Clinicians' perspectives on cannabis use and cannabis treatment in clients undertaking opioid dependence treatment

Cannabis is the most widely used substance among individuals receiving treatment for opioid dependence in Australia [1]. Cannabis use is associated with a range of physical, mental and social harms to individuals [2]. Cannabis and/or cannabinoids are also known to be associated with a range of therapeutic benefits in areas such as chronic pain, epilepsy, palliative care and clients receiving chemotherapy [3]. Although evidence regarding the efficacy of cannabis for anxiety [4], sleep disorders [5] and chronic pain [6, 7] remains limited and inconsistent; these conditions are among the most frequently reported reasons for the therapeutic use of cannabis among people who use it [8, 9].

With the evolving landscape of medicinal cannabis regulation in Australia and globally [3, 10], there is a change in community perspectives in recent years regarding cannabis use, with increasingly positive views regarding legalisation and reduced attribution of harms [11]. While various clinicians' perspectives about medicinal cannabis have been investigated widely in different settings, little is known about how clinicians working in opioid treatment programs (OTP) perceive cannabis use in the context of opioid dependence treatment. Generally, systematic reviews have demonstrated that clinicians' support for medical cannabis legalisation has increased over the years [12, 13]. However there was only one study investigating attitudes of clinicians working in the addiction field toward medicinal cannabis and clients’ cannabis use, which showed mixed attitudes toward medicinal cannabis and cannabis use, with most of them believing cannabis use in “trading one addiction for another” and that cannabis does not alleviate cravings for other substances, however, some believed both cannabis and medicinal cannabis may potentially assist in managing conditions such as anxiety and insomnia in clients suffering from substance use disorder [14].

Despite the high prevalence of cannabis use among people in OTP, there are no prior published studies specifically examining the perspectives of OTP clinicians on this issue, including their observations of patterns of cannabis use, clinicians’ perception of the percentage of their clients who experienced either harms or benefits, confidence in intervention delivery, and attitudes toward treatment options such as harm reduction and medicinal cannabis.

In this cross-sectional online survey implemented in six public OTP services across New South Wales, we explored 162 OTP clinicians’ views (an estimated response rate of 54%) on patterns of cannabis use among their clients, the harms and benefits of cannabis use, the extent to which clinicians address cannabis use with their clients, and clinicians’ confidence in implementing interventions to address cannabis use and range of services they believe should be available for OTP clients, including the role of medicinal cannabis. Clinicians estimated that 56.1% of OTP clients had used cannabis in the past month and that 44.9% met criteria for cannabis dependence. They also identified that only 15.3% of clients self-identified their cannabis use as problematic, and 10.7% sought cannabis related treatment in the previous year. The most commonly reported harms associated with cannabis use identified by clinicians were cannabis dependence (46.5%), financial issues (37.5%) and increased tobacco use (33.1%) and the most frequently identified benefits of cannabis use were management of sleep problems (49.7%), improvements in mental health (48.3%), and relief of chronic pain symptoms (35.6%). 63.7% of clinicians supported increasing service efforts to address cannabis use, with no participants supporting a reduction in services. Most clinicians (77.4%) recommended integrating cannabis treatment interventions into OTP services rather than referring clients to external services. Interventions clinicians most strongly supported included withdrawal services (81%), harm reduction strategies (77.4%), counselling (74%) and medicinal cannabis interventions (59.8%). Despite the support, most clinicians feel low confidence in delivering inpatient withdrawal and medicinal cannabis, with only 6% reporting being ‘very confident’ in delivering medicinal cannabis treatment.

In summary, this study makes several unique contributions to the existing literature on clinicians' perspectives about cannabis use and provides the first insight into the perspectives of OTP clinicians regarding cannabis use among their clients. Previous research has largely focused on exploring clinicians' perspectives on the therapeutic potential of cannabis, its adverse effects and clinicians' level of knowledge [12, 13, 15], and their opinions on cannabis legalisation [12, 13]. This study explores not only addiction clinicians' attitudes towards cannabis use in OTP clients but also investigates their perspectives on patterns of cannabis use amongst their clients, perceived harms and benefits, clients' treatment-seeking behaviours, service delivery preferences, and clinicians' confidence in delivering cannabis-related interventions. These findings highlight that despite clinicians' general awareness about high levels of cannabis use amongst their OTP clients, there is uncertainty regarding the potential benefits or harms of cannabis use in OTP patients. There are low levels of clinician-reported treatment-seeking by clients, and low levels of confidence by many staff in implementing treatment interventions. These findings highlight the need for professional development and further research to understand OTP clients’ perspectives on cannabis use, to co-design a clinician-led client-centred service for addressing cannabis use in OTP clinics.

Laila Parvaresh^1,2,3,4

¹Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
²Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
³School of Population Health, UNSW Sydney, Sydney, Australia
⁴Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia

Full paper is available Open Access:

Parvaresh L, Mills L, Gholami J, Jansen L, Jamshidi N, Baker K, Tremonti C, Tracy M, Dunlop A, Lintzeris N. Clinicians' Perspectives on Cannabis Use and Cannabis Treatment in Clients Undertaking Opioid Dependence Treatment. Drug Alcohol Rev. 2025 https://doi.org/10.1111/dar.14074

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