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Relationships between cannabis and cocaine use in a randomized trial of combined buprenorphine and naltrexone for DSM-IV cocaine dependence.

Crystal L Smith·Amaya Pelagio·Alex Schmidt·Sterling McPherson·Nicole Rodin·B Connor Stark·Mohammad Ali Hosseini·Andre Q C Miguel·Andrew J Saxon
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Abstract

BACKGROUND: Cannabis is the most commonly used drug in the United States, and among people who use cannabis, polysubstance use is common and understudied. We aimed to examine the association of tetrahydrocannabinol (THC) positive urine drug screen (+UDS) with the odds of submitting a cocaine + UDS during cocaine use disorder treatment. METHODS: We conducted a secondary data analysis of a previously reported double-blind, placebo-controlled clinical trial, CTN0048. Participants meeting criteria for opioid abuse/dependence were assigned to receive extended-release naltrexone and one of three conditions of buprenorphine (placebo, 4 mg/day, 16 mg/day) for 8 weeks. Generalized estimating equations (GEE) were used to analyze urine samples (Liu et al., 2018) collected over time, examining the association between THC + UDS and cocaine + UDS during treatment. RESULTS: Participants (n = 301) averaged 46 (SD = 8.64) years of age, were majority male (78.41 %), non-Hispanic (89.70 %), and African American (66.45 %). GEE results indicated that patients who submitted THC + UDS had significantly higher odds of submitting cocaine + UDS compared to participants who submitted THC-negative UDS across the 25 time points examined (OR = 1.47, 95 % CI = 1.21-1.79, p = 0.00). Time (OR = 0.9998, 95 % CI: 0.9997, 0.9999, p = 0.018) and the covariate of sex assigned at birth (OR = 1.77, 95 % CI = 1.13-2.77, p = 0.013) were also significant in the model, indicating very small decreases in the odds of submitting a cocaine + UDS over time for all patients and 77 % higher odds of submitting cocaine + UDS for females. CONCLUSION: THC + UDS was associated with increased odds of submitting a cocaine + UDS during treatment. Further investigation is needed to discern whether decreasing THC use will result in reduced cocaine use; however, these results suggest that it may be beneficial to counsel patients on cannabis use cessation both before and during treatment for cocaine use, as it is related to cocaine use treatment outcomes. TRIAL REGISTRATION: Secondary data analysis of ClinicalTrials.gov, TRN: NCT01402492 ("A randomized study to test the safety and effectiveness of buprenorphine in the presence of naltrexone for the treatment of cocaine dependence"; National Drug Abuse Treatment Clinical Trials Network (CTN) clinical trial: CTN0048), Registration date: 27 July 2011.

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HumansCocaine-Related DisordersNaltrexoneFemaleBuprenorphineMaleDouble-Blind MethodNarcotic AntagonistsDronabinolMarijuana AbuseMiddle AgedAdultDrug Therapy, CombinationDiagnostic and Statistical Manual of Mental DisordersOpioid-Related DisordersSubstance Abuse DetectionAgeCannabisCocainePolysubstance useSUD TreatmentSex Assigned at BirthStimulantJournal ArticleRandomized Controlled Trial

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Crystal L Smith, Amaya Pelagio, Alex Schmidt, Sterling McPherson, Nicole Rodin, B Connor Stark, Mohammad Ali Hosseini, Andre Q C Miguel, Andrew J Saxon. 2026-07-29. Relationships between cannabis and cocaine use in a randomized trial of combined buprenorphine and naltrexone for DSM-IV cocaine dependence.. https://doi.org/10.1016/j.addbeh.2026.108817

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Journal Article; Randomized Controlled Trial resourceAdult subjectAge subjectBuprenorphine subjectCannabis subjectCocaine subjectCocaine-Related Disorders subjectDiagnostic and Statistical Manual of Mental Disorders subjectDouble-Blind Method subjectDronabinol subjectDrug Therapy, Combination subjectFemale subjectHumans subjectJournal Article subjectMale subjectMarijuana Abuse subject

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