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It is mainly metabolized to pharmacologically active norbuprenorphine by the cytochrome P450 (CYP) isozyme 3A4. This may give rise to drug\u2013drug interactions under combinations with inhibitors or inducers of CYP3A4. Cannabis is a potential inhibitor of CYP3A4, and there is a large degree of concomitant cannabis use among OMT patients. We performed a retrospective analysis on liver healthy OMT patients substituted with buprenorphine, either with (<jats:italic>n<\/jats:italic>\u2009=\u200915) or without (<jats:italic>n<\/jats:italic>\u2009=\u200917) concomitant use of cannabis. Patients with additional illicit drugs or medications affecting CYP3A were excluded. Measured blood concentrations of buprenorphine and norbuprenorphine were compared between the two groups. Cannabis users and non-users received similar doses, but users had 2.7-fold higher concentrations of buprenorphine (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and 1.4-fold for norbuprenorphine (1.4-fold, <jats:italic>p<\/jats:italic>\u2009=\u20090.07). Moreover, the metabolite-to-parent drug ratio was 0.98 in non-users and 0.38 in users (<jats:italic>p<\/jats:italic>\u2009=\u20090.02). Female gender did not produce significant effects. These findings indicate that cannabis use decreases the formation of norbuprenorphine and elevates buprenorphine and norbuprenorphine concentrations in blood most probably by inhibition of CYP3A4. The pharmacokinetic interaction may give rise to enhanced or altered opioid activity and risk of intoxications. Physicians should inform patients about this risk and supervise cannabis users by regular control of buprenorphine blood levels, i.e., by therapeutic drug monitoring.<\/jats:p>","DOI":"10.1007\/s00406-019-01091-0","type":"journal-article","created":{"date-parts":[[2020,1,6]],"date-time":"2020-01-06T19:02:55Z","timestamp":1578337375000},"page":"847-856","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Buprenorphine\u2013cannabis interaction in patients undergoing opioid maintenance therapy"],"prefix":"10.1007","volume":"271","author":[{"given":"Christopher","family":"Vierke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte","family":"Marxen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Boettcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Hiemke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Havemann-Reinecke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,1,6]]},"reference":[{"key":"1091_CR1","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-019-00983-5","author":"S Chandra","year":"2019","unstructured":"Chandra S, Radwan MM, Majumdar CG et al (2019) New trends in cannabis potency in USA and Europe during the last decade (2008\u20132017). 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He is the managing editor of PSIAC () which provides an internet-based drug\u2013drug interaction program for psychopharmacotherapy. He reports no conflict of interest with this publication. Ursula Havemann-Reinecke has served on the advisory Board on opioid maintenance treatment of Sanofi and Indivior London. She has received speaker\u2019s fee from Hexal. She reports no conflict of interest with this publication. Michael B\u00f6ttcher and Christopher Vierke report no conflicts of interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}