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Perioperative Patient Beliefs Regarding Potential Effectiveness of Marijuana (Cannabinoids) for Treatment of Pain: A Prospective Population Survey. Reg Anesth Pain Med 2018; 42:652-659. [PMID: 28796754 DOI: 10.1097/aap.0000000000000654] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Cannabinoids have an expanding presence in medicine. Perioperative patients' perceptions of the effectiveness of these compounds, and acceptance if prescribed for pain, have not been previously described. Our primary objective was to describe patients' beliefs regarding the potential effectiveness of cannabinoids for the treatment of acute and chronic pain, as well as gauge patient acceptance of these compounds if prescribed by a physician. In addition, demographic and pain history data were collected to elucidate the predictors of the aforementioned patient attitudes. Secondarily, we sought to characterize the subgroup of patients who reported marijuana use. Predictors of marijuana use, effectiveness, and adverse effects were also reported for this subgroup. METHODS An anonymous questionnaire was administered to 501 patients in the preoperative registration area at Mount Sinai Hospital, New York, New York. The questionnaire was designed to collect data on patient demographics, presence of pain, pain severity, use of pain medication, history of illicit-drug use, tobacco use, cannabis use, patient beliefs about the potential effectiveness of marijuana for acute and chronic pain and their willingness to use cannabis for pain, if prescribed by a physician. Normality of distributions for continuous variables was assessed with skewness and kurtosis measures. A logistic regression model was used to assess the demographic and medical characteristics of marijuana users compared with nonusers. The effectiveness of marijuana in dealing with pain and adverse effects associated with its use were examined using exploratory principal component analysis. RESULTS More than 80% of this cohort of preoperative patients believed that marijuana could be at least somewhat effective for the treatment of pain after surgery and would be willing to use cannabinoid compounds if prescribed by their physician. Predictors of positive attitudes toward marijuana included history of marijuana use, pain history, and being a marijuana nonuser of white race. Approximately 27% of the respondents reported a history of marijuana use. Younger patients, those with higher levels of pain in the last 24 hours, and those who found standard therapies to be less effective for their pain were more likely to use marijuana. CONCLUSIONS Patients generally believe that marijuana could be at least somewhat effective for the management of pain and are willing to use cannabinoid compounds for this indication, if prescribed by a physician.
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Bryant LM, Daniels KE, Cognetti DM, Tassone P, Luginbuhl AJ, Curry JM. Therapeutic Cannabis and Endocannabinoid Signaling System Modulator Use in Otolaryngology Patients. Laryngoscope Investig Otolaryngol 2018; 3:169-177. [PMID: 30062131 PMCID: PMC6057224 DOI: 10.1002/lio2.154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/29/2018] [Accepted: 03/01/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives 1) review benefits and risks of cannabis use, with emphasis on otolaryngic disease processes; 2) define and review the endocannabinoid signaling system (ESS); and 3) review state and federal regulations for the use and research of cannabis and ESS modulators. Methods This manuscript is a review of the current literature relevant to the stated objectives. Results Cannabis (marijuana) use is increasing. It is the most widely used illicit substance in the world. There is increasing interest in its therapeutic potential due to changing perceptions, new research, and legislation changes controlling its use. The legal classification of cannabis is complicated due to varied and conflicting state and federal laws. There are currently two synthetic cannabinoid drugs that are FDA approved. Current indications for use include chemotherapy‐related nausea and vomiting, cachexia, and appetite loss. Research has demonstrated potential benefit for use in many other pathologies including pain, inflammatory states, and malignancy. Data exists demonstrating potential antineoplastic benefit in oral, thyroid, and skin cancers. Conclusions ESS modulators may play both a causal and therapeutic role in several disorders seen in otolaryngology patients. The use of cannabis and cannabinoids is not without risk. There is a need for further research to better understand both the adverse and therapeutic effects of cannabis use. With increasing rates of consumption, elevated public awareness, and rapidly changing legislation, it is helpful for the otolaryngologist to be aware of both the adverse manifestations of use and the potential therapeutic benefits when talking with patients.
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Affiliation(s)
- Lucas M Bryant
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Kelly E Daniels
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - David M Cognetti
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Patrick Tassone
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Adam J Luginbuhl
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
| | - Joseph M Curry
- Thomas Jefferson Hospital-Otolaryngology Head & Neck Surgery Philadelphia Pennsylvania U.S.A
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Hall W, Kozlowski LT. The diverging trajectories of cannabis and tobacco policies in the United States: reasons and possible implications. Addiction 2018; 113:595-601. [PMID: 28544367 DOI: 10.1111/add.13845] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/12/2016] [Accepted: 04/12/2017] [Indexed: 01/09/2023]
Abstract
AIM To examine briefly the (i) rationales for two policy proposals in the United States to make it mandatory for cigarettes to contain very low levels of nicotine and to legalize cannabis for recreational use by adults; and (ii) possible lessons that participants in each policy debate may learn from each other. METHOD We briefly describe the diverging policies towards cannabis and tobacco in the United States, explain and critically analyse their rationales and discuss possible policy lessons. RESULTS Advocates of cannabis legalization have argued that prohibition has been an ineffective and expensive policy that penalizes ethnic minority users unjustly of a drug that is far less harmful than alcohol. The prohibition of traditional tobacco cigarettes has been advocated as a way to eliminate cigarette smoking. These proposals embody very different attitudes towards the harms of recreational adult drug use. Advocates of nicotine prohibition demand that alternative methods of nicotine delivery must be shown to be completely safe before adults are allowed to use them. Advocates of tobacco prohibition ignore evidence that smokers may not use these products and the likelihood of expanding the illicit tobacco market. Advocates of legalizing and regulating recreational cannabis ignore the need to tax and regulate sales in order to minimize the harms of heavy use. CONCLUSIONS It is not clear that the prohibition of adult use has a useful role to play in the regulation of either cannabis or tobacco. If both products remain legal, the goals of regulating tobacco and cannabis products should be to restrict youth access, promote the use of the least harmful products, provide users with evidence-based information on both absolute and differential product risks of use and use differential taxes and marketing controls to promote ways of using these products that cause the least harm to their users.
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Affiliation(s)
- Wayne Hall
- The Centre for Youth Substance Abuse Research, University of Queensland, Australia and National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Lynn T Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
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Boehnke KF, Litinas E, Clauw DJ. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. THE JOURNAL OF PAIN 2016; 17:739-44. [PMID: 27001005 DOI: 10.1016/j.jpain.2016.03.002] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/23/2016] [Accepted: 03/07/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding. PERSPECTIVE This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal studies that also assess how CP patients use medical cannabis for pain management.
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Affiliation(s)
- Kevin F Boehnke
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Daniel J Clauw
- Departments of Anesthesiology, Medicine (Rheumatology), and Psychiatry, Medical School, University of Michigan, Ann Arbor, Michigan; Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan.
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van den Elsen GAH, Ahmed AIA, Verkes RJ, Kramers C, Feuth T, Rosenberg PB, van der Marck MA, Olde Rikkert MGM. Tetrahydrocannabinol for neuropsychiatric symptoms in dementia: A randomized controlled trial. Neurology 2015; 84:2338-46. [PMID: 25972490 DOI: 10.1212/wnl.0000000000001675] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/03/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To study the efficacy and safety of low-dose oral tetrahydrocannabinol (THC) in the treatment of dementia-related neuropsychiatric symptoms (NPS). METHODS This is a randomized, double-blind, placebo-controlled study. Patients with dementia and clinically relevant NPS were randomly assigned to receive THC 1.5 mg or matched placebo (1:1) 3 times daily for 3 weeks. Primary outcome was change in Neuropsychiatric Inventory (NPI), assessed at baseline and after 14 and 21 days. Analyses were based on intention-to-treat. RESULTS Twenty-four patients received THC and 26 received placebo. NPS were reduced during both treatment conditions. The difference in reduction from baseline between THC and placebo was not significant (mean difference NPItotal: 3.2, 95% confidence interval [CI] -3.6 to 10.0), nor were changes in scores for agitation (Cohen-Mansfield Agitation Inventory 4.6, 95% CI -3.0 to 12.2), quality of life (Quality of Life-Alzheimer's Disease -0.5, 95% CI -2.6 to 1.6), or activities of daily living (Barthel Index 0.6, 95% CI -0.8 to 1.9). The number of patients experiencing mild or moderate adverse events was similar (THC, n = 16; placebo, n = 14, p = 0.36). No effects on vital signs, weight, or episodic memory were observed. CONCLUSIONS Oral THC of 4.5 mg daily showed no benefit in NPS, but was well-tolerated, which adds valuable knowledge to the scarce evidence on THC in dementia. The benign adverse event profile of this dosage allows study of whether higher doses are efficacious and equally well-tolerated. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for patients with dementia-related NPS, low-dose THC does not significantly reduce NPS at 21 days, though it is well-tolerated.
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Affiliation(s)
- Geke A H van den Elsen
- From the Departments of Geriatric Medicine/Radboudumc Alzheimer Centre (G.A.H.v.d.E., A.I.A.A., M.A.v.d.M., M.G.M.O.R.), Pharmacology and Toxicology (A.I.A.A., C.K.), Psychiatry (R.-J.V.), Internal Medicine (C.K.), and Health Evidence (T.F.), Radboud university medical center, Nijmegen; the Department of Elderly (A.I.A.A.), Vincent van Gogh Institute, Venray; the Department of Clinical Pharmacy (C.K.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; and the Department of Psychiatry and Behavioral Sciences (P.B.R.), John Hopkins University School of Medicine, Baltimore, MD.
| | - Amir I A Ahmed
- From the Departments of Geriatric Medicine/Radboudumc Alzheimer Centre (G.A.H.v.d.E., A.I.A.A., M.A.v.d.M., M.G.M.O.R.), Pharmacology and Toxicology (A.I.A.A., C.K.), Psychiatry (R.-J.V.), Internal Medicine (C.K.), and Health Evidence (T.F.), Radboud university medical center, Nijmegen; the Department of Elderly (A.I.A.A.), Vincent van Gogh Institute, Venray; the Department of Clinical Pharmacy (C.K.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; and the Department of Psychiatry and Behavioral Sciences (P.B.R.), John Hopkins University School of Medicine, Baltimore, MD
| | - Robbert-Jan Verkes
- From the Departments of Geriatric Medicine/Radboudumc Alzheimer Centre (G.A.H.v.d.E., A.I.A.A., M.A.v.d.M., M.G.M.O.R.), Pharmacology and Toxicology (A.I.A.A., C.K.), Psychiatry (R.-J.V.), Internal Medicine (C.K.), and Health Evidence (T.F.), Radboud university medical center, Nijmegen; the Department of Elderly (A.I.A.A.), Vincent van Gogh Institute, Venray; the Department of Clinical Pharmacy (C.K.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; and the Department of Psychiatry and Behavioral Sciences (P.B.R.), John Hopkins University School of Medicine, Baltimore, MD
| | - Cees Kramers
- From the Departments of Geriatric Medicine/Radboudumc Alzheimer Centre (G.A.H.v.d.E., A.I.A.A., M.A.v.d.M., M.G.M.O.R.), Pharmacology and Toxicology (A.I.A.A., C.K.), Psychiatry (R.-J.V.), Internal Medicine (C.K.), and Health Evidence (T.F.), Radboud university medical center, Nijmegen; the Department of Elderly (A.I.A.A.), Vincent van Gogh Institute, Venray; the Department of Clinical Pharmacy (C.K.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; and the Department of Psychiatry and Behavioral Sciences (P.B.R.), John Hopkins University School of Medicine, Baltimore, MD
| | - Ton Feuth
- From the Departments of Geriatric Medicine/Radboudumc Alzheimer Centre (G.A.H.v.d.E., A.I.A.A., M.A.v.d.M., M.G.M.O.R.), Pharmacology and Toxicology (A.I.A.A., C.K.), Psychiatry (R.-J.V.), Internal Medicine (C.K.), and Health Evidence (T.F.), Radboud university medical center, Nijmegen; the Department of Elderly (A.I.A.A.), Vincent van Gogh Institute, Venray; the Department of Clinical Pharmacy (C.K.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; and the Department of Psychiatry and Behavioral Sciences (P.B.R.), John Hopkins University School of Medicine, Baltimore, MD
| | - Paul B Rosenberg
- From the Departments of Geriatric Medicine/Radboudumc Alzheimer Centre (G.A.H.v.d.E., A.I.A.A., M.A.v.d.M., M.G.M.O.R.), Pharmacology and Toxicology (A.I.A.A., C.K.), Psychiatry (R.-J.V.), Internal Medicine (C.K.), and Health Evidence (T.F.), Radboud university medical center, Nijmegen; the Department of Elderly (A.I.A.A.), Vincent van Gogh Institute, Venray; the Department of Clinical Pharmacy (C.K.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; and the Department of Psychiatry and Behavioral Sciences (P.B.R.), John Hopkins University School of Medicine, Baltimore, MD
| | - Marjolein A van der Marck
- From the Departments of Geriatric Medicine/Radboudumc Alzheimer Centre (G.A.H.v.d.E., A.I.A.A., M.A.v.d.M., M.G.M.O.R.), Pharmacology and Toxicology (A.I.A.A., C.K.), Psychiatry (R.-J.V.), Internal Medicine (C.K.), and Health Evidence (T.F.), Radboud university medical center, Nijmegen; the Department of Elderly (A.I.A.A.), Vincent van Gogh Institute, Venray; the Department of Clinical Pharmacy (C.K.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; and the Department of Psychiatry and Behavioral Sciences (P.B.R.), John Hopkins University School of Medicine, Baltimore, MD
| | - Marcel G M Olde Rikkert
- From the Departments of Geriatric Medicine/Radboudumc Alzheimer Centre (G.A.H.v.d.E., A.I.A.A., M.A.v.d.M., M.G.M.O.R.), Pharmacology and Toxicology (A.I.A.A., C.K.), Psychiatry (R.-J.V.), Internal Medicine (C.K.), and Health Evidence (T.F.), Radboud university medical center, Nijmegen; the Department of Elderly (A.I.A.A.), Vincent van Gogh Institute, Venray; the Department of Clinical Pharmacy (C.K.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; and the Department of Psychiatry and Behavioral Sciences (P.B.R.), John Hopkins University School of Medicine, Baltimore, MD
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Degenhardt L, Lintzeris N, Campbell G, Bruno R, Cohen M, Farrell M, Hall WD. Experience of adjunctive cannabis use for chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study. Drug Alcohol Depend 2015; 147:144-50. [PMID: 25533893 DOI: 10.1016/j.drugalcdep.2014.11.031] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is increasing debate about cannabis use for medical purposes, including for symptomatic treatment of chronic pain. We investigated patterns and correlates of cannabis use in a large community sample of people who had been prescribed opioids for chronic non-cancer pain. METHODS The POINT study included 1514 people in Australia who had been prescribed pharmaceutical opioids for chronic non-cancer pain. Data on cannabis use, ICD-10 cannabis use disorder and cannabis use for pain were collected. We explored associations between demographic, pain and other patient characteristics and cannabis use for pain. RESULTS One in six (16%) had used cannabis for pain relief, 6% in the previous month. A quarter reported that they would use it for pain relief if they had access. Those using cannabis for pain on average were younger, reported greater pain severity, greater interference from and poorer coping with pain, and more days out of role in the past year. They had been prescribed opioids for longer, were on higher opioid doses, and were more likely to be non-adherent with their opioid use. Those using cannabis for pain had higher pain interference after controlling for reported pain severity. Almost half (43%) of the sample had ever used cannabis for recreational purposes, and 12% of the entire cohort met criteria for an ICD-10 cannabis use disorder. CONCLUSIONS Cannabis use for pain relief purposes appears common among people living with chronic non-cancer pain, and users report greater pain relief in combination with opioids than when opioids are used alone.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW, Australia; School of Population and Global Health, University of Melbourne, Australia.
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Australia; The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Australia
| | | | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW, Australia; School of Medicine, University of Tasmania, Australia
| | - Milton Cohen
- St Vincent's Clinical School, UNSW Medicine, UNSW, Australia
| | | | - Wayne D Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Australia; National Addiction Centre, Kings College, London, England, United Kingdom
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