Willingness to Participate in Longitudinal Research Among People with Chronic Pain Who Take Medical Cannabis: A Cross-Sectional Survey

Exploring motivations for participating in research among Australian women with advanced gynaecological cancer: a qualitative study

PURPOSE

With global moves to increase research among those living with advanced cancer and legitimise consumers as part of cancer research, this article aims to build an understanding of women's motivations and reasons for participating in gynaecological cancer research. As a secondary aim, we considered the role of qualitative methods in enabling active involvement of consumers in research.

METHODS

We applied thematic discursive analysis to 18 in-depth interviews with women diagnosed with advanced (stage III-IV) gynaecological cancer living in Australia.

RESULTS

We found that women viewed research as a vehicle for change in two directions: improving the lives of future generations and improving education and awareness. Underpinning these two framings of research, women spoke about their own role and reasons for participating in this interview study. Women's stories were painted against a backdrop of social and medical silences around gynaecological cancer. It was from such silence that women chose to speak up and position themselves as participating in service for knowledge production.

CONCLUSION

We learned that trust, reciprocity and relationships are central to women's decisions to participate in cancer research. Legitimising consumers in cancer research requires methods, methodologies and practices that pay careful attention to power, control and representation.

Therapeutic Cannabis Use in Kidney Disease: A Survey of Canadian Nephrologists

Rationale & Objective

Cannabis use may be helpful for symptom management in patients with chronic kidney disease (CKD). Knowledge, attitudes, and comfort with use of medical cannabis among kidney care providers may be limiting more widespread evaluation and use. We surveyed Canadian nephrologists regarding current prescribing habits, attitudes, and overall comfort level with cannabis products.

Study Design

We carried out a nationwide, mail-in survey focused on capturing general and practice demographics, current cannabis prescribing status, and knowledge and attitudes regarding therapeutic cannabis use in patients with CKD.

Setting & Population

This survey was distributed to every registered nephrologist in Canada.

Analytical Approach

The results of this survey are reported descriptively.

Results

Responses were received from 208 of 723 (29%) nephrologists. Only 21 (10.1%) respondents currently prescribe cannabis, with chronic pain syndromes being the most frequent reason for cannabis prescription (95.2%). Overall, 116 (55.5%) participants reported that changes in legality of cannabis did not influence their decision to prescribe cannabis. The majority of respondents (n = 123; 59%) indicated that they were uncomfortable with their knowledge of the medical cannabis literature. Most respondents (n=188; 91%) indicated that further studies exploring the efficacy and safety of cannabis would likely influence their prescribing habits.

Limitations

Limitations of this study include possible nonresponse bias and a lack of specific data on practice considerations for specific subpopulations, such as transplant patients.

Conclusions

Only a small minority of Canadian nephrologists currently prescribe cannabis, with relatively little practice change after legalization. There is broad support amongst Canadian nephrologists for encouraging their patients to enroll in efficacy/safety studies of cannabis in the CKD population. Ultimately, given limited therapeutic options available for symptom control in CKD, this survey demonstrates the potential for nationwide practice change if cannabis efficacy and safety can be demonstrated in this population.

Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain

INTRODUCTION

In the USA, opioid analgesic use and overdoses have increased dramatically. One rapidly expanding strategy to manage chronic pain in the context of this epidemic is medical cannabis. Cannabis has analgesic effects, but it also has potential adverse effects. Further, its impact on opioid analgesic use is not well studied. Managing pain in people living with HIV is particularly challenging, given the high prevalence of opioid analgesic and cannabis use. This study's overarching goal is to understand how medical cannabis use affects opioid analgesic use, with attention to Δ9-tetrahydrocannabinol and cannabidiol content, HIV outcomes and adverse events.

METHODS AND ANALYSES

We are conducting a cohort study of 250 adults with and without HIV infection with (a) severe or chronic pain, (b) current opioid use and (c) who are newly certified for medical cannabis in New York. Over 18 months, we collect data via in-person visits every 3 months and web-based questionnaires every 2 weeks. Data sources include: questionnaires; medical, pharmacy and Prescription Monitoring Program records; urine and blood samples; and physical function tests. Using marginal structural models and comparisons within participants' 2-week time periods (unit of analysis), we will examine how medical cannabis use (primary exposure) affects (1) opioid analgesic use (primary outcome), (2) HIV outcomes (HIV viral load, CD4 count, antiretroviral adherence, HIV risk behaviours) and (3) adverse events (cannabis use disorder, illicit drug use, diversion, overdose/deaths, accidents/injuries, acute care utilisation).

ETHICS AND DISSEMINATION

This study is approved by the Montefiore Medical Center/Albert Einstein College of Medicine institutional review board. Findings will be disseminated through conferences, peer-reviewed publications and meetings with medical cannabis stakeholders.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT03268551); Pre-results.