Experts Disagree on How to Handle Marijuana Use with Long-Term Opioids

There is a lack of consensus among clinicians regarding responses to marijuana use among patients with chronic pain who are on long-term opioid therapy, according to the results of a recent study.

Although marijuana use is common among long-term opioid users with chronic pain, there is little available evidence to guide clinical response, the researchers explained.

They conducted an analysis of data from an online Delphi study involving 42 clinician experts in pain and opioid management from across the United States. The participants generated management strategies for use in response to marijuana use among these patients, then rated the strategies’ importance and reported factors influencing their decision-making.

Overall, while there was consensus that tapering opioids as the initial response to marijuana use is not important, the participants disagreed about the importance of tapering opioids if a repeated pattern of marijuana use without cannabis use disorder was present. They agreed on that tapering is of some importance if there is suspicion of cannabis use disorder.

Factors that influenced the experts’ perceptions included the benefits and harms of marijuana for the individual patient, their personal beliefs about the overall risks of marijuana use, and varying laws and practice policies.

“Experts disagree and are uncertain about the importance of opioid tapering for patients with marijuana use. Experts were influenced by patient factors, provider beliefs, and marijuana policy, highlighting the need for further research.”

—Michael Potts

Starrels JL, Young SR, Azari SS, et al. Disagreement and Uncertainty Among Experts About how to Respond to Marijuana Use in Patients on Long-term Opioids for Chronic Pain: Results of a Delphi Study. Pain Medicine. 2020;21(2):247–254.