recommended to treat opioid use disorder, but buprenorphine or methadone are.
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 others decide to get off the medication after a short period of time. Still others find themselves unable to continue to afford the medication, and therefore need 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 common and expected. During that taper or detoxification period, some people find cannabis to be therapeutic for the heightened anxiety and physical discomfort associated with buprenorphine tapering. There is no clinical evidence opposing this as long as the person doesn’t have cannabis use disorder or risk factors for psychosis (like a family history of schizophrenia).
If you have trouble with withdrawal symptoms during your Suboxone taper, I do recommend that you talk with your medical provider about how you could manage them. There are a lot of medications that can help (like clonidine, lofexidine, etc.). The benefit of working with your provider and a pharmacy is that you can be sure exactly what you’re getting (the dose, the potency, the potential risks, that it’s not contaminated or cut with anything weird), unlike with cannabis, which can be variable.
The verdict on combining marijuana with buprenorphine? 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 harm reduction and 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. But while it is your choice, it’s smart to speak with a medical provider while you’re deciding to help you understand how cannabis could interact with your particular health and history.
If you decide to try it, check in with yourself frequently. Because smoking has an impact on lung health, if you decide to use cannabis, edibles might be better than smoking. Pay attention to how you’re feeling and be on guard for signs of addictive behavior around your cannabis use. That means noticing if you slip into compulsive use, like using it 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 that 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.
Workit Health operates on 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. You will not be punished by Workit Health if your urine drug screens show cannabis use. 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.