ArticleEuropean archives of psychiatry and clinical neuroscience2021
Buprenorphine-cannabis interaction in patients undergoing opioid maintenance therapy.
Article in European archives of psychiatry and clinical neuroscience, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Evidence-based consensus guidelines for the pharmacological management of substance dependence: Recommendations from the British Association for Psychopharmacology.Journal of psychopharmacology (Oxford, England) · 2026Guideline
- MASCC guideline: cannabis for cancer-related pain and risk of harms and adverse events.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2023Guideline
- Questions on Medicines, Alcohol, and Illicit Drug Interactions in the Finnish AddictionLink Online Service: A Descriptive Analysis.Nordisk alkohol- & narkotikatidskrift : NAT · 2026Article
- Can Buprenorphine Be Overdosed? The Ceiling Effect and Its Clinical Implications.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Opioid reduction in patients with chronic non-cancer pain undergoing treatment with medicinal cannabis.Pain management · 2025Article
- Cannabis Use in Opioid Maintenance Therapy: Prevalence, Clinical Correlates and Reasons for Use.Brain sciences · 2025Article
- Drug interactions in a sample of inpatients diagnosed with cannabis use disorder.Journal of neural transmission (Vienna, Austria : 1996) · 2025Article
- An Overview of the Potential for Pharmacokinetic Interactions Between Drugs and Cannabis Products in Humans.Pharmaceutics · 2025Review
- Buprenorphine and cannabidiol co-administration reduces survival in a mouse model of orthopedic trauma.Frontiers in pharmacology · 2025Article
- Research and Clinical Practice Involving the Use ofPharmaceuticals (Basel, Switzerland) · 2024Review
- Associations of discomfort intolerance, discomfort avoidance, and cannabis and alcohol use among persons with chronic pain receiving prescription buprenorphine for opioid use disorder.Drug and alcohol dependence · 2024Article
- Buprenorphine Use for Analgesia in Palliative Care.Pharmacy (Basel, Switzerland) · 2024Article
- Review
- CBD and THC in Special Populations: Pharmacokinetics and Drug-Drug Interactions.Pharmaceutics · 2024Review
- Quantifying a potential protective effect of buprenorphine on fatality risk during acute fentanyl exposures.Journal of substance use and addiction treatment · 2024Article
- Human Data on Pharmacokinetic Interactions of Cannabinoids: A Narrative Review.Current pharmaceutical design · 2024Review
- Drug Interactions of Tetrahydrocannabinol and Cannabidiol in Cannabinoid Drugs.Deutsches Arzteblatt international · 2023Review
- An Examination of the Complex Pharmacological Properties of the Non-Selective Opioid Modulator Buprenorphine.Pharmaceuticals (Basel, Switzerland) · 2023Review
- Association Between Buprenorphine Dose and the Urine "Norbuprenorphine" to "Creatinine" Ratio: Revised.Substance abuse : research and treatment · 2023Article
- Clinical Relevance of Drug Interactions with Cannabis: A Systematic Review.Journal of clinical medicine · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Buprenorphine is a partial μ-opioid agonist widely used for opioid maintenance therapy (OMT). It is mainly metabolized to pharmacologically active norbuprenorphine by the cytochrome P450 (CYP) isozyme 3A4. This may give rise to drug-drug interactions under combinations with inhibitors or inducers of CYP3A4. Cannabis is a potential inhibitor of CYP3A4, and there is a large degree of concomitant cannabis use among OMT patients. We performed a retrospective analysis on liver healthy OMT patients substituted with buprenorphine, either with (n = 15) or without (n = 17) concomitant use of cannabis. Patients with additional illicit drugs or medications affecting CYP3A were excluded. Measured blood concentrations of buprenorphine and norbuprenorphine were compared between the two groups. Cannabis users and non-users received similar doses, but users had 2.7-fold higher concentrations of buprenorphine (p < 0.01) and 1.4-fold for norbuprenorphine (1.4-fold, p = 0.07). Moreover, the metabolite-to-parent drug ratio was 0.98 in non-users and 0.38 in users (p = 0.02). Female gender did not produce significant effects. These findings indicate that cannabis use decreases the formation of norbuprenorphine and elevates buprenorphine and norbuprenorphine concentrations in blood most probably by inhibition of CYP3A4. The pharmacokinetic interaction may give rise to enhanced or altered opioid activity and risk of intoxications. Physicians should inform patients about this risk and supervise cannabis users by regular control of buprenorphine blood levels, i.e., by therapeutic drug monitoring.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.