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Min AK, Keane AM, Weinstein MP, Swartz TH. The impact of cannabinoids on inflammasome signaling in HIV-1 infection. NEUROIMMUNE PHARMACOLOGY AND THERAPEUTICS 2023; 2:79-88. [PMID: 37027347 PMCID: PMC10070009 DOI: 10.1515/nipt-2023-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
Human immunodeficiency virus type 1 (HIV-1) is a chronic disease that afflicts over 38 million people worldwide without a known cure. The advent of effective antiretroviral therapies (ART) has significantly decreased the morbidity and mortality associated with HIV-1 infection in people living with HIV-1 (PWH), thanks to durable virologic suppression. Despite this, people with HIV-1 experience chronic inflammation associated with co-morbidities. While no single known mechanism accounts for chronic inflammation, there is significant evidence to support the role of the NLRP3 inflammasome as a key driver. Numerous studies have demonstrated therapeutic impact of cannabinoids, including exerting modulatory effects on the NLRP3 inflammasome. Given the high rates of cannabinoid use in PWH, it is of great interest to understand the intersecting biology of the role of cannabinoids in HIV-1-associated inflammasome signaling. Here we describe the literature of chronic inflammation in people with HIV, the therapeutic impact of cannabinoids in PWH, endocannabinoids in inflammation, and HIV-1-associated inflammation. We describe a key interaction between cannabinoids, the NLRP3 inflammasome, and HIV-1 viral infection, which supports further investigation of the critical role of cannabinoids in HIV-1 infection and inflammasome signaling.
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Affiliation(s)
- Alice K. Min
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aislinn M. Keane
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Paltiel Weinstein
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Talia H. Swartz
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Aebischer JH, Dieckmann NF, Jones KD, St John AW. Chronic Pain Clinical and Prescriptive Practices in the Cannabis Era. Pain Manag Nurs 2021; 23:109-121. [PMID: 34973920 DOI: 10.1016/j.pmn.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/20/2021] [Accepted: 11/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND To explore how health care providers in the United States are adapting clinical recommendations and prescriptive practices in response to patient use of medical cannabis (MC) for chronic pain symptoms. DESIGN Literature searches queried MeSH/Subject terms "chronic pain," "clinician," "cannabis," and Boolean text words "practice" and "analgesics" in EBSCOHost, EMBASE, PubMed, and Scopus, published 2010-2021 in the United States. Twenty-one primary, peer-reviewed studies met criteria. METHODS Studies are synthesized under major headings: recommending MC for chronic pain; MC and prescription opioids; and harm reduction of MC. RESULTS MC is increasingly utilized by patients for chronic pain symptoms. Clinical recommendations for or against MC are influenced by scopes of practice, state or federal laws, institutional policies, education, potential patient harm (or indirect harm of others), and perceived confidence. Epidemiologic and cohort studies show downward trajectories of opioid prescribing and consumption in states with legal cannabis. However, clinicians' recommendations and prescription practices are nonuniform. Impacts of cannabis laws are clear between nongovernmental and governmental institutions. Strategies addressing MC and opioid use include frequent visits, and, to reduce harm, suggesting alternative therapies and treating substance use disorders. CONCLUSIONS MC use for chronic pain is increasing with cannabis legalization. Provider practices are heterogenous, demonstrating a balance of treating chronic pain using available evidence, while being aware of potential harms associated with MC and opioids.
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Affiliation(s)
| | - Nathan F Dieckmann
- Oregon Health & Science University, School of Nursing, Portland, OR; Oregon Health & Science University & Portland State University, School of Public Health, Core Faculty, Portland, OR; Oregon Health & Science University, School of Medicine, Division of Psychology & Psychiatry, Portland, OR
| | - Kim D Jones
- Linfield University, School of Nursing, Portland, OR
| | - Amanda W St John
- Oregon Health & Science University, School of Medicine, Division of Anesthesiology & Perioperative Medicine, Portland, OR
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Factors Associated with Pain Treatment Satisfaction Among Patients with Chronic Non-Cancer Pain and Substance Use. J Am Board Fam Med 2021; 34:1082-1095. [PMID: 34772764 PMCID: PMC8813175 DOI: 10.3122/jabfm.2021.06.210214] [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] [Received: 05/20/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION A better understanding of pain treatment satisfaction in patients with chronic noncancer pain (CNCP) and substance use is needed, especially as opioid prescribing policies are changing. We sought to identify factors associated with pain treatment satisfaction in individuals with CNCP on recent opioid therapy and prior or active substance use. METHODS An exploratory cross-sectional analysis using baseline data from a cohort study of 300 adults with CNCP receiving >20 morphine milligram equivalents of opioids for ≥3 of the preceding 12 months and prior or active substance use. Participants completed interviews, clinical assessments, urine drug screening, and medical chart review. RESULTS Participants were predominantly middle-aged (mean age 57.5 years), Black (44%), and cisgender men (60%). One-third (33%) had high, 28% moderate, and 39% low pain treatment satisfaction. Post-traumatic stress disorder (PTSD), tobacco use, past-year opioid discontinuation, and higher average pain scores were associated with lower satisfaction. HIV and prescription cannabis use were associated with higher satisfaction. CONCLUSIONS The relationship between PTSD and tobacco use with lower satisfaction should be explored to augment pain outcomes. Higher satisfaction among individuals with HIV and prescription cannabis use presents potential research areas to guide CNCP management and reduce reliance on opioid therapies.
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Sajdeya R, Joseph V, Stetten NE, Ibañez GE, Wang Y, Powell L, Somboonwit C, Corsi KF, Cook RL. Reasons for Marijuana Use and Its Perceived Effectiveness in Therapeutic and Recreational Marijuana Users Among People Living with HIV in Florida. CANNABIS (ALBUQUERQUE, N.M.) 2021; 4:40-52. [PMID: 37287994 PMCID: PMC10212235 DOI: 10.26828/cannabis/2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Therapeutic and recreational marijuana use are common among people living with HIV (PLWH). However, the distinction between perceived "therapeutic" and "recreational" use is blurred, with little information about the specific reasons for use and perceived marijuana effectiveness in adults with chronic conditions. We aimed to compare reasons for use and reason-specific perceived marijuana effectiveness between therapeutic and recreational users among PLWH. In 2018-2019, 213 PLWH currently using marijuana (mean age 48 years, 59% male, 69% African American) completed a questionnaire assessing their specific reasons for using marijuana, including the "main reason." Participants were categorized into one of three motivation groups: therapeutic, recreational, or both equally. For each specific reason, participants rated marijuana effectiveness as 0-10, with 10 being the most effective. The mean effectiveness scores were compared across the three motivation groups via ANOVA, with p <0.05 considered statistically significant. The most frequent main reasons for marijuana use in the therapeutic (n=63, 37%), recreational (n=48, 28%), and both equally (n=59, 35%) categories were "Pain" (21%), "To get high" (32%), and "To relax" (20%), respectively. Compared to recreational users, therapeutic and both equally users provided significantly higher mean effectiveness scores for "Pain," and "To reduce anger." The "Both equally" group also provided significantly higher mean effectiveness scores for "To feel better in general," "To get high," and "To relax" compared to the other two categories. There is a significant overlap in self-reported reasons for marijuana use in primarily therapeutic or recreational users. Perceived marijuana effectiveness was lowest among recreational users.
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Affiliation(s)
- Ruba Sajdeya
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Verlin Joseph
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nichole E. Stetten
- Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Yan Wang
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lauren Powell
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Charurut Somboonwit
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Karen F. Corsi
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, USA
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
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Le Foll B. Opioid-sparing effects of cannabinoids: Myth or reality? Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110065. [PMID: 32828853 DOI: 10.1016/j.pnpbp.2020.110065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Abstract
A converging line of evidence is indicating that cannabinoids may have an opioid-sparing effect. This property, well validated in preclinical studies, allow when both drugs are co-administered to reduce the dose of opioids without loss of analgesic effects. A meta-analysis of pre-clinical studies indicated in 2017 that the median effective dose (ED50) of morphine administered in combination with delta-9-tetrahydrocannabinol (delta-9-THC) is 3.6 times lower than the ED50 of morphine alone (Nielsen et al., 2017). However, very few studies have been conducted in humans to validate this effect. This narrative review provides an update on whether or not cannabinoid drugs can be used to produce an opioid sparing effect. For this, various lines of evidence ranging from preclinical, epidemiological and human studies will be summarized. Overall, this review indicates that the preclinical results are strongly and consistently supportive of the presence of an opioid sparing effect of cannabinoid drugs. However, to date the clinical studies have been mostly negative; and, the evidence collected in humans so far is so limited that it is premature to conclude. Therefore, prospective high quality controlled clinical trials are still required to validate this. Priorities for future research are also discussed.
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Affiliation(s)
- Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada; Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Division of Brain and Therapeutics, University of Toronto, Toronto, ON, Canada.; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
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Cody SL, Hobson JM, Gilstrap SR, Gloston GF, Riggs KR, Justin Thomas S, Goodin BR. Insomnia severity and depressive symptoms in people living with HIV and chronic pain: associations with opioid use. AIDS Care 2021; 34:679-688. [PMID: 33625927 DOI: 10.1080/09540121.2021.1889953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic pain commonly occurs in people living with HIV (PLWH). Many PLWH in the United States obtain opioids for chronic pain management. Whether insomnia severity and depressive symptoms are exacerbated by chronic pain and opioid use in PLWH remains to be determined. This study examined insomnia severity and depressive symptoms in 85 PLWH with chronic pain and 35 PLWH without chronic pain. Among PLWH with chronic pain, reported opioid use was examined in relation to insomnia severity and depressive symptoms. PLWH with chronic pain reported significantly greater insomnia severity (p = .033) and depressive symptoms (p = .025) than PLWH without chronic pain. Among PLWH with chronic pain who reported opioid use (n = 36), insomnia severity was greater compared to those who denied opioid use (n = 49), even after controlling for pain severity and number of comorbidities (p = .026). Greater pain severity was significantly associated with greater insomnia severity (p < .001) and depressive symptoms (p = .048) among PLWH with chronic pain who reported opioid use. These associations were not significant among those PLWH with chronic pain who denied opioid use. Findings suggest that PLWH with chronic pain are likely to experience poor sleep and depressed mood. Furthermore, poor sleep was associated with opioid use among PLWH with chronic pain.
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Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
| | - Joanna M Hobson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shannon R Gilstrap
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabrielle F Gloston
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin R Riggs
- Division of Preventive Medicine, University of Alabama in Birmingham School of Medicine, Birmingham, AL, USA
| | - S Justin Thomas
- Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Addiction & Pain Prevention & Intervention (CAPPI), University of Alabama at Birmingham, Birmingham, AL, USA
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Need to Improve Dose Measurements in Studies of Marijuana Use for Pain. J Acquir Immune Defic Syndr 2020; 83:e23. [PMID: 32032280 DOI: 10.1097/qai.0000000000002238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nugent SM, Meghani SH, Rogal SS, Merlin JS. Medical cannabis use among individuals with cancer: An unresolved and timely issue. Cancer 2020; 126:1832-1836. [PMID: 32012232 DOI: 10.1002/cncr.32732] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Shannon M Nugent
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Salimah H Meghani
- Department of Biobehavioral Health Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shari S Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Jessica S Merlin
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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