title: Concomitant cannabis abuse/dependence in patients treated with opioids for non-cancer pain.
abstract: OBJECTIVE
  Cannabis use is common among patients taking prescription opioids, although rates of concomitant cannabis use disorder (CUD) have been largely unexamined. CUD may increase safety risks in those taking opioid pain medications but it is unknown whether cannabis and opioids function as substitutes (cannabis use is associated with less prescription opioid use), or rather as complements (cannabis is associated with increased use of prescription opioids).
  
  
  METHODS
  We examined rates of CUD in a national sample of Veterans Health Administration (VHA) patients (n = 1,316,464) with non-cancer pain diagnoses receiving opioid medications in fiscal year 2012. Using bivariate analysis to identify potentially confounding variables associated with CUD (e.g., psychotropic medication, other substance use disorders) in this population, we then utilized logistic regression to examine rates of cannabis use disorder among individuals receiving different numbers of opioid prescriptions (0, 1-2, 3-10, 11-19, 20+).
  
  
  RESULTS
  Descriptive analysis, largely confirmed by logistic regression, demonstrated that greater numbers of prescription opioid fills were associated with greater likelihood of CUD. This relationship was reduced somewhat for those receiving the most opioid prescriptions (20+) in the logistic regression, which controlled for potentially confounding variables.
  
  
  CONCLUSIONS
  These results warrant increased attention to CUDs among patients receiving numerous opioid prescriptions. Increasing legalization of cannabis is likely to further increase use and abuse of cannabis in patients prescribed opioids.
  
  
  CONCLUSIONS
  These findings suggest that clinicians should be alert to concomitant CUD and prescription opioid use, as these substances appear to complement each other.
authors.affiliation: Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, Connecticut.|Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hefner
authors.affiliation: Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, Connecticut.|Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sofuoglu
authors.affiliation: Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, Connecticut.|Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D055553:Prescription Drugs / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs