Cannabis use and retention in telemedicine treatment for opioid use disorder: a retrospective cohort study

Cannabis use can be a barrier to treatment for opioid use disorder due to clinic policies in some settings requiring full abstinence to initiate or continue care. Telemedicine represents an important opportunity to expand treatment access. While there is conflicting evidence on the impact of cannabis use on retention to treatment for opioid use disorder in in-person settings, this relationship has not been evaluated in telemedicine care. We assessed the association between self-reported cannabis use and 6-month retention in telemedicine opioid use disorder treatment. We conducted a retrospective cohort study of 7,752 individuals initiating low-barrier virtual opioid use disorder treatment between April 2020 and August 2022. Using logistic regression, we estimated adjusted odds of being retained in telemedicine treatment for opioid use disorder at 6 months. At the time of treatment enrollment, 39.6% of individuals reported cannabis use. The odds of remaining in treatment at 6 months were 1.17 ( p = 0.118) times higher for individuals reporting baseline cannabis use only than those who reported no recent substance use. Cannabis use with other substance use and other substance use only were associated with statistically significantly lower odds of retention. In low-barrier, telemedicine treatment for opioid use disorder, concurrent cannabis use without other reported substance use by individuals at enrollment was not associated with attrition. Inclusive virtual care models for substance use treatment represent an important opportunity to expand treatment access for individuals living with opioid use disorder.