Can Cannabis Be Used With Methadone to Help Treat Opioid Addiction?

Methadone is a medicine for chronic pain and one of the top medication-assisted treatments for opioid use disorder (OUD). Methadone is safe and effective when used correctly. But it can also cause many unpleasant or severe side effects. And it may not be the right treatment for everyone.  

With the relaxation of state cannabis laws, there is growing interest in using cannabis as a substitute for other medications. There is special interest in using it as an alternative to opioid medications and for treating opioid use disorder. Treating opioid addiction is part of the effort to end the ongoing opioid epidemic, which is responsible for a surge in drug overdose deaths across the country.

It is important to note that cannabis is illegal in some states. Also, it is not allowed in most methadone treatment programs. 

What is methadone, and how is it used to treat opioid addiction?

Methadone is a medication used to treat opioid addiction, more preferably called opioid use disorder. It is the oldest and most-used medication for this disorder. 

Methadone is also an opioid. But when used in a provider-monitored setting, it is safer than misuse of opioids. Methadone is also a more effective treatment for OUD than not using opioids at all. For people with OUD, methadone is not intoxicating. 

Methadone helps reduce the cravings and withdrawal symptoms someone may have when they stop using other opioids. These cravings and withdrawal symptoms can be difficult to cope with. They can cause someone to start using drugs again. Methadone helps people break the cycle of their addiction and begin a process of recovery.

People usually take methadone every day at an outpatient clinic. After enough progress, people can receive doses to take at home. This treatment is called methadone maintenance therapy (MMT) because there is no set length of time for treatment. At least 12 months of treatment are recommended. But treatment can continue for as long as it’s helpful.

What are the possible problems with using methadone?   

Methadone is safe when used correctly to treat opioid use disorder. However, there are many reasons that people can’t or don’t want to use methadone or want to use less of it:

• Side effects: Methadone can cause unpleasant side effects, like itching, sweating, sleep problems, constipation, abnormal heartbeat, and mood changes (like anxiety and depression). 

• Risk of relapse and/or overdose: As an opioid, there is some risk that people can misuse methadone, possibly leading to relapse or overdose. 

• Withdrawal symptoms: Methadone can cause withdrawal symptoms, which can make it difficult to stop treatment. These withdrawal symptoms can last even longer than withdrawal symptoms from other opioids. 

• Availability of methadone: Another possible issue is availability. Methadone is only available at treatment clinics, which are usually found in or near cities. Treatment programs need to have very strict rules to keep people safe. This means people have to attend therapy in person and be drug tested. These rules can be hard for some people to follow.

• Affordability: OUD treatment is expensive. Average costs start at almost $6,000 per year, and it is not always covered by insurance. There are also indirect costs, like transportation and time lost from work to attend treatment.  

These issues have led to people looking for other treatments for opioid addiction, like cannabis.

Why do people take cannabis with methadone?

Mixing cannabis and methadone is not a traditional treatment approach for opioid use disorder, since cannabis is not allowed in most MMT programs. But there may be some benefits to using cannabis with methadone when someone is in treatment for opioid use disorder. 

Here’s how cannabis might be able to help: 

• You may be able to take a lower dose of methadone. When you take cannabis with methadone, it increases methadone’s effects. This means you may not need to take as much methadone as before. Taking less methadone could mean that you have a lower risk of side effects. It can also lessen the risk of methadone overdose.

• You may not enjoy or crave other opioids as much. High-CBD cannabis formulas, in particular, may make other opioids less pleasurable. So, if someone is in treatment for opioid use disorder but still using opioids, cannabis can help reduce these drugs’ intoxicating effects. It may also help reduce the opioid cravings that often lead to relapse. 

• You may reduce withdrawal symptoms. There is evidence that cannabis, especially CBD, can treat symptoms of opioid withdrawal. Combining cannabis with methadone may reduce withdrawal symptoms better than methadone alone. This may also help reduce some of the side effects or withdrawal symptoms caused by methadone.  

How does cannabis impact methadone treatment?

There isn’t much quality scientific research available on using cannabis along with methadone for opioid addiction. The evidence that does exist is mixed, meaning some studies show that it’s helpful while others don’t. 

Still, researchers are interested in seeing if cannabis can be used with methadone to help improve treatment success. Here is what the research shows to date:  

• Cannabis may lower the risk of opioid overdose. In one study, people who used cannabis and methadone were much less likely to overdose than those who didn’t use cannabis. 

• There’s no solid evidence yet that cannabis lowers the misuse of opioids. One survey found that people using cannabis with low doses of methadone misused fewer opioids than those who did not use cannabis. But a much larger review found no proof that cannabis lowered opioid use while in methadone treatment.  

• It’s not clear if cannabis helps people stay in treatment longer. One study showed that cannabis use increased the chance of people staying in the program by about 20%. But a review of other studies didn’t find any proof that this was true. 

We do know that using cannabis is common among people who take opioids. But the science is still unclear about the role cannabis may play in treating opioid addiction. 

Are there any risks of using cannabis with methadone?

Even though combining cannabis and methadone is typically safe, there are several possible risks involved with mixing the two:

• Side effects of cannabis use: Keep in mind that cannabis use has its own benefits and risks. It may not be right for everyone. But the side effects of cannabis are much less dangerous than the side effects of opioids. Most importantly, you cannot fatally overdose on cannabis like you can with opioids. 

• Risks of using illegally sold cannabis: Although legally sold cannabis is carefully regulated, there are extra risks involved with illegally sold cannabis. There is no easy way to know the actual contents of illegally sold cannabis. It could be contaminated by pesticides, mold, or other dangerous substances.  

• Legality: Remember that cannabis is still illegal according to the federal government and in some states. Before using cannabis, be sure to review the cannabis laws in your state.

• Treatment program restrictions: If you’re in a methadone treatment program, be extra careful to check the program's rules. Many programs drug test and do not allow mind-altering substances like cannabis, even in states where it’s legal.

Is cannabis legal in your state? 

Medical cannabis is available in many states but can usually only be recommended for certain medical conditions. These conditions are different in every state. Cannabis can be prescribed for treating opioid use disorder only in the following states:    

• New Jersey

• Pennsylvania

• New York

• New Mexico

• Nevada

There are also several other states that allow practitioners to recommend medical cannabis for any condition they feel would benefit from it, so OUD may count. Currently, these states are:

• California

• Colorado

• Maryland

• Massachusetts

• Missouri

• Oklahoma

• Oregon

• Rhode Island

• Virginia

• Washington

• Washington, D.C. 

How to use cannabis with methadone to treat opioid use disorder

Don’t go it alone. A healthcare provider should oversee this process. But it may be difficult to find someone who understands how to use cannabis with methadone. This is because it is not a standard treatment. Try asking your healthcare provider if they have experience with this. If not, see if they can refer you to someone who does. 

You can also search your state's medical cannabis website. Most will have a list of providers who can recommend cannabis. 

So far, there has not been much research to determine the best cannabis formulations or compositions (like high THC or high CBD) for treating OUD (or most other conditions). As a general rule, it is recommended to “start low and go slow.” This means starting with a small amount of cannabis. For example, take just a puff or two of a joint or a drop or two of a tincture. 

The type of cannabis also matters. A high-CBD formula will be much less likely to make you feel high. This might be a better choice to reduce the chance of misuse. Increase the amount of cannabis that you take slowly over time until you feel that it is effectively treating your symptoms.

You may find that, as you increase your cannabis dose, you need less methadone to treat your symptoms. But you should not lower your methadone dose on your own. Work with your healthcare provider to find the right balance of both medications. 

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Written by:

Arielle Tandowski, MPH

Arielle Tandowski, MPH, is a freelance writer for GoodRx. She holds a master's degree in public health from the University of Haifa, where she focused on mental health, substance use, and harm reduction.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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Keep in mind that cannabis is legal in some states for recreational and/or medicinal use, but not in others. Cannabis is still illegal under federal law. Before you use cannabis products, find out the laws in your state.