U of A psychiatrist probes links between cannabis, opioid abuse

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A study led by a University of Alberta psychiatrist is aiming to clarify whether cannabis use makes it more or less likely a person will later develop problems with opioids.

Dr. Bo Cao, an assistant professor in the U of A department of psychiatry, is heading a study that will use health-care data to look at the relationship between the two substances in a medical setting.

“There’s a big debate,” says Cao.

On the one hand, there are those who believe that, under medical supervision, cannabis can be used to decrease opioid dosages, decreasing the risk of future opioid use disorders and overdoses.

Others argue cannabis can be a “gateway” drug that actually increases the risk of future problematic opioid use.

“We don’t know,” said Cao, who is Canada Research Chair in computational psychiatry. “We just want to have a peek (at) this problem using the current data.”

Opioids are prescribed to treat pain, but opioid misuse is common. Last year was Alberta’s deadliest on record for overdoses with 1,316 drug-related deaths, 1,144 of which were linked to opioids.


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According to Alberta Health, about 1.2 million Albertans used prescription opioids within the past five years. A much smaller subset use both prescription opioids and medical cannabis. Some of those are cancer patients prescribed Nabilone, a type of synthetic cannabis used to treat nausea.

Cao’s study focuses specifically on Albertans who use medical cannabis outside of cancer treatments, relying on anonymized data from Alberta Health and Alberta Health Services.

“We want to perform, in our opinion, quite an objective study,” he said. “We don’t have any expectations or bias, to say whether (cannabis) is beneficial or not.

“We want to see, does cannabis increase the risk or decrease the risk for opiate outcomes (overdoses and use disorders) when people use them together, compared to the people who use only one of them?”

Cao is broadly interested in the two substances. However, at this stage, he is focused on cannabis and opioid use in medical settings, because there is little quality data on street use or recreational drug use.

The study will also involve patients and clinicians “to help us get the bigger picture,” Cao said. “Eventually, we hope that this can help patients and help clinicians.” Part of that will include creating statistical tools — using machine learning — to help make predictions about a specific patient’s risk level for future opioid abuse.

Dr. Avininder Aulakh runs Savera Medical Centre, an addictions treatment clinic in south Edmonton. He is also the former clinical lead for AHS’s opioid dependency program.


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Aulakh says those who come to his clinic typically started with cannabis before moving to more problematic substances. But he acknowledged he sees a small subset of the population who are already struggling with addictions.

“Many people may try cannabis and don’t have any struggles with it,” he said in a news release. “But cannabis is a gateway to other drugs for some people, and once opioids come into play, that becomes the dominant drug.”

He said the biggest factor that influences whether someone develops a use disorder is the age at which they started using. “The earlier cannabis use starts, the more likely a person is to develop addictions.”

Cao’s study is one of three cannabis-related studies receiving around $1 million in total from Alberta Innovates, a provincially funded research and innovation agency. The group’s mCannabis.Real World Program aims to address “urgent clinical or policy knowledge gaps” around cannabis use.




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