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Lazris D, Gaur D, Curseen K, Kavalieratos D, Maxwell M, Quest T, Zarrabi AJ. Integrated Medical Cannabis Consultations in a Palliative Care Program: Policies, Procedures, and Progress after Six Years of Practice. J Palliat Med 2022; 25:802-806. [PMID: 35319304 DOI: 10.1089/jpm.2021.0577] [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: 11/12/2022] Open
Abstract
Introduction: Our academic ambulatory palliative care program has counseled, monitored, and certified patients for cannabis as part of routine palliative care practice for six years. Objective: We describe the population certified for cannabis and policies, procedures, and medicolegal challenges in our palliative care clinic. Methods: We performed a retrospective review of patients, qualifying diagnoses for cannabis certification, reasons for referral, and number of annual certifications. Results: Between 2015 and 2021, we certified 1711 patients for cannabis. The most common indications were cancer (64%), pain (24%), and neuropathy (9%). Other three months in 2021, 28% of new referrals to our practice were certified for cannabis and 15% of patients were referred explicitly for cannabis certification. Conclusion: Despite legal and practical challenges to implementing a medical cannabis program, our palliative care program has fully integrated cannabis as part of our standard outpatient clinical practice.
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Affiliation(s)
- David Lazris
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dhruv Gaur
- Brown University, Providence, Rhode Island, USA
| | - Kimberly Curseen
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dio Kavalieratos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Meredith Maxwell
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tammie Quest
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali John Zarrabi
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Prosk E, Arboleda MF, Rapin L, El Hage C, Dworkind M. The model of care at a leading medical cannabis clinic in Canada. Complement Ther Med 2021; 60:102740. [PMID: 34052339 DOI: 10.1016/j.ctim.2021.102740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/11/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
Medical cannabis access has been legalized in more than 30 countries worldwide and popularity among patients is increasing rapidly. Cannabinoid-based treatments have been shown to be beneficial for several symptoms such as chemotherapy-induced nausea and vomiting, spasticity, chronic pain, intractable seizures and insomnia, yet high-quality clinical trials are still limited. As millions of patients now have legal access to medical cannabis, little information is available about the development of best clinical practices and an effective medical cannabis clinic model. A medical cannabis clinic is an innovative and emergent practice model that may be necessary to bridge the gap between patient and healthcare provider interest and existing barriers to the prescription of medical cannabis treatments, such as limited medical education, lack of high-quality clinical research and challenging or evolving regulatory frameworks. In this paper, we describe the model of care and organization of a dedicated medical cannabis clinic operating in Quebec, Canada since 2014. We share the principles of medical cannabis practice, including the structure of its medical and support team, clinic organisation and procedure guidelines. Key clinic statistics and patient demographics are shared with year by year comparison. Operating since 2014, the clinic has endured a rapidly changing regulatory landscape in Canada, overcoming numerous challenges including medical and social stigma, limited funding, resources and institutional support combined with a high demand for services. To support medical cannabis leaders globally, an important knowledge-sharing is required. The clinic has expanded to a network of four clinic sites across Quebec and offers continuing education and preceptorships to health care providers and trainees as well as research services to both academic and industry partners. The description of the clinic offers guidance on medical cannabis treatment and care and discusses possible solutions to associated challenges. The clinic model of care can be adapted to different healthcare settings and regulatory frameworks; it may assist physicians and health care providers in the development of medical cannabis clinics or the implementation of best practices as medical cannabis access continues to evolve.
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Affiliation(s)
- Erin Prosk
- Santé Cannabis, Research Department, Canada.
| | | | | | | | - Michael Dworkind
- Santé Cannabis, Research Department, Canada; McGill University Faculty of Medicine, Canada.
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Wang YL, Kong XQ, Ji FH. Effect of dexmedetomidine on intraoperative Surgical Pleth Index in patients undergoing video-assisted thoracoscopic lung lobectomy. J Cardiothorac Surg 2020; 15:296. [PMID: 33008451 PMCID: PMC7532649 DOI: 10.1186/s13019-020-01346-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/28/2020] [Indexed: 02/03/2023] Open
Abstract
Background The Surgical Pleth Index (SPI) is a monitoring method that reflects painful stimuli during general anesthesia, and dexmedetomidine is an analgesic adjuvant with an opioid-sparing effect. But up to now, it is still unclear whether dexmedetomidine has any influence on SPI. To investigate whether dexmedetomidine has an effect on SPI during video-assisted thoracoscopic surgery. Methods We enrolled 94 patients who underwent video-assisted thoracoscopic lung lobectomy. Patients were randomly assigned to a dexmedetomidine group (dexmedetomidine: 0.8 μg/kg administered for 10 min before anesthesia) or normal saline group (equal volume of normal saline). SPI and vital signs were recorded. The number rating scale (NRS) pain score was also evaluated. Results SPI values were significantly lower in the dexmedetomidine group than in the normal saline group at intubation and at discharge from the postanesthesia care unit. Compared with the normal saline group, mean arterial pressure and heart rate were both significantly lower in the dexmedetomidine group at intubation. Heart rate was lower at skin incision in the dexmedetomidine group. The NRS score in the normal saline group was noticeably higher vs. the dexmedetomidine group at discharge from the postanesthesia care unit. Conclusions Dexmedetomidine decreased intraoperative SPI and NRS scores. Our results showed that dexmedetomidine attenuated noxious stimuli. Trial registration Chinese Clinical Trial Registry (ChiCTR): ChiCTR-OOC-16009450, Registered 16 October, 2016.
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Affiliation(s)
- Yu-Lan Wang
- Department of Anesthesia Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Xiao-Qi Kong
- Department of Anesthesia Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Fu-Hai Ji
- Department of Anesthesia Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China.
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Kaplan L, Klein T, Wilson M, Graves J. Knowledge, Practices, and Attitudes of Washington State Health Care Professionals Regarding Medical Cannabis. Cannabis Cannabinoid Res 2020; 5:172-182. [PMID: 32656349 DOI: 10.1089/can.2019.0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Health care providers in Washington State practice in a unique environment where both medical and recreational cannabis use are legal. Five types of health care providers can authorize medical cannabis. State-certified medical cannabis consultants may advise patients in a cannabis retail store regarding use and consumption. Washington State's health care professionals' perspectives about medical cannabis can inform policy-makers nationwide who are navigating challenges posed by legalization of medical and recreational cannabis. Materials and Methods: A cross-sectional mixed-mode survey using a 26-item questionnaire was administered to a random sample of actively licensed health care professionals legally permitted to provide medical cannabis authorizations in Washington State. We describe participant demographics and summarize responses to survey questions. We report comparisons across provider types using Fisher's exact tests with a level of significance of p<0.01. Results: Among the 1440 health care professionals invited to participate in the study, 310 respondents met eligibility criteria (response rate 24%). Only 57 respondents (18.4%) indicated having ever issued a medical cannabis authorization. Among them, 6, all naturopaths, had provided more than 500. Over half (58%) reported that they did not feel they had the knowledge and skills necessary to provide authorizations. Depending on the condition, 29-93% of respondents correctly identified conditions that qualified a patient to receive a medical cannabis authorization. Very few knew that employers are not required to provide accommodations for medical cannabis. Health care professionals (64.8%) served as the most frequent source of information regarding cannabis risks and benefits. Over half (62%) strongly or somewhat agreed that the Drug Enforcement Agency should reschedule cannabis to make it legal at the federal level. Conclusion: A wide range of knowledge was exhibited within our sample of health care professionals regarding qualifying conditions for medical cannabis. As more states adopt comprehensive medical cannabis laws, health care professionals must be prepared to provide information to patients regarding the effects, risks, and benefits of cannabis. Standardized education could ensure that health care professionals are prepared to responsibly promote the use of cannabis when indicated for medically appropriate symptoms and conditions. A rational approach to medical cannabis is needed to assure that unforeseen consequences are mitigated.
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Affiliation(s)
- Louise Kaplan
- College of Nursing, Washington State University Vancouver, Vancouver, Washington, USA
| | - Tracy Klein
- College of Nursing, Washington State University Vancouver, Vancouver, Washington, USA
| | - Marian Wilson
- College of Nursing, Washington State University Spokane, Spokane, Washington, USA
| | - Janessa Graves
- College of Nursing, Washington State University Spokane, Spokane, Washington, USA
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Maher DP, Carr DB, Hill K, McGeeney B, Weed V, Jackson WC, DiBenedetto DJ, Moriarty EM, Kulich RJ. Cannabis for the Treatment of Chronic Pain in the Era of an Opioid Epidemic: A Symposium-Based Review of Sociomedical Science. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:2311-2323. [PMID: 29016917 PMCID: PMC7963205 DOI: 10.1093/pm/pnx143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
OBJECTIVE This manuscript reviews medical literature published pertaining to the management of chronic pain with medical marijuana therapy (MMJ), with an emphasis on the social, medical, and legal aspects of therapy. DESIGN Narrative review of peer-reviewed literature. METHODS The 3rd Symposium on Controlled Substances and Their Alternatives for the Treatment of Pain was held in Boston on February 27, 2016, with a focus on MMJ for the treatment of chronic pain. Invited speakers had diverse backgrounds, including pain management, addiction psychiatry, neurology, and legal authorities. The purpose of this conference and this subsequent narrative review is to provide a medical, legal, and logistical framework for physicians and other health care providers to refer to when considering the initiation of medical marijuana therapy. RESULTS The invited speakers each covered a unique aspect of MMJ therapy for the treatment of chronic pain. These presentations highlighted the current data for and against the use of MMJ as a pain therapy. Optimal patient selection and screening, in addition to policy developments, were discussed. CONCLUSIONS Increasing interest in MMJ for chronic pain underscores a need for primary care and pain physicians to better understand the indications and evidence for its use free from cultural bias. Given a lack of full conclusive clinical utility, continued research is needed to better understand how to best utilize MMJ therapy for the treatment of chronic pain. Policy initiatives, such as enumerated indications, should follow medical science in order to prevent another abused substance epidemic.
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Affiliation(s)
- Dermot P Maher
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel B Carr
- Tufts University School of Dental Medicine, Boston, Massachusetts
| | - Kevin Hill
- McLean Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian McGeeney
- Boston University School of Medicine, Boston, Massachusetts
| | | | - William C Jackson
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Craniofacial Pain and Headache Center, Tufts University, Boston, Massachusetts
| | | | | | - Ronald J Kulich
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Craniofacial Pain and Headache Center, Tufts University, Boston, Massachusetts
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Abstract
Since March 2017, the prescription of medical cannabis at the expense of the statutory health insurance is possible after approval by the respective medical services. Chronic pain is the most common indication, as health claims data and the accompanying survey show. From the point of view of the law, a prescription is indicated in cases of serious illness, missing or not indicated established therapeutic approaches and a not entirely remote prospect of improvement of the illness or its symptoms. This describes a broader indication spectrum than can currently be based on randomised controlled clinical trials. There is weak evidence of low efficacy for neuropathic pain. For pain related to spasticity and cancer-related pain there is evidence of improvements in quality of life, but effects on pain are of little relevance. For all other indications, only an individual therapeutic trial can be justified based on the available external evidence. However, this usually corresponds to the demand of "a not entirely remote prospect" of a noticeably positive effect of medical cannabis. It is also problematic that almost no long-term studies for the application and efficacy of flowers and extracts are available.Current knowledge on the use of cannabis-based drugs and, more clearly, medical cannabis for chronic pain is insufficient. The increase in the number of countries with marketing authorisations or exemptions for medicinal cannabis or cannabis-based drugs for chronic pain will also pave the way for larger empirical and population-based studies that will further improve the evidence base of research and clinical use.
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DiBenedetto DJ, Weed VF, Wawrzyniak KM, Finkelman M, Paolini J, Schatman ME, Herrera D, Kulich RJ. The Association Between Cannabis Use and Aberrant Behaviors During Chronic Opioid Therapy for Chronic Pain. PAIN MEDICINE 2019; 19:1997-2008. [PMID: 29947796 DOI: 10.1093/pm/pnx222] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Health care providers are likely to see an increase in the concomitant use of cannabis and opioids, particularly with the increased liberalization and ongoing research into the possible role of medical marijuana for chronic pain. Recent literature reports a prevalence of concurrent use ranging from 8.9% to 31.8%. The primary aim of this study was to determine the relationship between cannabis use and aberrant drug behaviors in noncancer pain patients receiving chronic opioid therapy. Design Retrospective chart review. Setting Community-based, interdisciplinary pain management center. Subjects Data from 209 patients who were evaluated for a medication management program between October 1, 2011, and January 1, 2014, and met inclusion criteria. Forty-four were positive for cannabis in their initial random urine drug toxicology. Methods Data from electronic health records, including demographics, urine drug toxicology, disability, opioid dose, opioid risk assessment data, and pain severity were analyzed to examine differences among cannabis users and noncannabis users. Results Subjects with cannabis in their initial urine drug toxicology were more likely to have a future occurrence of an opioid-related aberrancy (P < 0.001), be male (P = 0.047), have a history of substance abuse (P = 0.013), and be enrolled into a higher level of clinical monitoring of opioid medication use (P = 0.008). No other associations with demographic and clinical variables reached statistical significance. Conclusions Concurrent use of cannabis and opioids by patients with chronic pain appears to indicate higher risk for opioid misuse. Closer monitoring for opioid-related aberrancy is indicated for this group of patients.
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Affiliation(s)
- David J DiBenedetto
- Department of Diagnostic Sciences, Boston Pain Care, Tufts University School of Dental Medicine, Boston, Massachusetts
| | | | - Kelly M Wawrzyniak
- Department of Diagnostic Sciences, Boston Pain Care, Tufts University School of Dental Medicine, Boston, Massachusetts
| | - Matthew Finkelman
- Division of Biostatistics and Experimental Design, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Michael E Schatman
- Department of Public Health and Community Medicine, Boston Pain Care, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Ronald J Kulich
- Department of Diagnostic Sciences, Tufts University of School Dental Medicine, Boston, Massachusetts.,Department of Anesthesia Critical Care and Pain Medicine, Harvard Medical School/Massachusetts General Hospital Boston, Massachusetts, USA
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Lejczak S, Rousselot H, Di Patrizio P, Debouverie M. Dronabinol use in France between 2004 and 2017. Rev Neurol (Paris) 2019; 175:298-304. [DOI: 10.1016/j.neurol.2018.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 06/07/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022]
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9
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Häuser W, Finn DP, Kalso E, Krcevski-Skvarc N, Kress HG, Morlion B, Perrot S, Schäfer M, Wells C, Brill S. European Pain Federation (EFIC) position paper on appropriate use of cannabis-based medicines and medical cannabis for chronic pain management. Eur J Pain 2018; 22:1547-1564. [PMID: 30074291 DOI: 10.1002/ejp.1297] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/24/2018] [Indexed: 01/30/2023]
Abstract
Cannabis-based medicines are being approved for pain management in an increasing number of European countries. There are uncertainties and controversies on the role and appropriate use of cannabis-based medicines for the management of chronic pain. EFIC convened a European group of experts, drawn from a diverse range of basic science and relevant clinical disciplines, to prepare a position paper to empower and inform specialist and nonspecialist prescribers on appropriate use of cannabis-based medicines for chronic pain. The expert panel reviewed the available literature and harnessed the clinical experience to produce these series of recommendations. Therapy with cannabis-based medicines should only be considered by experienced clinicians as part of a multidisciplinary treatment and preferably as adjunctive medication if guideline-recommended first- and second-line therapies have not provided sufficient efficacy or tolerability. The quantity and quality of evidence are such that cannabis-based medicines may be reasonably considered for chronic neuropathic pain. For all other chronic pain conditions (cancer, non-neuropathic noncancer pain), the use of cannabis-based medicines should be regarded as an individual therapeutic trial. Realistic goals of therapy have to be defined. All patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to reach the predefined goals and/or the patient is additionally burdened by an unacceptable level of adverse effects and/or there are signs of abuse and misuse of the drug by the patient, therapy with cannabis-based medicines should be terminated. SIGNIFICANCE This position paper provides expert recommendations for nonspecialist and specialist healthcare professionals in Europe, on the importance and the appropriate use of cannabis-based medicines as part of a multidisciplinary approach to pain management, in properly selected and supervised patients.
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Affiliation(s)
- Winfried Häuser
- Department Internal Medicine 1, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany.,Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, Galway Neuroscience Centre and Centre for Pain Research, NCBES, National University of Ireland Galway, Galway, Ireland
| | - Eija Kalso
- Department of Perioperative Medicine, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Nevenka Krcevski-Skvarc
- Department of Anesthesiology, Intensive Care and Pain Treatment, Faculty of Medicine of University Maribor, University Medical Center Maribor and Institute for Palliative Medicine and Care, Maribor, Slovenia
| | - Hans-Georg Kress
- Department of Special Anaesthesia and Pain Therapy, Medical University of Vienne/AKH, Vienna, Austria
| | - Bart Morlion
- Leuven Centre for Algology and Pain Management, University Hospital Leuven, Leuven, Belgium
| | - Serge Perrot
- Department of Pain Center and INSERM U987, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Michael Schäfer
- Department of Anaesthesiology and Intensive Care Medicine, Charité University Berlin, Berlin, Germany
| | | | - Silviu Brill
- Pain Center, Sourasky Medical Center, Tel Aviv, Israel
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Flahaut M, Laurent NL, Michetti M, Hirt-Burri N, Jensen W, Lontis R, Applegate LA, Raffoul W. Patient care for postamputation pain and the complexity of therapies: living experiences. Pain Manag 2018; 8:441-453. [PMID: 30175653 DOI: 10.2217/pmt-2018-0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM Limb amputation traumatically alters body image. Sensations rapidly prevail that the limb is still present and 85% of patients portray phantom limb pain. Throughout the testimonies of amputated patients with intense phantom limb pain, we show the difficulty in treating this chronic pain with current pharmacological and nonpharmacological therapies. PATIENTS & METHODS We qualitatively analyzed the therapeutic choices of five amputees, the effectiveness of the treatments chosen and the impact on patients' quality-of-life. RESULTS & CONCLUSION In general, patients who are refractory to pharmacological treatments are in favor of trying alternative therapies. It is therefore crucial to design a combined and personalized therapeutic plan under the coordination of a multidisciplinary team for the wellbeing of the patient.
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Affiliation(s)
- Marjorie Flahaut
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Nicolas L Laurent
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Murielle Michetti
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Nathalie Hirt-Burri
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Winnie Jensen
- Department of Health Science & Technology, Center for Sensory-Motor Interaction, Aalborg University, 9000 Aalborg, Denmark
| | - Romulus Lontis
- Department of Health Science & Technology, Center for Sensory-Motor Interaction, Aalborg University, 9000 Aalborg, Denmark
| | - Lee A Applegate
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive & Hand Surgery, Unit of Regenerative Therapy, University Hospital of Lausanne, 1066 Epalinges, Switzerland
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Saadeh CE, Rustem DR. Medical Marijuana Use in a Community Cancer Center. J Oncol Pract 2018; 14:e566-e578. [DOI: 10.1200/jop.18.00057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: The primary purpose of this study was to compare the incidence of marijuana use between patients with early- versus advanced-stage cancers. Differences in adverse effects, drug-drug interactions, and drug-disease interactions between those who use marijuana and those who do not were also compared. Methods: Patients age 18 years and older who were receiving chemotherapy were asked to complete an electronic self-reported questionnaire. In addition to questions about patient demographics, current adverse effects, cancer type and stage, comorbidities, performance status, treatment regimen, and general marijuana use, those patients who used marijuana within the last 30 days (current marijuana users) were asked additional questions about the route and frequency of marijuana administration, about reason(s) for use, about possession of a marijuana card, and if they had received any counseling about marijuana. Drug-drug and drug-disease interactions were also analyzed. Results: The overall incidence of marijuana use was 18.3% (32 of 175 patients). The incidence of marijuana use in patients with early- versus advanced-stage cancers was 19.6% (11 of 56 patients) versus 17.6% (21 of 119 patients; P = .75). Patients who use marijuana reported more pain, nausea, appetite issues, and anxiety. There were more drug-drug interactions associated with marijuana use, primarily with concurrent CNS depressants. The frequency of drug-disease interactions between those who use marijuana versus those who do not was similar. Conclusion: Approximately one in five patients with cancer who were receiving chemotherapy were using marijuana, and the frequency was equal in early- and advanced-stage cancer groups. The risks versus benefits should be discussed with all patients who use marijuana.
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Affiliation(s)
- Claire E. Saadeh
- Ferris State University College of Pharmacy, Big Rapids; and Herbert Herman Cancer Center, Lansing, MI
| | - Danielle R. Rustem
- Ferris State University College of Pharmacy, Big Rapids; and Herbert Herman Cancer Center, Lansing, MI
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Savage SR, Romero-Sandoval A, Schatman M, Wallace M, Fanciullo G, McCarberg B, Ware M. Cannabis in Pain Treatment: Clinical and Research Considerations. THE JOURNAL OF PAIN 2016; 17:654-68. [DOI: 10.1016/j.jpain.2016.02.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/27/2016] [Accepted: 02/09/2016] [Indexed: 12/21/2022]
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Roy-Byrne P, Maynard C, Bumgardner K, Krupski A, Dunn C, West II, Donovan D, Atkins DC, Ries R. Are medical marijuana users different from recreational users? The view from primary care. Am J Addict 2015; 24:599-606. [DOI: 10.1111/ajad.12270] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 05/08/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Charles Maynard
- Department of Health Services, School of Public Health; University of Washington; Seattle Washington
| | - Kristin Bumgardner
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Antoinette Krupski
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Chris Dunn
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Imara I. West
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Dennis Donovan
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - David C. Atkins
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
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