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Leroux T, Ajrawat P, Sundararajan K, Maldonado-Rodriguez N, Ravi B, Gandhi R, Rampersaud R, Veillette C, Mahomed N, Clarke H. Understanding the epidemiology and perceived efficacy of cannabis use in patients with chronic musculoskeletal pain. J Cannabis Res 2024; 6:28. [PMID: 38961506 PMCID: PMC11220958 DOI: 10.1186/s42238-024-00231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/11/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The belief that cannabis has analgesic and anti-inflammatory properties continues to attract patients with chronic musculoskeletal (MSK) pain towards its use. However, the role that cannabis will play in the management of chronic MSK pain remains to be determined. This study examined 1) the rate, patterns of use, and self-reported efficacy of cannabis use among patients with chronic MSK pain and 2) the interest and potential barriers to cannabis use among patients with chronic MSK pain not currently using cannabis. METHODS Self-reported cannabis use and perceived efficacy were prospectively collected from chronic MSK pain patients presenting to the Orthopaedic Clinic at the University Health Network, Toronto, Canada. The primary dependent variable was current or past use of cannabis to manage chronic MSK pain; bivariate and multivariable logistic regression were used to identify patient characteristics independently associated with this outcome. Secondary outcomes were summarized descriptively, including self-perceived efficacy among cannabis users, and interest as well as barriers to cannabis use among cannabis non-users. RESULTS The sample included 629 patients presenting with chronic MSK pain (mean age: 56±15.7 years; 56% female). Overall, 144 (23%) reported past or present cannabis use to manage their MSK pain, with 63.7% perceiving cannabis as very or somewhat effective and 26.6% considering it as slightly effective. The strongest predictor of cannabis use in this study population was a history of recreational cannabis use (OR 12.7, p<0.001). Among cannabis non-users (N=489), 65% expressed interest in using cannabis to manage their chronic MSK pain, but common barriers to use included lack of knowledge regarding access, use and evidence, and stigma. CONCLUSIONS One in five patients presenting to an orthopaedic surgeon with chronic MSK pain are using or have used cannabis with the specific intent to manage their pain, and most report it to be effective. Among non-users, two-thirds reported an interest in using cannabis to manage their MSK pain, but common barriers to use existed. Future double-blind placebo-controlled trials are required to understand if this reported efficacy is accurate, and what role, if any, cannabis may play in the management of chronic MSK pain.
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Affiliation(s)
- Timothy Leroux
- The Arthritis Program, University Health Network, 399 Bathurst St, East Wing, 1st Floor, Room 1-436, Toronto, Ontario, M5T 2S8, Canada.
| | - Prabjit Ajrawat
- The Arthritis Program, University Health Network, 399 Bathurst St, East Wing, 1st Floor, Room 1-436, Toronto, Ontario, M5T 2S8, Canada
| | - Kala Sundararajan
- The Arthritis Program, University Health Network, 399 Bathurst St, East Wing, 1st Floor, Room 1-436, Toronto, Ontario, M5T 2S8, Canada
| | - Naomi Maldonado-Rodriguez
- The Arthritis Program, University Health Network, 399 Bathurst St, East Wing, 1st Floor, Room 1-436, Toronto, Ontario, M5T 2S8, Canada
| | - Bheeshma Ravi
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajiv Gandhi
- The Arthritis Program, University Health Network, 399 Bathurst St, East Wing, 1st Floor, Room 1-436, Toronto, Ontario, M5T 2S8, Canada
| | - Raja Rampersaud
- The Arthritis Program, University Health Network, 399 Bathurst St, East Wing, 1st Floor, Room 1-436, Toronto, Ontario, M5T 2S8, Canada
| | - Christian Veillette
- The Arthritis Program, University Health Network, 399 Bathurst St, East Wing, 1st Floor, Room 1-436, Toronto, Ontario, M5T 2S8, Canada
| | - Nizar Mahomed
- The Arthritis Program, University Health Network, 399 Bathurst St, East Wing, 1st Floor, Room 1-436, Toronto, Ontario, M5T 2S8, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Dunn TJ, Holmes E, Yang Y, Bentley JP, Kashmiri S, Ramachandran S. The relationship between medical marijuana use and prescription pain reliever use among U.S. adults: A retrospective analysis utilizing the 2015-2019 National Survey on Drug Use and Health (NSDUH). EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100368. [PMID: 38054191 PMCID: PMC10694753 DOI: 10.1016/j.rcsop.2023.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/20/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023] Open
Abstract
Background Despite a number of states in the U.S. enacting medical marijuana policies, there is currently a lack of research outlining the role that individual-level factors play in predicting medical marijuana use, especially regarding use and misuse of prescription pain relievers. The overall aim of this study was to assess the prevalence of medical marijuana use in the U.S. and to identify clinical, social, and demographic predictors. Methods A retrospective secondary database analysis was conducted utilizing five years of the National Survey on Drug Use and Health (NSUDH). A multivariable logistic regression model assessed the association between prescription pain reliever use and medical marijuana in the adult U.S. population while adjusting for substance use factors, psychiatric factors, and demographic characteristics. Results Within the U.S. adult population from 2015 to 2019, medical marijuana use increased from 1.6% to 2.4%, while appropriate prescription pain reliever use decreased from 33.4% to 27.5%, and prescription pain reliever misuse decreased from 4.7% to 3.7%. Of all marijuana users, 15.1% resided within non-medical marijuana states. Medical marijuana users are more likely to have a serious mental illness (14.0% vs. 4.4%) and a non-marijuana related substance dependence (5.3% vs. 1.2%). Past-year medical marijuana use was significantly more likely to be reported among appropriate users of prescription pain relievers (OR = 1.99, p < .001) and misusers (OR = 1.94, p < .001) (relative to nonusers). Conclusions Prescription pain reliever appropriate use and misuse were associated with higher odds of medical marijuana use. This study identified a potential treatment gap among individuals residing in states with no medical marijuana availability. These study findings highlight the potential benefits of medical marijuana legalization that future research can build on to guide policy making decisions.
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Affiliation(s)
- Tyler J. Dunn
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS 38677, USA
| | - Erin Holmes
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS 38677, USA
| | - Yi Yang
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS 38677, USA
| | - John P. Bentley
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS 38677, USA
| | - Saim Kashmiri
- Department of Marketing, University of Mississippi School of Business, University, MS 38677, USA
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS 38677, USA
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Gordon AM, Golub IJ, Diamond KB, Kang KK, Choueka J. Cannabis Abuse Is Associated With Greater Medical Complications, Emergency Department Visits, and Readmissions Following Open Reduction and Internal Fixation for Distal Radius Fractures. Hand (N Y) 2023:15589447231210948. [PMID: 38006235 DOI: 10.1177/15589447231210948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND Despite increased legalization, little is known about the influence of cannabis use disorder (CUD) following open reduction and internal fixation (ORIF) for distal radius fractures (DRFs). The aims were to determine whether CUD patients undergoing ORIF for DRF have increased: (1) medical complications; and (2) health care utilization (emergency department [ED] visits and readmission rates). METHODS Patients were identified from an insurance database from 2010 to 2020 using Current Procedural Terminology codes: 25607, 25608, and 25609. Patients with a history of CUD were 1:5 ratio matched to controls by age, sex, tobacco use, alcohol abuse, opioid dependence, and comorbidities. This yielded 13,405 patients with (n = 2,297) and without (n = 11,108) CUD. Outcomes were to compare 90-day medical complications, ED visits, and readmissions. Multivariable logistic regression models computed the odds ratios of CUD on dependent variables. P values less than .005 were significant. RESULTS The incidence of CUD among patients aged 20 to 69 years undergoing ORIF increased from 4.0% to 8.0% from 2010 to 2020 (P < .001). Cannabis use disorder patients incurred significantly higher rates and odds of developing 90-day medical complications (15.24% vs 5.76%), including pneumoniae (3.66% vs 1.67%), cerebrovascular accidents (1.04% vs 0.32%), pulmonary emboli (0.57% vs 0.16%), respiratory failures (1.00% vs 0.48%), and surgical site infections (1.70% vs 1.04%; all P < .004). Emergency department visits (2.53% vs 1.14%) and readmission rates (5.79% vs 4.29%) within 90 days were higher among cannabis abusers. CONCLUSIONS With a greater number of states legalizing cannabis, hand surgeons should be cognizant of the association with increased 90-day complications and health care utilization parameters.
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Affiliation(s)
- Adam M Gordon
- Maimonides Medical Center, Brooklyn, NY, USA
- Questrom School of Business, Boston University, MA, USA
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Tavabi N, Raza M, Singh M, Golchin S, Singh H, Hogue GD, Kiapour AM. Disparities in cannabis use and documentation in electronic health records among children and young adults. NPJ Digit Med 2023; 6:138. [PMID: 37553423 PMCID: PMC10409778 DOI: 10.1038/s41746-023-00885-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
The legalizations of medical and recreational cannabis have generated a great deal of interest in studying the health impacts of cannabis products. Despite increases in cannabis use, its documentation during clinical visits is not yet mainstream. This lack of information hampers efforts to study cannabis's effects on health outcomes. A clear and in-depth understanding of current trends in cannabis use documentation is necessary to develop proper guidelines to screen and document cannabis use. Here we have developed and used a natural language processing pipeline to evaluate the trends and disparities in cannabis documentation. The pipeline includes a screening step to identify clinical notes with cannabis use documentation which is then fed into a BERT-based classifier to confirm positive use. This pipeline is applied to more than 23 million notes from a large cohort of 370,087 patients seen in a high-volume multi-site pediatric and young adult clinic over a period of 21 years. Our findings show a very low but growing rate of cannabis use documentation (<2%) in electronic health records with significant demographic and socioeconomic disparities in both documentation and positive use, which requires further attention.
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Affiliation(s)
- Nazgol Tavabi
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marium Raza
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mallika Singh
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Shahriar Golchin
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Computer Science, University of Arizona, Tucson, USA
| | - Harsev Singh
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Grant D Hogue
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ata M Kiapour
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Gewandter JS, Edwards RR, Hill KP, Wasan AD, Hooker JE, Lape EC, Besharat S, Cowan P, Foll BL, Ditre JW, Freeman R. Cannabinoid Therapy: Attitudes and Experiences of People With Chronic Pain. Clin J Pain 2023; 39:249-258. [PMID: 36971412 PMCID: PMC10563515 DOI: 10.1097/ajp.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Clinical trials of cannabinoids for chronic pain have mixed and often inconclusive results. In contrast, many prospective observational studies show the analgesic effects of cannabinoids. This survey study aimed to examine the experiences/attitudes of individuals with chronic pain who are currently taking, have previously taken, or never taken cannabinoids for chronic pain to inform future research. METHODS This study is based on a cross-sectional, web-based survey of individuals with self-reported chronic pain. Participants were invited to participate through an email that was distributed to the listservs of patient advocacy groups and foundations that engage individuals with chronic pain. RESULTS Of the 969 respondents, 444 (46%) respondents reported currently taking, 213 (22%) previously taken, and 312 (32%) never taken cannabinoids for pain. Participants reported using cannabinoids to treat a wide variety of chronic pain conditions. Those currently taking cannabinoids (vs previously) more frequently reported: (1) large improvements from cannabinoids in all pain types, including particularly difficult-to-treat chronic overlapping pain conditions (eg, pelvic pain), (2) improvements in comorbid symptoms (eg, sleep), and (3) lower interference from side effects. Those currently taking cannabinoids reported more frequent and satisfactory communication with clinicians regarding cannabinoid use. Those never taken cannabinoids reported a lack of suggestion/approval of a clinician (40%), illegality (25%), and lack of FDA regulation (19%) as reasons for never trying cannabinoids. CONCLUSION These findings underscore the importance of conducting high-quality clinical trials that include diverse pain populations and clinically relevant outcomes that if successful, could support FDA approval of cannabinoid products. Clinicians could then prescribe and monitor these treatments similarly to other chronic pain medications.
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Affiliation(s)
- Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Kevin P. Hill
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ajay D. Wasan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julia E. Hooker
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Emma C. Lape
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Soroush Besharat
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Bernard Le Foll
- Department of Family and Community Medicine, University of Toronto, CA
- Addictions Division, Centre for Addiction and Mental Health, Toronto, CA
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Dekeseredy P, Brownstein H, Haggerty T, Sedney CL. Using Medical Cannabis for Chronic Pain: A Social-Ecological Framework. Cannabis Cannabinoid Res 2023. [PMID: 37155681 DOI: 10.1089/can.2023.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Early studies suggest medical cannabis (MC) has the potential to benefit people who suffer from chronic pain by offering a less addictive alternative to opioids; however, most investigators agree more research is indicated. Today, in 2023, cannabis remains a Schedule I drug and is an illegal substance in the United States under the Controlled Substances Act of 1970. Despite this designation, as of February 2022, 37 states, three territories, and the District of Columbia allowed using cannabis products to treat certain painful medical conditions. The contradictory status of federal and state legislation regarding cannabis use has resulted in delays and restrictions on relevant research. As a result, an inadequate foundation of knowledge exists needed to inform policy, program, and practice decisions concerning MC to treat pain. Implementing and controlling access to MC is influenced by overlapping individual, interpersonal, community, and organizational influences that all fall under the umbrella of federal and state policies. Increasingly, the legalization and expanded access to MC necessitates the integration of evidence, policy, and social-ecological reality. To adequately delineate these complex factors to anticipate and plan future interventions at multiple levels, we propose a social-ecological framework (SEF) for using MC to treat pain. This SEF assumes the transactional relationship between the individual and the environment and that no single factor can predict behavior or health outcomes. Our framework illustrates five dynamic levels of analysis that interact between dimensions. Key elements and intersections are discussed at the intrapersonal, interpersonal, institutional, community, and policy levels.
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Affiliation(s)
- Patricia Dekeseredy
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Henry Brownstein
- Sociology and Anthropology, West Virginia University, Morgantown, West Virginia, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Cara L Sedney
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
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Klein TA, Clark CS. Therapeutic use of cannabis in the US. Nurse Pract 2022; 47:16-25. [PMID: 36399143 PMCID: PMC9674439 DOI: 10.1097/01.npr.0000884880.81603.c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT NPs are likely to encounter patients using cannabis with therapeutic intent, with or without legal authorization. During the clinical history and assessment process, NPs need to engage in frank discussion about cannabis therapeutics, including the risks and benefits, evidence for use, dosing considerations, potential drug interactions, and harm reduction.
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