Does cannabis use predict poor outcome for heroin-dependent patients on maintenance treatment? Past findings and more evidence against

David H. Epstein, K. L. Preston

Research output: Contribution to journalReview articlepeer-review

67 Scopus citations


Aims: To determine whether cannabinoid-positive urine specimens in heroin-dependent out-patients predict other drug use or impairments in psychosocial functioning, and whether such outcomes are better predicted by cannabis-use disorders than by cannabis use itself. Design: Retrospective analyses of three clinical trials; each included a behavioral intervention (contingency management) for cocaine or heroin use during methadone maintenance. Trials lasted 25-29 weeks; follow-up evaluations occurred 3, 6 and 12 months post-treatment. For the present analyses, data were pooled across trials where appropriate. Setting: Urban out-patient methadone clinic. Participants: Four hundred and eight polydrug abusers meeting methadone-maintenance criteria. Measurements: Participants were categorized as non-users, occasional users or frequent users of cannabis based on thrice-weekly qualitative urinalyses. Cannabis-use disorders were assessed with the Diagnostic Interview Schedule III-R. Outcome measures included proportion of cocaine- and opiate-positive urines and the Addiction Severity Index (at intake and follow-ups). Findings: Cannabis use was not associated with retention, use of cocaine or heroin, or any other outcome measure during or after treatment. Our analyses had a power of 0.95 to detect an r2 of 0.11 between cannabis use and heroin or cocaine use: the r2 we detected was less than 0.03 and non-significant. A previous finding, that cannabis use predicted lapse to heroin use in heroin-abstinent patients, did not replicate in our sample. However, cannabis-use disorders were associated weakly with psychosocial problems at post-treatment follow-up. Conclusions: Cannabinoid-positive urines need not be a major focus of clinical attention during treatment for opiate dependence, unless patients report symptoms of cannabis-use disorders.

Original languageEnglish (US)
Pages (from-to)269-279
Number of pages11
Issue number3
StatePublished - Mar 1 2003
Externally publishedYes


  • Cannabis
  • Methadone maintenance
  • Treatment outcome

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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