Buprenorphine

For an informed discussion with your doctor or pharmacist. This information collection is not a clinically validated interaction checker. Missing data do not establish safety. Do not change or stop prescribed medicines on the basis of this information. The findings apply to the specific conditions studied; laboratory and animal studies cannot be directly extrapolated to humans.

Active substance: Buprenorphine

Examples of brand names: Transtec [DE]; Subutex [DE]

ATC code: N02AE01

Main use (for orientation): Pain; opioid dependence

Documented research summary

Different human findings explicitly separated: Vierke 2021 (online 2020), retrospective 15 cannabis users versus 17 controls at comparable buprenorphine doses: buprenorphine concentration 2.7-fold higher, norbuprenorphine 1.4-fold (p=0.07, not significant); CYP3A4 inhibition is an explanation, not directly proven. London 2025 pilot RCT with oral CBD 600 mg/day for 28 days: 30 treated (18 CBD/12 placebo), no significant pharmacokinetic interaction or serious events in the abstract. Do not infer general safety. Suzuki 2022 open-label study n=5: one case of moderate sedation with CBD 600 mg/day for 3 days. Suzuki 2023 mixed methadone/buprenorphine RCT n=10 and Costa 2026 open-label mixed study n=7 mainly investigate craving/pain, not reliable individual-opioid pharmacokinetics. Lent 2025 observation with buprenorphine/naloxone and THC/CBD 5/5 mg in 47 people: symptomatic changes without a control group, not pharmacokinetic proof. Individual vasospasm/stroke reports with cannabis plus buprenorphine/naloxone do not establish a causal pair effect. Preclinical contexts conflict: Briones 2025 rats receiving low-dose buprenorphine/CBD showed more favourable analgesia/respiratory parameters, whereas Bouchard 2025 found increased mortality with the combination after fracture in mice also receiving carprofen; no human antidote or risk figure can be inferred.

Uncertainties and limitations

No quantification of the absent effect in the CBD RCT abstract; small samples. Natural-cannabis composition, administration, adherence and retrospective-study confounders limit causality. No clinical pair studies with rare plant cannabinoids identified. Animal doses and opioid formulations not interchangeable.

Separately recorded findings

7 separately recorded findings. Each statement applies to its documented study context.

Cannabis (composition not isolated) – clinical signals

Finding ID: B0098

Type of result: Context-specific finding; read the limitations

Observation: Cannabis users had approximately 2.7-fold higher buprenorphine concentrations.

Mechanism: Pharmacokinetic association; CYP3A4 inhibition suspected

Study type: Retrospective observational study; online 2020

Context studied: Retrospective comparison in opioid maintenance treatment.

Clinical interpretation: Individual medical / pharmaceutical assessment; do not use as dosage instructions

Limitations and uncertainties: Confounding and multi-substance exposure; do not attribute to isolated CBD or THC.

Original sources for this finding: Buprenorphine-cannabis interaction in patients undergoing opioid maintenance therapy [EX10]

CBD, oral – clinically investigated

Finding ID: B0128

Type of result: No / minor effect under the conditions studied

Observation: No significant effect on buprenorphine pharmacokinetics; no serious adverse events/deaths.

Mechanism: Human pharmacokinetic assessment; no significant exposure effect

Study type: Randomised placebo-controlled study

Context studied: CBD 600 mg/day for 28 days; 35 enrolled, 30 in safety analysis (18 CBD/12 placebo).

Clinical interpretation: Limited to the regimen investigated; does not automatically contradict differently formulated cannabis

Limitations and uncertainties: Do not extrapolate to THC-containing cannabis or other CBD doses.

Original sources for this finding: Adjunctive Cannabidiol in Inpatient Buprenorphine Treatment for Opioid Use Disorder: A Pilot Randomized Trial. [CA_P_41467610]

Oral CBD – clinical signals

Finding ID: B0129

Type of result: Positive finding / indication

Observation: Moderate sedation in one of five people; no other major changes reported; craving decreased.

Mechanism: Pharmacodynamic add-on administration

Study type: Open-label pilot study

Context studied: n=5; CBD 600 mg on 3 days during buprenorphine treatment.

Clinical interpretation: Limited sedation signal

Limitations and uncertainties: No controlled pharmacokinetics, tiny sample; effect cannot be attributed solely to the interaction.

Original sources for this finding: Cannabidiol Effect on Cue-Induced Craving for Individuals with Opioid Use Disorder Treated with Buprenorphine: A Small Proof-of-Concept Open-Label Study. [CA_P_36105269]

THC/CBD combination – clinical signals

Finding ID: B0130

Type of result: Co-medication context without an isolated interaction

Observation: Open-label observation reported better pain, sleep and quality-of-life scores but no significant change in illicit opioid use or craving.

Mechanism: Adjunctive therapy, not isolated pharmacokinetic measurement

Study type: Open-label adjunctive-treatment study

Context studied: n=47 receiving buprenorphine/naloxone; THC/CBD 5 mg each daily over 3 months.

Clinical interpretation: Context finding, not interaction evidence

Limitations and uncertainties: Combination preparation and open-label study; neither therapeutic synergy nor a pharmacokinetic interaction proven.

Original sources for this finding: Clinical and psychosocial changes in adults with opioid use disorder and chronic pain using medical cannabis: a brief report. [CA_P_40533856]

Oral CBD – clinical signals

Finding ID: B0134

Type of result: Mixed/context-dependent finding

Observation: No general dose-dependent improvement in pain tests in the very small mixed opioid-agonist-treatment cohort. Post-hoc between-group comparisons: higher heat threshold with buprenorphine than methadone at CBD 400 mg, and higher heat tolerance at CBD 800 mg.

Mechanism: Experimental pharmacodynamics; opioid-dependent differences

Study type: Open-label exploratory pilot with sequentially ascending CBD doses

Context studied: n=7 overall receiving methadone or buprenorphine; CBD 400/800/1200 mg.

Clinical interpretation: Hypothesis-generating

Limitations and uncertainties: No pharmacokinetics; tiny subgroups, multiple endpoints. No treatment recommendation.

Original sources for this finding: Exploring the effects of cannabidiol on pain sensitivity using quantitative sensory testing among individuals receiving methadone or buprenorphine for opioid use disorder: an open-label, proof-of-concept study. [CA_P_41496743]

CBD – laboratory and animal studies

Finding ID: B0148

Type of result: Preclinical finding

Observation: Rat experiment reported more favourable analgesia/breathing with low-dose buprenorphine plus CBD and a shorter buprenorphine half-life; no corresponding general protective effect on morphine-related breathing.

Mechanism: Preclinical analgesia/respiratory and pharmacokinetic investigation

Study type: Rat study

Context studied: Investigated low-dose opioid combinations, 2025.

Clinical interpretation: Not usable as a human protective mechanism

Limitations and uncertainties: Species- and dose-dependent; do not recommend for human risk reduction.

Original sources for this finding: Combination of Cannabidiol and Low-Dose Buprenorphine Suggests Synergistic Analgesia and Attenuates Buprenorphine-Induced Respiratory Depression. [CA_P_40468945]

Intraperitoneal CBD – laboratory and animal studies

Finding ID: B0149

Type of result: Preclinical harm signal

Observation: Combination with buprenorphine increased mortality/gastrointestinal complications; two acute apnoea events after injection.

Mechanism: Preclinical multiple treatment after fracture

Study type: Mouse fracture model

Context studied: 80 male mice; CBD 100 mg/kg intraperitoneally daily for 7 days, buprenorphine 0.1 mg/kg subcutaneously every 12 hours for 3 days; all received carprofen 20 mg/kg for 3 days.

Clinical interpretation: Warning signal in the model, not a human effect size

Limitations and uncertainties: High CBD dose, injection route, male animals and mandatory concomitant carprofen prevent isolated clinical attribution.

Original sources for this finding: Buprenorphine and cannabidiol co-administration reduces survival in a mouse model of orthopedic trauma. [CA_P_41019985]

References and access status

[CA_L_D0143] D0143 official SPL

Original source / bibliographic reference

Authors: PAI Holdings, LLC dba PAI Pharma

Year: 2026

Source type: Current published human-use SPL / product information

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

[EX10] Buprenorphine-cannabis interaction in patients undergoing opioid maintenance therapy

Original source / bibliographic reference

Authors: Vierke C; Marxen B; Boettcher M; Hiemke C; Havemann-Reinecke U

Year: 2021

Source type: Retrospective observational study; online 2020

DOI: 10.1007/s00406-019-01091-0

PMID: 31907614

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_41467610] Adjunctive Cannabidiol in Inpatient Buprenorphine Treatment for Opioid Use Disorder: A Pilot Randomized Trial.

Original source / bibliographic reference

Authors: London ED, Dean AC, De La Garza R, Lachoff H, Mooney LJ, Torrington M, Whelan F, McClintick M, Ghahremani D, Elezi G, Whitelegge JP, Sugar C, Vocci FJ.

Year: 2025

Source type: Journal Article

DOI: 10.1097/adm.0000000000001640

PMID: 41467610

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_41496743] Exploring the effects of cannabidiol on pain sensitivity using quantitative sensory testing among individuals receiving methadone or buprenorphine for opioid use disorder: an open-label, proof-of-concept study.

Original source / bibliographic reference

Authors: Costa GPA, Suh R, Sofuoglu M, De Aquino JP.

Year: 2026

Source type: brief-report; Journal Article

DOI: 10.1016/j.abrep.2025.100654

PMID: 41496743

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_41019985] Buprenorphine and cannabidiol co-administration reduces survival in a mouse model of orthopedic trauma.

Original source / bibliographic reference

Authors: Bouchard C, Frégeau G, Massé I, De Beaumont L.

Year: 2025

Source type: brief-report; Journal Article

DOI: 10.3389/fphar.2025.1683842

PMID: 41019985

Source access – 23 October 2026: Automated direct retrieval was restricted; this does not establish that the link is broken.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_40468945] Combination of Cannabidiol and Low-Dose Buprenorphine Suggests Synergistic Analgesia and Attenuates Buprenorphine-Induced Respiratory Depression.

Original source / bibliographic reference

Authors: Briones MS, DeYoung DZ, Heinzerling KG.

Year: 2025

Source type: research-article; Journal Article; Research Support, N.I.H., Extramural

DOI: 10.1089/can.2025.0004

PMID: 40468945

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_36105269] Cannabidiol Effect on Cue-Induced Craving for Individuals with Opioid Use Disorder Treated with Buprenorphine: A Small Proof-of-Concept Open-Label Study.

Original source / bibliographic reference

Authors: Suzuki J, Martin B, Prostko S, Chai PR, Weiss RD.

Year: 2022

Source type: research-article; Journal Article

DOI: 10.1089/imr.2022.0070

PMID: 36105269

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_37065899] Impact of cannabidiol on reward- and stress-related neurocognitive processes among individuals with opioid use disorder: A pilot, double-blind, placebo-controlled, randomized cross-over trial.

Original source / bibliographic reference

Authors: Suzuki J, Prostko S, Szpak V, Chai PR, Spagnolo PA, Tenenbaum RE, Ahmed S, Weiss RD.

Year: 2023

Source type: brief-report; Journal Article

DOI: 10.3389/fpsyt.2023.1155984

PMID: 37065899

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_40533856] Clinical and psychosocial changes in adults with opioid use disorder and chronic pain using medical cannabis: a brief report.

Original source / bibliographic reference

Authors: Lent MR, Keen R, Ruiz M, Callahan HR, Galluzzi KE, Dugosh KL.

Year: 2025

Source type: research-article; Journal Article

DOI: 10.1186/s42238-025-00297-5

PMID: 40533856

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_19887017] Interaction of drugs of abuse and maintenance treatments with human P-glycoprotein (ABCB1) and breast cancer resistance protein (ABCG2).

Original source / bibliographic reference

Authors: Tournier N, Chevillard L, Megarbane B, Pirnay S, Scherrmann JM, Declèves X.

Year: 2010

Source type: Journal Article

DOI: 10.1017/s1461145709990848

PMID: 19887017

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_27833768] Stroke from Vasospasm due to Marijuana Use: Can Cannabis Synergistically with Other Medications Trigger Cerebral Vasospasm?

Original source / bibliographic reference

Authors: Jamil M, Zafar A, Adeel Faizi S, Zawar I.

Year: 2016

Source type: research-article; Journal Article

DOI: 10.1155/2016/5313795

PMID: 27833768

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_28917206] Maternal and infant outcomes following third trimester exposure to marijuana in opioid dependent pregnant women maintained on buprenorphine.

Original source / bibliographic reference

Authors: O'Connor AB, Kelly BK, O'Brien LM.

Year: 2017

Source type: Journal Article

DOI: 10.1016/j.drugalcdep.2017.08.012

PMID: 28917206

Source access – 23 October 2026: Automated direct retrieval was restricted; this does not establish that the link is broken.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_16288738] Enhancement of transdermal fentanyl and buprenorphine antinociception by transdermal delta9-tetrahydrocannabinol.

Original source / bibliographic reference

Authors: Cichewicz DL, Welch SP, Smith FL.

Year: 2005

Source type: Journal Article; Research Support, N.I.H., Extramural

DOI: 10.1016/j.ejphar.2005.09.039

PMID: 16288738

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_31496363] Reduced urinary opioid levels from pain management patients associated with marijuana use.

Original source / bibliographic reference

Authors: Goggin MM, Shahriar BJ, Stead A, Janis GC.

Year: 2019

Source type: Journal Article

DOI: 10.2217/pmt-2019-0017

PMID: 31496363

Source access – 23 October 2026: Automated direct retrieval was restricted; this does not establish that the link is broken.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

Research as of 23 October 2026. Not all original full texts could be reviewed in full. Source accessibility and the strength of scientific evidence must be assessed separately. An accessible link does not establish medical approval; a bibliographic record with an abstract does not replace the original full text.

Drug search and explanation of the evidence · Guide: cannabinoids and medicines · Author and responsibility