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Hebert SV, Green MA, Mashaw SA, Brouillette WD, Nguyen A, Dufrene K, Shelvan A, Patil S, Ahmadzadeh S, Shekoohi S, Kaye AD. Assessing Risk Factors and Comorbidities in the Treatment of Chronic Pain: A Narrative Review. Curr Pain Headache Rep 2024; 28:525-534. [PMID: 38558165 DOI: 10.1007/s11916-024-01249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW Chronic pain affects a significant portion of the population globally, making it a leading cause of disability. Understanding the multifaceted nature of chronic pain, its various types, and the intricate relationship it shares with risk factors, comorbidities, and mental health issues like depression and anxiety is critical for comprehensive patient care. Factors such as socioeconomic status (SES), age, gender, and obesity collectively add layers of complexity to chronic pain experiences and pose management challenges. RECENT FINDINGS Low SES presents barriers to effective pain care, while gender differences and the prevalence of chronic pain in aging adults emphasize the need for tailored approaches. The association between chronic pain and physical comorbidities like cardiovascular disease, chronic obstructive pulmonary disease (COPD), and diabetes mellitus reveals shared risk factors and further highlights the importance of integrated treatment strategies. Chronic pain and mental health are intricately linked through biochemical mechanisms, profoundly affecting overall quality of life. This review explores pharmacologic treatment for chronic pain, particularly opioid analgesia, with attention to the risk of substance misuse and the ongoing opioid epidemic. We discuss the potential role of medical cannabis as an alternative treatment with a nuanced perspective on its impact on opioid use. Addressing the totality and complexity of pain states is crucial to individualizing chronic pain management. With different types of pain having different underlying mechanisms, considerations should be made when approaching their treatment. Moreover, the synergistic relationship that pain states can have with other comorbidities further complicates chronic pain conditions.
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Affiliation(s)
- Sage V Hebert
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Melanie A Green
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Sydney A Mashaw
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - William D Brouillette
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Angela Nguyen
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Kylie Dufrene
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Anitha Shelvan
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Shilpadevi Patil
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
- Department of Pharmacology, Louisiana State University Health Sciences Center at Shreveport, Toxicology, and Neurosciences, Shreveport, LA, 71103, USA
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Duhart Clarke SE, Victor G, Lynch P, Suen LW, Ray B. Cannabis donation as a harm reduction strategy: a case study. Harm Reduct J 2024; 21:58. [PMID: 38449029 PMCID: PMC10916026 DOI: 10.1186/s12954-024-00974-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The United States (US) continues to experience unprecedented rates of overdose mortality and there is increased need to identify effective harm reduction practices. Research from Canada describes cannabis donation through harm reduction agencies as an adjunctive strategy to mitigate the negative consequences of more harmful drugs. This case study describes the operational logistics, feasibility, and potential benefits of a cannabis donation program that was operated through a harm reduction program in rural Michigan. CASE PRESENTATION We applied a community driven research approach to gather information from harm reduction program staff about the implementation and evolution of cannabis donation efforts in Michigan. We also examined 20-months (September 2021 through May 2023) of administrative data from a cannabis company to compare the sale and donation of cannabis products. Ten cannabis-experienced harm reduction clients received cannabis donations, with clinical staff determining client interest and appropriateness, and providing weekly pick-up or delivery. To expand product availability and sustainability, we examined administrative data from a commercialcannabis company that volunteered to provide donations. This administrative data suggests that while flower products constitute most of the adult and medical sales, edible, oil, and topical products predominated donations. Further, cost analysis suggests that donations represent only 1% of total gross sales and account for much less than the expected yearly donation amount. CONCLUSIONS Research suggests there is potential to reduce alcohol and drug use related harms of more dangerous substances through substitution with cannabis. This case study is the first to document cannabis donation as a harm reduction practice in the US and suggests potential for sustainability dependent on state laws. Findings from this case study provide a starting point for inquiry into cannabis donation as a harm reduction strategy in the US; future research is needed to fully understand the individual-level outcomes, public health impacts, necessary legal regulations, and best practices for cannabis donation programs through harm reduction organizations.
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Affiliation(s)
| | - Grant Victor
- School of Social Work, Rutgers University, 120 Albany Street, New Brunswick, NJ, 08901, USA
| | - Pamela Lynch
- RTI International, 3040 Cornwallis Road, 27709, Research Triangle Park, NC, USA
| | - Leslie W Suen
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, 2540 23rd Street, San Francisco, CA, USA
| | - Bradley Ray
- RTI International, 3040 Cornwallis Road, 27709, Research Triangle Park, NC, USA
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Bleyer A, Barnes B, Finn K. United States marijuana legalization and opioid mortality trends before and during the first year of the COVID-19 pandemic. J Opioid Manag 2024; 20:119-132. [PMID: 38700393 DOI: 10.5055/jom.0829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND To determine if marijuana legalization was associated with reduced opioid mortality. STUDY DESIGN The United States (US) opioid mortality trend during the 2010-2019 decade was compared in states and District of Columbia (jurisdictions) that had implemented marijuana legalization with states that had not. Acceleration of opioid mortality during 2020, the first year of the coronavirus disease 2019 (COVID-19) pandemic, was also compared in recreational and medicinal-only legalizing jurisdictions. METHODS Joinpoint methodology was applied to the Centers for Disease Control and Prevention WONDER data. Trends in legalizing jurisdictions were cumulative aggregates. RESULTS The overall opioid and fentanyl death rates and the percentage of opioid deaths due to fentanyl increased more during 2010-2019 in jurisdictions that legalized marijuana than in those that did not (pairwise comparison p = 0.007, 0.05, and 0.006, respectively). By 2019, the all-opioid and fentanyl death rates were 44 and 50 percent greater in the legalizing than in the nonlegalizing jurisdictions, respectively. When the COVID-19 pandemic hit in 2020, jurisdictions that implemented recreational marijuana legalization before 2019 had significantly greater increases in both overall opioid and fentanyl death rates than jurisdictions with medicinal-only legalization. For all-opioids, the mean (95 percent confidence interval) 2019-to-2020 increases were 46.5 percent (36.6, 56.3 percent) and 29.1 percent (20.2, 37.9 percent), respectively (p = 0.02). For fentanyl, they were 115.6 percent (80.2, 151.6 percent) and 55.4 percent (31.6, 79.2 percent), respectively (p = 0.01). CONCLUSIONS During the past decade, marijuana legalization in the US was associated at the jurisdiction level with a greater acceleration in opioid death rate. An even greater increase in opioid mortality occurred in recreational-legalizing jurisdictions with the onset of the COVID-19 pandemic. Marijuana legalization is correlated with worsening of the US opioid epidemic.
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Affiliation(s)
- Archie Bleyer
- Oregon Health and Science University, Portland, Oregon; University of Texas McGovern Medical School, Houston, Texas. ORCID: https://orcid.org/0000-0001-7738-5146
| | - Brian Barnes
- St. Charles Healthcare System, Bend, Oregon; PhD Candidate, Integral and Transpersonal Psychology, California Institute of Integral Studies, San Francisco, California
| | - Kenneth Finn
- Springs Rehabilitation, Colorado Springs, Colorado
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Calabrese MJ, Shaya FT, Palumbo F, McPherson ML, Villalonga-Olives E, Zafari Z, Mutter R. State-level policies and receipt of CDC-informed opioid thresholds among commercially insured new chronic opioid users. J Opioid Manag 2024; 20:149-168. [PMID: 38700395 DOI: 10.5055/jom.0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
OBJECTIVES To evaluate the association of state-level policies on receipt of opioid regimens informed by Centers for Disease Control and Prevention (CDC) morphine milligram equivalent (MME)/day recommendations. DESIGN A retrospective cohort study of new chronic opioid users (NCOUs). SETTING Commercially insured plans across the United States using IQVIA PharMetrics® Plus for Academics database with new chronic use between January 2014 and March 2015. PARTICIPANTS NCOUs with ≥60-day coverage of opioids within a 90-day period with ≥30-day opioid-free period prior to the date of the first qualifying opioid prescription. INTERVENTIONS State-level policies including Prescription Drug Monitoring Program (PDMP) robustness and cannabis policies involving the presence of medical dispensaries and state-wide decriminalization. MAIN OUTCOME MEASURES NCOUs were placed in three-tiered risk-based average MME/day thresholds: low (>0 to <50), medium (≥50 to <90), and high (≥90). Multinomial logistic regression was used to estimate the association of state-level policies with the thresholds while adjusting for relevant patient-specific factors. RESULTS NCOUs in states with medium or high PDMP robustness had lower odds of receiving medium (adjusted odds ratio [AOR] 0.74; 95 percent confidence interval [CI]: 0.62-0.69) and high (AOR 0.74; 95 percent CI: 0.59-0.92) thresholds. With respect to cannabis policies, NCOUs in states with medical cannabis dispensaries had lower odds of receiving high (AOR 0.75; 95 percent CI: 0.60-0.93) thresholds, while cannabis decriminalization had higher odds of receiving high (AOR 1.24; 95 percent CI: 1.04-1.49) thresholds. CONCLUSION States with highly robust PDMPs and medical cannabis dispensaries had lower odds of receiving higher opioid thresholds, while cannabis decriminalization correlated with higher odds of receiving high opioid thresholds.
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Affiliation(s)
- Martin J Calabrese
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy; Center for Medicare, Centers for Medicare & Medicaid Services, Baltimore, Maryland. ORCID: https://orcid.org/0000-0003-4304-396X
| | - Fadia T Shaya
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland
| | - Francis Palumbo
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland
| | - Mary Lynn McPherson
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland
| | - Ester Villalonga-Olives
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland
| | - Zafar Zafari
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland
| | - Ryan Mutter
- Congressional Budget Office, Health Analysis Division, Washington, DC
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Davidson WM, Mahavni A, Chrusciel T, Salas J, Miller-Matero LR, Sullivan MD, Zabel C, Lustman PJ, Ahmedani BK, Scherrer JF. Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana. J Cannabis Res 2024; 6:7. [PMID: 38383471 PMCID: PMC10882913 DOI: 10.1186/s42238-024-00218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE Marijuana use is increasingly common among patients with chronic non-cancer pain (CNCP) and long-term opioid therapy (LTOT). We determined if lifetime recreational and medical marijuana use were associated with more frequent and higher dose prescription opioid use. DESIGN Cross-sectional SUBJECTS: Eligible patients (n=1,037), who had a new period of prescription opioid use lasting 30-90 days, were recruited from two midwestern health care systems to a study of long-term prescription opioid use and mental health outcomes. The present cross-sectional analyses uses baseline data from this on-going cohort study. METHODS Primary exposures were participant reported lifetime recreational and medical marijuana use versus no lifetime marijuana use. Prescription opioid characteristics included daily versus non-daily opioid use and ≥50 morphine milligram equivalent (MME) dose per day vs. <50 MME. Multivariate, logistic regression models estimated the association between lifetime recreational and medical marijuana use vs. no use and odds of daily and higher dose prescription opioid use, before and after adjusting for confounding. RESULTS The sample was an average of 54.9 (SD±11.3) years of age, 57.3% identified as female gender, 75.2% identified as White, and 22.5% identified as Black race. Among all participants, 44.4% were never marijuana users, 21.3% were recreational only, 7.7% medical only and 26.6% were both recreational and medical marijuana users. After controlling for all confounders, lifetime recreational marijuana use, as compared to no use, was significantly associated with increased odds of daily prescription opioid use (OR=1.61; 95%CI:1.02-2.54). There was no association between lifetime recreational or medical marijuana use and daily opioid dose. CONCLUSION Lifetime medical marijuana use is not linked to current opioid dose, but lifetime recreational use is associated with more than a 60% odds of being a daily prescription opioid user. Screening for lifetime recreational marijuana use may identify patients with chronic pain who are vulnerable to daily opioid use which increases risk for adverse opioid outcomes. Prospective data is needed to determine how marijuana use influences the course of LTOT and vice versa.
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Affiliation(s)
- Whitney M Davidson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA
| | - Anika Mahavni
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Blvd, Suite 301, St. Louis, MO, 63108, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA.
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., St. Louis, MO, 63104, USA.
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA.
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA.
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Albers L, Rogers CJ, Steinberg J, Vos RO, Soto D, Lee R, Wu JS, Unger JB. Proximity to Cannabis Retailers and Recent Cannabis Use among a Diverse Sample of California Adolescents. Subst Use Misuse 2023; 59:643-650. [PMID: 38115623 DOI: 10.1080/10826084.2023.2294965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Background: As of May 2023, 23 states and Washington, DC have legalized the sale of cannabis for adults aged 21+, and 38 states, three territories, and D.C. have legalized medical cannabis. Exposure to cannabis retailers could increase adolescent cannabis use. Few studies have examined the impact of residential proximity to cannabis retailers on adolescent cannabis use, and previous findings are inconsistent. Methods: This study examined associations between proximity to cannabis retailers and past 30-day cannabis use. Data were from Project Cal Teens, a statewide survey of California adolescents regarding cannabis-related opinions/behaviors (N = 1406, mean age = 15.5 years, 48% female, 38% Hispanic/Latinx, 33% White, 15% Asian/Pacific Islander, 10% Black/African American, 5% Other/Multiracial). Participants were recruited via schools/social media in 2018-2020. Results: For every additional 5 driving miles to the nearest cannabis retailer, the risk of past 30-day cannabis use was reduced by 3.6% [IRR: 0.964; 95% CI: 0.935-0.994]. For every additional 5 miles from a licensed retailer, the risk of past 30-day cannabis use was reduced by 4.3% [IRR: 0.957; 95% CI: 0.926-0.989]. Interaction analyses revealed that among Hispanic/Latinx students, every 5 miles from a licensed retailer was associated with an 11.9% reduction in the risk of past 30-day cannabis use [IRR: 0.881; 95% CI: 0.820-0.945]. Conclusions: As the number of cannabis retailers in the U.S. increases with the continued legalization of adult cannabis use, research examining the effects of these policies on underage use is crucial. Interventions could include enforcement of zoning laws in/near residential areas to reduce accessibility of adolescents to cannabis retailers.
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Affiliation(s)
- Larisa Albers
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Christopher J Rogers
- Department of Health Sciences, California State University, Northridge, Los Angeles, CA, USA
| | - Jane Steinberg
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Robert O Vos
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jasmine Siyu Wu
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Buttorff C, Wang GS, Wilks A, Tung G, Kress A, Schwam D, Pacula RL. Impact of Recreational Cannabis Legalization on Opioid Prescribing and Opioid-Related Hospital Visits in Colorado: an Observational Study. J Gen Intern Med 2023; 38:2726-2733. [PMID: 37340250 PMCID: PMC10506996 DOI: 10.1007/s11606-023-08195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/30/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Cannabis may be a substitute for opioids but previous studies have found conflicting results when using data from more recent years. Most studies have examined the relationship using state-level data, missing important sub-state variation in cannabis access. OBJECTIVE To examine cannabis legalization on opioid use at the county level, using Colorado as a case study. Colorado allowed recreational cannabis stores in January 2014. Local communities could decide whether to allow dispensaries, creating variation in the level of exposure to cannabis outlets. DESIGN Observational, quasi-experimental design exploiting county-level variation in allowance of recreational dispensaries. SUBJECTS Colorado residents MEASURES: We use licensing information from the Colorado Department of Revenue to measure county-level exposure to cannabis outlets. We use the state's Prescription Drug Monitoring Program (2013-2018) to construct opioid-prescribing measures of number of 30-day fills and total morphine equivalents, both per county resident per quarter. We construct outcomes of opioid-related inpatient visits (2011-2018) and emergency department visits (2013-2018) with Colorado Hospital Association data. We use linear models in a differences-in-differences framework that accounts for the varying exposure to medical and recreational cannabis over time. There are 2048 county-quarter observations used in the analysis. RESULTS We find mixed evidence of cannabis exposure on opioid-related outcomes at the county level. We find increasing exposure to recreational cannabis is associated with a statistically significant decrease in number of 30-day fills (coefficient: -117.6, p-value<0.01) and inpatient visits (coefficient: -0.8, p-value: 0.03), but not total MME nor ED visits. Counties with no medical exposure prior to recreational legalization experience greater reductions in the number of 30-day fills and MME than counties with prior medical exposure (p=0.02 for both). CONCLUSIONS Our mixed findings suggest that further increases in cannabis beyond medical access may not always reduce opioid prescribing or opioid-related hospital visits at a population level.
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Affiliation(s)
| | - George Sam Wang
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Asa Wilks
- RAND Corporation, Santa Monica, CA USA
| | - Gregory Tung
- Department of Health Systems, Management & Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Amii Kress
- ECHO Data Analysis Center, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA USA
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Hammaker K, Weathington N, Maroon J, Tang LW, Donohue B, Yehuda R, Ford KM, Figura M, Kelmendi B, Tan B, Cook MW, Factor SD, Lagano L, Driscoll HP, Howe AS, Cho EG, Rabin DM. An answered call for aid? Cannabinoid clinical framework for the opioid epidemic. Harm Reduct J 2023; 20:110. [PMID: 37587466 PMCID: PMC10428550 DOI: 10.1186/s12954-023-00842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND The opioid crisis continues in full force, as physicians and caregivers are desperate for resources to help patients with opioid use and chronic pain disorders find safer and more accessible non-opioid tools. MAIN BODY The purpose of this article is to review the current state of the opioid epidemic; the shifting picture of cannabinoids; and the research, policy, and current events that make opioid risk reduction an urgent public health challenge. The provided table contains an evidence-based clinical framework for the utilization of cannabinoids to treat patients with chronic pain who are dependent on opioids, seeking alternatives to opioids, and tapering opioids. CONCLUSION Based on a comprehensive review of the literature and epidemiological evidence to date, cannabinoids stand to be one of the most interesting, safe, and accessible tools available to attenuate the devastation resulting from the misuse and abuse of opioid narcotics. Considering the urgency of the opioid epidemic and broadening of cannabinoid accessibility amidst absent prescribing guidelines, the authors recommend use of this clinical framework in the contexts of both clinical research continuity and patient care.
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Affiliation(s)
- Krista Hammaker
- Northeast Ohio Medical University, 4209 St Rt 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Nathaniel Weathington
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- University of Pittsburgh Medical Center, 200 Delafield Rd, Ste 2040, Pittsburgh, PA, 15215, USA
| | - Joseph Maroon
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- University of Pittsburgh Medical Center, 1218 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA
| | - Lawton W Tang
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- Huntington Hospital, 100 West California Blvd, Pasadena, CA, 91105, USA
| | - Brian Donohue
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- University of Pittsburgh Medical Center, 1300 Oxford Dr, Bethel Park, PA, 15102, USA
| | - Rachel Yehuda
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Kenneth M Ford
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- Institute for Human and Machine Cognition (IHMC), 40 South Alcaniz, Pensacola, FL, 32502, USA
| | - Myro Figura
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- University of California Los Angeles, 757 Westwood Plaza, Ste 3325, Los Angeles, CA, 90095-7403, USA
| | - Ben Kelmendi
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- Yale University, 300 George St, Ste 901, New Haven, CT, 06511, USA
| | - Belinda Tan
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- People Science, Inc, 3870 Del Amo Blvd, Unit 507, Torrance, CA, 90503, USA
| | - Matthew W Cook
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- BioReset Medical, 3803 S Bascom Ave, Ste 203, Campbell, CA, 95008, USA
| | - Steven D Factor
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- Abington Neurological Associates, 1151 Old York Rd, Ste 200, Abington, PA, 19001, USA
| | - Laura Lagano
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
| | | | - Adam S Howe
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
- Albany Medical Center, 23 Hackett Blvd, MC-108, Albany, NY, 12208, USA
| | - EunBit G Cho
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA
| | - David M Rabin
- The Board of Medicine, 1942 5th Ave, Pittsburgh, PA, 15219, USA.
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Han B, Shi Y. Associations of recreational cannabis dispensaries' availability, storefront signage and health benefit signs with cannabis use: findings from a representative adult sample in California, United States. Addiction 2023; 118:1270-1279. [PMID: 36680550 PMCID: PMC10272035 DOI: 10.1111/add.16132] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS There are concerns that availability of recreational cannabis dispensaries (RCDs) and point-of-sale marketing may lead to increased cannabis use in jurisdictions where cannabis retail sale is legal. This paper examined whether the availability RCDs and the presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs were associated with cannabis use and risk perceptions. DESIGN Cross-sectional, secondary data analysis. SETTING California, USA. PARTICIPANTS A representative sample of 3385 adults in California who participated in the 2020 probability-based Marijuana Use and Environment Survey. MEASUREMENTS Binary outcomes included past-month overall cannabis use, perceiving cannabis smoking as harmful and past-month cannabis use by purpose (medical only, recreational only and dual). The objectively assessed predictors included proximity and density of RCDs and presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs. FINDINGS In terms of proximity, thepresence of storefront signage in the nearest RCD was associated with smaller odds of perceiving cannabis smoking as harmful [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.39, 0.99] if the RCD was located within 2 miles of home. Presence of health benefit signs in the nearest RCD was associated with greater odds of overall cannabis use (OR = 2.45, 95% CI = 1.17, 5.16) and recreational use (OR = 3.50, 95% CI = 1.027, 11.91) if the RCD was located within 2-4 miles of home. In terms of density, count of RCDs, count of RCDs with storefront signage and count of RCDs with health benefit signs within 2 miles of home were each separately associated with greater odds of overall cannabis use and cannabis use for dual purposes. CONCLUSIONS The availability of recreational cannabis dispensaries within 2 miles of one's home and the presence of storefront signage indicating the availability of cannabis and signs promoting health benefits of cannabis appear to be associated with increased cannabis use and reduced risk perceptions among adults in California, USA.
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Affiliation(s)
- Bing Han
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Castillo-Carniglia A, Rivera-Aguirre A, Santaella-Tenorio J, Fink DS, Crystal S, Ponicki W, Gruenewald P, Martins SS, Keyes KM, Cerdá M. Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002-2020. Epidemiology 2023; 34:467-475. [PMID: 36943813 PMCID: PMC10712490 DOI: 10.1097/ede.0000000000001609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Cannabis legalization for medical and recreational purposes has been suggested as an effective strategy to reduce opioid and benzodiazepine use and deaths. We examined the county-level association between medical and recreational cannabis laws and poisoning deaths involving opioids and benzodiazepines in the US from 2002 to 2020. METHODS Our ecologic county-level, spatiotemporal study comprised 49 states. Exposures were state-level implementation of medical and recreational cannabis laws and state-level initiation of cannabis dispensary sales. Our main outcomes were poisoning deaths involving any opioid, any benzodiazepine, and opioids with benzodiazepines. Secondary analyses included overdoses involving natural and semi-synthetic opioids, synthetic opioids, and heroin. RESULTS Implementation of medical cannabis laws was associated with increased deaths involving opioids (rate ratio [RR] = 1.14; 95% credible interval [CrI] = 1.11, 1.18), benzodiazepines (RR = 1.19; 95% CrI = 1.12, 1.26), and opioids+benzodiazepines (RR = 1.22; 95% CrI = 1.15, 1.30). Medical cannabis legalizations allowing dispensaries was associated with fewer deaths involving opioids (RR = 0.88; 95% CrI = 0.85, 0.91) but not benzodiazepine deaths; results for recreational cannabis implementation and opioid deaths were similar (RR = 0.81; 95% CrI = 0.75, 0.88). Recreational cannabis laws allowing dispensary sales was associated with consistent reductions in opioid- (RR = 0.83; 95% CrI = 0.76, 0.91), benzodiazepine- (RR = 0.79; 95% CrI = 0.68, 0.92), and opioid+benzodiazepine-related poisonings (RR = 0.83; 95% CrI = 0.70, 0.98). CONCLUSIONS Implementation of medical cannabis laws was associated with higher rates of opioid- and benzodiazepine-related deaths, whereas laws permitting broader cannabis access, including implementation of recreational cannabis laws and medical and recreational dispensaries, were associated with lower rates. The estimated effects of the expanded availability of cannabis seem dependent on the type of law implemented and its provisions.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
- Millennium Nucleus on Sociomedicine (Sociomed), Chile
- Department of Population Health, New York University Grossman School of Medicine, NY
| | - Ariadne Rivera-Aguirre
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
- Department of Population Health, New York University Grossman School of Medicine, NY
| | | | | | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, New Brunswick, NJ
| | - William Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | | | | | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, NY
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Manthey J, Jacobsen B, Hayer T, Kalke J, López-Pelayo H, Pons-Cabrera MT, Verthein U, Rosenkranz M. The impact of legal cannabis availability on cannabis use and health outcomes: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104039. [PMID: 37126997 DOI: 10.1016/j.drugpo.2023.104039] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND For alcohol, regulating availability is an effective way to reduce consumption and harm. Similarly, the higher availability of medical cannabis dispensaries has been linked to increased cannabis consumption and harm. For recreational cannabis markets, such a link is suspected but still poorly understood. METHODS A systematic literature review (PROSPERO registration number 342357) was conducted on 1 July 2022 in common libraries (Medline, Web of Science, PsycInfo, Psyndex, CINAHL, Embase, SCOPUS, Cochrane) for publications since 2012. Studies linking variations in the availability of legal cannabis products to behavioral outcomes (cannabis use or related health indicators) were included, while studies focusing solely on the legalization of medical cannabis were excluded. The risk of bias was assessed using an adapted version of the Newcastle-Ottawa-Scale. RESULTS After screening n = 6,253 studies, n = 136 were selected for full-text review, out of which n = 13 met the inclusion criteria, reporting on n = 333,550 study participants and n = 855,630 presentations to emergency departments. All studies were conducted in North America, with the majority from Western US states. Using longitudinal (n = 1), cross-sectional (n = 4), or repeated cross-sectional (n = 8) study designs, an increased availability of legal cannabis was linked to increased current cannabis use and health-related outcomes (vomiting, psychosis, or cannabis-involved pregnancies), regardless of the indicator employed to measure availability (proximity or density) among both adults and adolescents. The positive correlation between cannabis availability and consumption is most pronounced among those groups who have been less exposed to cannabis before legalization. The association between the availability of legal cannabis and risky use indicators was less consistent. CONCLUSIONS Groups who have been least exposed to cannabis before legalization may be most susceptible to increased availability. In jurisdictions with legal cannabis markets, restrictions on the number of legal cannabis retailers, especially in densely populated areas, appear warranted.
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Affiliation(s)
- Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany.
| | - Britta Jacobsen
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany
| | - Tobias Hayer
- University of Bremen, Institute of Public Health and Nursing Research, Department for Health and Society, Grazerstr. 2, 28359 Bremen, Germany
| | - Jens Kalke
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany
| | - Hugo López-Pelayo
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Unitat de Conductes Addictives, Servei de Psiquiatria Psicologia (ICN), Hospital Clínic de Barcelona, Barcelona, Spain; Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Spain
| | - Maria Teresa Pons-Cabrera
- Grup de Recerca en Addicions Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Unitat de Conductes Addictives, Servei de Psiquiatria Psicologia (ICN), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Moritz Rosenkranz
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute for Interdisciplinary Addiction and Drug Research, Lokstedter Weg 24, 20251 Hamburg, Germany
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12
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Davis MP, Case AA, Cyr C. Do We Have Structure, Process and Outcomes to Support Cannabis as Supportive Therapy in Cancer? Am J Hosp Palliat Care 2023; 40:341-350. [PMID: 35532011 DOI: 10.1177/10499091221101561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cannabis is becoming more popular and more available in the United States. It has been approved for use by multiple states for various conditions and several states now allow recreational cannabis. We explore the structure of cannabis distribution, the process of acquisition, outcomes, and the safety of cannabis in the United States.
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Affiliation(s)
- Mellar P Davis
- 2780Geisinger Commonwealth School of Medicine, Danville, PA, USA
| | - Amy A Case
- Department of Medicine, Department of Supportive and Palliative Care, 2074Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Claude Cyr
- Supportive and Palliative Care Division, 12367McGill University Health Center, Montreal, QC, Canada
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13
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Mathur NK, Ruhm CJ. Marijuana legalization and opioid deaths. JOURNAL OF HEALTH ECONOMICS 2023; 88:102728. [PMID: 36808015 DOI: 10.1016/j.jhealeco.2023.102728] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 06/18/2023]
Abstract
Many states have legalized marijuana over the last two decades, initially for medical purposes and more recently for recreational consumption. Despite prior research, it remains unclear how these policies are related to rates of opioid-involved overdose deaths, which have trended rapidly upwards over time. We examine this question in two ways. First, we replicate and extend previous investigations to show that the prior empirical results are frequently fragile to the choice of specifications and time periods, and probably provide an overly optimistic assessment of the effects of marijuana legalization on opioid deaths. Second, we present new estimates suggesting that legal medical marijuana, particularly when available through retail dispensaries, is associated with higher opioid mortality. The results for recreational marijuana, while less reliable, also indicate that retail sales may be correlated with greater death rates relative to the counterfactual of no legal cannabis. A likely mechanism for these effects is the emergence of illicit fentanyl, which has increased the riskiness of even small positive effects of cannabis legalization on the consumption of opioids.
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Affiliation(s)
- Neil K Mathur
- Department of Economics, University of Virginia, United States
| | - Christopher J Ruhm
- Frank Batten School of Leadership & Public Policy, University of Virginia and National Bureau of Economic Research, 235 McCormick Road, Charlottesville, VA 22903-4893, United States.
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Cano M, Oh S, Osborn P, Olowolaju SA, Sanchez A, Kim Y, Moreno AC. County-level predictors of US drug overdose mortality: A systematic review. Drug Alcohol Depend 2023; 242:109714. [PMID: 36463764 DOI: 10.1016/j.drugalcdep.2022.109714] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This systematic review summarized published literature on county-level predictors of drug overdose mortality in the United States (US). METHODS Peer-reviewed studies and doctoral dissertations published in English between 1990 and July 19, 2022 were identified from PubMed, Web of Science, ProQuest Dissertations & Theses, PsycINFO, CINAHL, and EconLit. Eligible studies examined at least one county-level predictor of drug overdose mortality in US counties. Two reviewers independently completed screening, quality assessment (with an adapted National Institutes of Health Quality Assessment Tool), and data extraction. Results were qualitatively summarized and grouped by predictor categories. RESULTS Of 56 studies included, 42.9% were subnational, and 53.6% were limited to opioid overdose. In multiple studies, measures related to opioid prescribing, illness/disability, economic distress, mining employment, incarceration, family distress, and single-parent families were positively associated with drug overdose mortality outcomes, while measures related to cannabis dispensaries, substance use treatment, social capital, and family households were negatively associated with drug overdose mortality outcomes. Both positive and negative associations were documented for smoking, uninsurance, healthcare professional shortage status, physicians per capita, unemployment, income, poverty, educational attainment, racial composition, and rurality. Findings within studies also differed by subpopulation (by race/ethnicity, gender, age, or rurality) and the type of drugs involved in overdose. CONCLUSIONS The findings of this review provide relatively mixed evidence regarding many county-level predictors of overdose mortality, several of which also vary between subpopulations, supporting the importance of additional research to elucidate pathways through which the county context may shape risk of fatal overdose.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, USA.
| | - Sehun Oh
- College of Social Work, The Ohio State University, USA
| | | | | | - Armando Sanchez
- Department of Social Work, University of Texas at San Antonio, USA
| | - Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, USA; School of Social Work, University of Texas at Arlington, USA
| | - Alberto Cano Moreno
- Department of Public Policy, Universidad Autónoma del Estado de Hidalgo, México
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15
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Keyhani S, Leonard S, Byers AL, Zaman T, Krebs E, Austin PC, Moss-Vazquez T, Austin C, Sandbrink F, Bravata DM. Association of a Positive Drug Screening for Cannabis With Mortality and Hospital Visits Among Veterans Affairs Enrollees Prescribed Opioids. JAMA Netw Open 2022; 5:e2247201. [PMID: 36525274 PMCID: PMC9856228 DOI: 10.1001/jamanetworkopen.2022.47201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Cannabis has been proposed as a therapeutic with potential opioid-sparing properties in chronic pain, and its use could theoretically be associated with decreased amounts of opioids used and decreased risk of mortality among individuals prescribed opioids. OBJECTIVE To examine the risks associated with cannabis use among adults prescribed opioid analgesic medications. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among individuals aged 18 years and older who had urine drug screening in 2014 to 2019 and received any prescription opioid in the prior 90 days or long-term opioid therapy (LTOT), defined as more than 84 days of the prior 90 days, through the Veterans Affairs health system. Data were analyzed from November 2020 through March 2022. EXPOSURES Biologically verified cannabis use from a urine drug screen. MAIN OUTCOMES AND MEASURES The main outcomes were 90-day and 180-day all-cause mortality. A composite outcome of all-cause emergency department (ED) visits, all-cause hospitalization, or all-cause mortality was a secondary outcome. Weights based on the propensity score were used to reduce confounding, and hazard ratios [HRs] were estimated using Cox proportional hazards regression models. Analyses were conducted among the overall sample of patients who received any prescription opioid in the prior 90 days and were repeated among those who received LTOT. Analyses were repeated among adults aged 65 years and older. RESULTS Among 297 620 adults treated with opioids, 30 514 individuals used cannabis (mean [SE] age, 57.8 [10.5] years; 28 784 [94.3%] men) and 267 106 adults did not (mean [SE] age, 62.3 [12.3] years; P < .001; 247 684 [92.7%] men; P < .001). Among all patients, cannabis use was not associated with increased all-cause mortality at 90 days (HR, 1.07; 95% CI, 0.92-1.22) or 180 days (HR, 1.00; 95% CI, 0.90-1.10) but was associated with an increased hazard of the composite outcome at 90 days (HR, 1.05; 95% CI, 1.01-1.07) and 180 days (HR, 1.04; 95% CI, 1.01-1.06). Among 181 096 adults receiving LTOT, cannabis use was not associated with increased risk of all-cause mortality at 90 or 180 days but was associated with an increased hazard of the composite outcome at 90 days (HR, 1.05; 95% CI, 1.02-1.09) and 180 days (HR, 1.05; 95% CI, 1.02-1.09). Among 77 791 adults aged 65 years and older receiving LTOT, cannabis use was associated with increased 90-day mortality (HR, 1.55; 95% CI, 1.17-2.04). CONCLUSIONS AND RELEVANCE This study found that cannabis use among adults receiving opioid analgesic medications was not associated with any change in mortality risk but was associated with a small increased risk of adverse outcomes and that short-term risks were higher among older adults receiving LTOT.
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Affiliation(s)
- Salomeh Keyhani
- Department of Medicine, University of California, San Francisco
- San Francisco VA Medical Center, San Francisco, California
| | - Samuel Leonard
- Northern California Institute for Research and Education, San Francisco
| | - Amy L. Byers
- Department of Medicine, University of California, San Francisco
- San Francisco VA Medical Center, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Tauheed Zaman
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Addiction Recovery and Treatments Services, San Francisco VA Health Care System, San Francisco, California
| | - Erin Krebs
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Peter C. Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto
| | | | - Charles Austin
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Friedhelm Sandbrink
- National Pain Management, Opioid Safety and Prescription Drug Monitoring Program, Veterans Health Administration, Washington, District of Columbia
- Department of Neurology, George Washington University, Washington District of Columbia
| | - Dawn M. Bravata
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
- Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis
- Regenstreif Institute, Indianapolis Indiana
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16
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Schlag AK, Lynskey M, Fayaz A, Athanasiou-Fragkouli A, Brandner B, Haja B, Iveson E, Nutt DJ. Characteristics of People Seeking Prescribed Cannabinoids for the Treatment of Chronic Pain: Evidence From Project Twenty 21. FRONTIERS IN PAIN RESEARCH 2022; 3:891498. [PMID: 35775024 PMCID: PMC9237624 DOI: 10.3389/fpain.2022.891498] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/16/2022] [Indexed: 12/11/2022] Open
Abstract
Background Prescribed cannabinoids are now legal in the UK and increasingly being used for a variety of conditions, with one of the most frequent conditions being chronic pain. This paper describes the characteristics of individuals seeking prescribed cannabinoids for the treatment of chronic pain in Project Twenty 21, a UK based real world data registry of prescribed cannabis patients. Method By 1st November 2021 data were available for 1,782 people who had sought treatment with medical cannabis as part of Project Twenty 21. The most common diagnosis among this cohort was chronic pain with 949 (53.5%) of the cohort reporting a primary condition related to chronic pain. Medical and self-report data on the characteristics of these patients, their health status and type/s of cannabinoid/s prescribed are summarized in this report. Results Of the 949 people reporting chronic pain as a primary condition 54.7% were male and their average age was 42.0 years (range = 18–84). Patients reported a low quality of life and high levels of comorbidity: people reported an average of 4.6 comorbid conditions with the most common comorbid conditions including anxiety, depression, insomnia and stress. A range of cannabinoid products were prescribed with the most common products being classified as high THC flower (48.5%). The majority of patients also reported using at least one other prescribed medication (68.7%). Conclusions Consistent with findings in other national and international databases, chronic pain was the most common primary condition in this real world study of prescribed cannabinoids. There was considerable variation in the types of chronic pain, comorbid pathology and in the characteristics of products being prescribed to treat these conditions. Together, this evidence supports the utility of real world evidence, as opposed to clinical trial approaches to studying the potential benefits of prescribed cannabinoids in treating chronic pain.
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Affiliation(s)
- Anne Katrin Schlag
- Drug Science, London, United Kingdom
- Department of Psychiatry, Imperial College London, London, United Kingdom
- *Correspondence: Anne Katrin Schlag
| | | | - Alan Fayaz
- Anaesthesia and Pain Medicine, University College London Hospital National Health Service (NHS) Foundation Trust, University College London, London, United Kingdom
| | | | - Brigitta Brandner
- Anaesthesia and Pain Medicine, University College London Hospital National Health Service (NHS) Foundation Trust, University College London, London, United Kingdom
| | | | - Elizabeth Iveson
- Stroke and Neurorehabilitation, Nuffield Health, London, United Kingdom
| | - David J. Nutt
- Drug Science, London, United Kingdom
- Department of Psychiatry, Imperial College London, London, United Kingdom
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United States marijuana legalization and opioid mortality epidemic during 2010–2020 and pandemic implications. J Natl Med Assoc 2022; 114:412-425. [DOI: 10.1016/j.jnma.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/23/2022]
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Nutt D. Why doctors have a moral imperative to prescribe and support medical cannabis—an essay by David Nutt. BMJ : BRITISH MEDICAL JOURNAL 2022. [DOI: 10.1136/bmj.n3114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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French MT, Zukerberg J, Lewandowski TE, Piccolo KB, Mortensen K. Societal Costs and Outcomes of Medical and Recreational Marijuana Policies in the United States: A Systematic Review. Med Care Res Rev 2022; 79:743-771. [PMID: 35068253 DOI: 10.1177/10775587211067315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Significant support exists in the United States for legalization of marijuana/cannabis. As of 2021, 36 states and four territories approved the legalization of medical cannabis via medical marijuana laws (MMLs), and 15 states and District of Columbia (DC) have adopted recreational marijuana laws (RMLs). We performed structured and systematic searches of articles published from 2010 through September 2021. We assess the literature pertaining to adolescent marijuana use; opioid use and opioid-related outcomes; alcohol use; tobacco use; illicit and other drug use; marijuana growing and cultivation; employment, earnings, and other workplace outcomes; academic achievement and performance; criminal activity; perceived harmfulness; traffic and road safety; and suicide and sexual activity. Overall, 113 articles satisfied our inclusion criteria. Except for opioids, studies on use of other substances (illicit drugs, tobacco, and alcohol) were inconclusive. MMLs and RMLs do not generate negative outcomes in the labor market, lead to greater criminal activity, or reduce traffic and road safety.
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Kim JH, Martins SS, Shmulewitz D, Hasin D. Association between fatal opioid overdose and state medical cannabis laws in US national survey data, 2000-2011. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103449. [PMID: 34587580 PMCID: PMC8755580 DOI: 10.1016/j.drugpo.2021.103449] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 02/09/2023]
Abstract
AIMS Most information on the relationship between medical cannabis laws (MCL) and the risk for opioid overdose fatality has been based on studies with ecological designs. To contribute additional information, we used a novel case-control design and individual-level data from national surveys to assess whether state medical cannabis laws were associated with reduced risk of fatal opioid overdose between 2000-2011. METHODS Data from participants surveyed in the National Health Interview Survey (NHIS) between 1986-2011 were included. For those sampled between 1986-2009, detailed mortality follow-up data were available from the National Death Index up to 12/31/2011. Opioid overdose decedents (n = 791) were classified as cases. Between 2000-2011, all cases arising in a given year were matched to adult controls who were surveyed the same year and eligible for mortality follow-up (n = 723,920). The distribution of exposure to state MCL was contrasted between cases and controls, providing an approximation of the rate ratio of fatal opioid overdose associated with MCLs. Due to a NHIS sample redesign, we stratified analysis using timeframes before and after 2005. RESULTS Overall, compared to controls, cases were more likely to be male, middle-aged, non-Hispanic White, separated/divorced; less educated, and have a family income below the poverty threshold. No overall association between state MCLs and the rate of opioid overdose was observed between 2000-2005 (aOR = 1.22, 95% CI: 0.83-1.79) or between 2006-2011 (aOR = 0.87, 95% CI: 0.60-1.25). No significant difference between sampling timeframes was observed (ratio of aOR's = 0.71, 95% CI: 0.49-1.01). CONCLUSIONS We found no overall protective relationship between state MCLs and opioid overdose. Future research with more recent mortality data and more refined cannabis policy classifications would be useful. The importance of the study is two-fold. First, the findings provide an additional source of information countering claims of a protective effect of MCLs on opioid overdoses, suggesting that other solutions to the opioid overdose crisis are needed. Second, the study offers a potentially useful design to answer important population-level public health questions.
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Affiliation(s)
- June H. Kim
- New York State Psychiatric Institute, New York
| | - Silvia S. Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York State Psychiatric Institute, New York
| | - Deborah Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York State Psychiatric Institute, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York
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Tormohlen KN, Bicket MC, White S, Barry CL, Stuart EA, Rutkow L, McGinty EE. The State of the Evidence on the Association Between State Cannabis Laws and Opioid-Related Outcomes: a Review. CURRENT ADDICTION REPORTS 2021; 8:538-545. [DOI: 10.1007/s40429-021-00397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
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