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Boehnke KF, Scott JR, Martel MO, Smith T, Bergmans RS, Kruger DJ, Williams DA, Fitzcharles MA. Substituting Medical Cannabis for Medications Among Patients with Rheumatic Conditions in the United States and Canada. ACR Open Rheumatol 2024. [PMID: 39236308 DOI: 10.1002/acr2.11717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE There are numerous reports of people substituting medical cannabis (MC) for medications. Our obejctive was to investigate the degree to which this substitution occurs among people with rheumatic conditions. METHODS In a secondary analysis from a cross-sectional survey conducted with patient advocacy groups in the US and Canada, we investigated MC use and medication substitution among people with rheumatic conditions. We subgrouped by whether participants substituted MC for medications and investigated differences in perceived symptom changes and use patterns, including methods of ingestion, cannabinoid content (cannabidiol vs delta-9-tetrahydrocannabinol [THC]), and use frequency. RESULTS Among 763 participants, 62.5% reported substituting MC products for medications, including nonsteroidal anti-inflammatory drugs (54.7%), opioids (48.6%), sleep aids (29.6%), and muscle relaxants (25.2%). Following substitution, most participants reported decreases or cessation in medication use. The primary reasons for substitution were fewer adverse effects, better symptom management, and concerns about withdrawal symptoms. Substitution was associated with THC use and significantly higher symptom improvements (including pain, sleep, anxiety, and joint stiffness) than nonsubstitution, and a higher proportion of substitutors used inhalation routes than those who did not. CONCLUSION Although the determination of causality is limited by our cross-sectional design, these findings suggest that an appreciable number of people with rheumatic diseases substitute medications with MC for symptom management. Inhalation of MC products containing some THC was most commonly identified among those substituting, and disease characteristics did not differ by substitution status. Further study is needed to better understand the role of MC for symptom management in rheumatic conditions.
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Affiliation(s)
| | - J Ryan Scott
- University of Michigan Medical School, Ann Arbor
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Zaharakis N, Coatsworth JD, Riggs NR, Radford A, Rayburn S, Mennis J, Russell MA, Brown A, Mason MJ. Treating young adult cannabis use disorder with text message-delivered peer network counseling. Contemp Clin Trials 2024; 144:107635. [PMID: 39019156 DOI: 10.1016/j.cct.2024.107635] [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: 04/19/2024] [Revised: 06/28/2024] [Accepted: 07/13/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Approximately 16.5% of U.S. young adults have a cannabis use disorder (CUD) and are at risk for negative outcomes. Treatment can reduce cannabis use, but young adults are less likely to seek help than older adults. Peer Network Counseling-txt (PNC-txt) is a brief, text-delivered, Motivational Interviewing-informed substance use intervention focusing on peer relations and activity spaces as mechanisms for behavioral change. PNC-txt has shown evidence of reducing tobacco and cannabis use with adolescents and young adults, but it has not been tested in the context of legal cannabis use. The current randomized controlled trial sought to expand the evidence regarding the context of PNC-txt effects, comparing one state in which cannabis is legal (Colorado) and one state in which it is not (Tennessee). We hypothesized that participants randomized to PNC-txt would show significant reductions in cannabis use compared to controls, with larger reductions for females and those in Colorado, and that peer relations and activity space would mediate effects. METHODS One thousand, seventy eight 18-25 year olds (CO: 551; TN: 527) who met screening criteria for CUD and biologically-verified cannabis use were randomly assigned to PNC-txt or waitlist control condition. Every other day for 4 weeks, participants assigned to PNC-txt received pre-programmed text conversations, tailored via data from the baseline assessment. Self-report and biological indicators of cannabis use were measured at 1-, 3-, and 6-months. DISCUSSION Data analysis is underway. Results will provide evidence regarding whether, and how, PNC-txt reduces cannabis use in young adults with CUD. TRIAL REGISTRATION This trial was prospectively registered on September 28, 2020 with ClinicalTrials.gov (NCT04567394).
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Affiliation(s)
- Nikola Zaharakis
- Center for Behavioral Health Research, University of Tennessee Knoxville, 600 Henley St, Suite 221, Knoxville, TN 37996, United States.
| | - J Douglas Coatsworth
- Center for Behavioral Health Research, University of Tennessee Knoxville, 600 Henley St, Suite 221, Knoxville, TN 37996, United States
| | - Nathaniel R Riggs
- Prevention Research Center, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Aubrie Radford
- Prevention Research Center, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Stephanie Rayburn
- Prevention Research Center, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Jeremy Mennis
- Temple University, 328 Gladfelter Hall, Philadelphia, PA 19122, United States
| | - Michael A Russell
- The Pennsylvania State University, 107 BBH Building, University Park, PA 16802, United States
| | - Aaron Brown
- University of Kentucky, Patterson Office Tower #1825, Lexington, KY 40506, United States
| | - Michael J Mason
- Center for Behavioral Health Research, University of Tennessee Knoxville, 600 Henley St, Suite 221, Knoxville, TN 37996, United States
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Böttge-Wolpers C, Bialas P, Gottschling S, Juckenhöfel S, Konietzke D, Madlinger A, Welsch P, Häuser W. [Benefits and harms of cannabis-based medicines from the viewpoint of patients with chronic pain and their physicians : A cohort study in three pain centers of the German federal state Saarland]. Schmerz 2024; 38:241-249. [PMID: 36662296 DOI: 10.1007/s00482-022-00688-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND There are no studies available that have simultaneously assessed the benefits and harms of cannabis-based medicines from the viewpoint of patients and their physicians. METHODS All chronic pain patients at three pain centres in the German federal state of Saarland who had received at least one prescription of cannabis-based medicines (CbMs) in the past from the study centre were included in a cross-sectional study from January 1 to December 31, 2021. Patients and their physicians completed a self-developed questionnaire separately. RESULTS All 187 contacted patients participated in the study. Since the start of CbM therapy, 44.9% of patients reported to be much or very much, 43.3% to be moderately and 8.0% to be slightly improved overall. A total of 2.7% reported no change and 1.1% a moderate deterioration of overall wellbeing. From the patients' point of view, the symptoms most frequently reported to have substantially improved were sleep problems (36.4%), muscle tension (25.1%) and appetite problems (22.1%). The most frequent bothersome side effects were sweating (6.4%), concentration problems (4.2%) and nausea (4.1%). Physicians noted substantial pain relief in 60.7%, improvement of sleep in 65.7% and of mental well-being in 34.3%. A complete cessation of opioids was achieved in 64.7%, of anticonvulsants in 57.9% and of antidepressants in 60% of patients that had received these medications before the start of CbM therapy. CONCLUSIONS CbMs can contribute to a clinically relevant reduction in pain, sleep problems and muscle tension and can improve daily functioning in carefully selected and supervised patients with chronic pain. CbM can contribute to the reduction or complete cessation of other pain medications (antidepressants, anticonvulsants, opioids).
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Affiliation(s)
- Claudia Böttge-Wolpers
- Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken-St. Johann, Großherzog-Friedrich-Str. 44-46, 66111, Saarbrücken, Deutschland
| | - Patric Bialas
- Schmerzambulanz, Universitätskliniken des Saarlandes, Homburg/Saar, Deutschland
- Schmerzmedizinische Praxis am Kleinen Markt Saarlouis, Saarlouis, Deutschland
| | - Sven Gottschling
- Zentrum für altersübergreifende Palliativmedizin und Kinderschmerztherapie, Universitätskliniken des Saarlandes, Homburg/Saar, Deutschland
| | - Stephanie Juckenhöfel
- Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken-St. Johann, Großherzog-Friedrich-Str. 44-46, 66111, Saarbrücken, Deutschland
| | - Dieter Konietzke
- Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken-St. Johann, Großherzog-Friedrich-Str. 44-46, 66111, Saarbrücken, Deutschland
| | - Albrecht Madlinger
- Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken-St. Johann, Großherzog-Friedrich-Str. 44-46, 66111, Saarbrücken, Deutschland
| | - Patrick Welsch
- Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken-St. Johann, Großherzog-Friedrich-Str. 44-46, 66111, Saarbrücken, Deutschland
| | - Winfried Häuser
- Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken-St. Johann, Großherzog-Friedrich-Str. 44-46, 66111, Saarbrücken, Deutschland.
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Luque JS. Discussions on Medical Cannabis: Addressing Missed Opportunities in Cancer Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:217-219. [PMID: 38466546 DOI: 10.1007/s13187-024-02402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- John S Luque
- Florida A&M University, 1515 South Martin Luther King Jr Blvd, Tallahassee, FL, 32307, USA.
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Karst M. Overview: Chronic Pain and Cannabis-Based Medicines. PHARMACOPSYCHIATRY 2024; 57:152-159. [PMID: 38198809 PMCID: PMC11076105 DOI: 10.1055/a-2231-6630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
Chronic pain is primarily conceptualized as a disease in its own right when it is associated with emotional distress and functional impairment. Pathophysiologically, dysfunction of the cortico-mesolimbic connectome is of major importance, with overlapping signals in the nociceptive and stress systems. The endocannabinoid system plays an important role in the central processing of nociceptive signals and regulates the central stress response. Clinically, there is moderate evidence that cannabis-based medicines (CBM) can contribute to a significant reduction in pain, especially the associated pain affect, and improvement in physical function and sleep quality in a proportion of patients with chronic pain. The analgesic effect appears to be largely independent of the cause of pain. In this context, CBM preferentially regulates stress-associated pain processing.
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Affiliation(s)
- Matthias Karst
- Anesthesiology, Pain Clinic, Hannover Medical School, Hannover,
Germany
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Xiao Y, Liu Y. Comparison of pain between bilateral ICL surgeries in patients with myopia. BMC Ophthalmol 2024; 24:175. [PMID: 38627709 PMCID: PMC11022364 DOI: 10.1186/s12886-024-03450-5] [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: 10/11/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The purpose of this study was to compare the preoperative anxiety, aqueous humor monocyte chemoattractant protein-1 (MCP-1) concentration, intraoperative pain, and degree of cooperation of the first eye implantable collamer lens (ICL) surgery with the second eye surgery, of the 1-day interval group with the 1-week interval group, and to investigate the possible causes of these differences, as well as to determine the appropriate interval between bilateral eye ICL surgeries. METHOD The study was a prospective observational study. A total of 120 patients who underwent bilateral ICL surgery at the Department of Ophthalmology, West China Fourth Hospital, Sichuan University, from July to September 2023, were enrolled. The patients were divided into a 1-day interval group and a 1-week interval group. The ICL surgery was performed on both eyes according to the schedule. Anxiety levels, aqueous humor MCP1, cooperativeness, surgical time, pain and satisfaction, and patients' estimations of the time spent in the operation were recorded for each eye. The patients were instructed to recall the intraoperative pain of the first eye surgery after the operation of the second eye. Statistical analyses (two independent samples t-test,two paired samples t-test, the rank-sum test, the chi-square test, non-parametric test with multiple independent samples) were performed to compare the differences between each score in both eyes and two groups. Furthermore, we examined the relationship between pain levels and the reproductive history of the patients. RESULTS In the 1-day interval group, male/female is 22/52, average age is 25.24±5.00. In the 1-week interval group, male/female is 17/29, average age is 25.39±5.57. There was no statistically significant difference between the two groups. In both groups, patients were less nervous, had significantly more pain, had less surgical satisfaction, had a longer estimated operative time, and had elevated preoperative MCP1 during the second eye operation. In the second eye surgery, the patient's cooperation worsened, but it did not lead to an increase in surgical time. A significant proportion of patients, particularly in the 1-week interval group, recalled experiencing reduced pain during the first eye surgery. The 1-week interval group had a higher difference in all indicators between the bilateral surgeries. In the second eye surgery, patients in the 1-week interval group experienced more severe pain, less cooperation, longer estimated operation duration, and a greater MCP1 than those in the 1-day interval group. CONCLUSION Patients undergoing second eye ICL surgery had decreased nervousness, increased pain, decreased cooperation, and satisfaction, and increased MCP1 compared to the first eye surgery. It is recommended that an interval of about one week should be avoided between bilateral surgeries when developing a surgical schedule to improve patients' cooperation, satisfaction, and comfort.
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Affiliation(s)
- Yu Xiao
- West China School of Public Health and West China Fourth Hospital,Sichuan University, Chengdu, Sichuan, China
| | - Yali Liu
- West China School of Public Health and West China Fourth Hospital,Sichuan University, Chengdu, Sichuan, China.
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Starkey B, Pearlson GD, Bond D, Glaser C, Bhargava A, Grosberg BM, Verhaak A. Characterizing Cannabis Use and Perceived Benefit in a Tertiary Headache Center Patient Sample. Neurol Clin Pract 2024; 14:e200285. [PMID: 38455123 PMCID: PMC10915819 DOI: 10.1212/cpj.0000000000200285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024]
Abstract
Background and Objectives Research suggests a potential role for cannabinoids in the etiology and treatment of migraine. However, there is a paucity of research on usage patterns and perceived benefits of cannabis use in clinical headache patient populations. Methods Patients from a tertiary headache center completed a 1-time online survey regarding cannabis use patterns and perceived benefits of cannabis-based products in treating migraine symptoms, clinical features, and risk factors (e.g., depression, sleep disturbance). Descriptive analyses were performed. Results Data were collected from 1373 patients (response rate 25.4% [1,373/5,400]), with 55.7% reporting cannabis-based product use in the past 3 years and 32.5% indicating current use. The most frequently cited reasons for cannabis-based product use were treating headache (65.8%) and sleep concerns (50.8%). Inhaled products (i.e., smoked/vaped) and edibles were the most commonly reported delivery methods, with THC/CBD (∆9 tetrahydrocannabinol/cannabidiol) blends as the most-cited product composition. A majority of participants reported cannabis-related improvements in migraine headache characteristics (i.e., intensity: 78.1%; duration: 73.4%; frequency: 62.4%), nausea (56.3%), and risk factors (sleep disturbance: 81.2%; anxiety: 71.4%; depression: 57.0%). Over half (58.0%) of the respondents reported only using cannabis products when experiencing a headache, while 42.0% used cannabis most days/daily for prevention. Nearly half (48.9%) of the respondents reported that cannabis use contributed to a reduction in medication amount for headache treatment, and 14.5% reported an elimination of other medications. A minority (20.9%) of participants reported experiencing side effects when using cannabis products for headache, most commonly fatigue/lethargy. For those participants who reported no use of cannabis-based products in the previous 3 years, approximately half indicated not knowing what cannabis product to take or the appropriate dosage. Discussion This is the largest study to date to document cannabis product usage patterns and perceived benefits for migraine management in a clinical headache patient sample. A majority of patients surveyed reported using cannabis products for migraine management and cited perceived improvements in migraine characteristics, clinical features, and associated risk factors. The findings warrant experimental trials to confirm the perceived benefits of cannabis products for migraine prevention and treatment.
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Affiliation(s)
- Brianna Starkey
- Hartford HealthCare Headache Center (BS, CG, AB, BMG, AV), Ayer Neuroscience Institute, West Hartford; Olin Neuropsychiatric Research Center (GDP), Institute of Living, Hartford; Department of Psychiatry and Neuroscience (GDP), Yale School of Medicine, New Haven; Department of Research (DB), Hartford Hospital/Hartford HealthCare; Department of Neurology (BMG, AV), University of Connecticut School of Medicine, Farmington; and Division of Health Psychology (AV), The Institute of Living/Hartford Hospital, CT
| | - Godfrey D Pearlson
- Hartford HealthCare Headache Center (BS, CG, AB, BMG, AV), Ayer Neuroscience Institute, West Hartford; Olin Neuropsychiatric Research Center (GDP), Institute of Living, Hartford; Department of Psychiatry and Neuroscience (GDP), Yale School of Medicine, New Haven; Department of Research (DB), Hartford Hospital/Hartford HealthCare; Department of Neurology (BMG, AV), University of Connecticut School of Medicine, Farmington; and Division of Health Psychology (AV), The Institute of Living/Hartford Hospital, CT
| | - Dale Bond
- Hartford HealthCare Headache Center (BS, CG, AB, BMG, AV), Ayer Neuroscience Institute, West Hartford; Olin Neuropsychiatric Research Center (GDP), Institute of Living, Hartford; Department of Psychiatry and Neuroscience (GDP), Yale School of Medicine, New Haven; Department of Research (DB), Hartford Hospital/Hartford HealthCare; Department of Neurology (BMG, AV), University of Connecticut School of Medicine, Farmington; and Division of Health Psychology (AV), The Institute of Living/Hartford Hospital, CT
| | - Cathy Glaser
- Hartford HealthCare Headache Center (BS, CG, AB, BMG, AV), Ayer Neuroscience Institute, West Hartford; Olin Neuropsychiatric Research Center (GDP), Institute of Living, Hartford; Department of Psychiatry and Neuroscience (GDP), Yale School of Medicine, New Haven; Department of Research (DB), Hartford Hospital/Hartford HealthCare; Department of Neurology (BMG, AV), University of Connecticut School of Medicine, Farmington; and Division of Health Psychology (AV), The Institute of Living/Hartford Hospital, CT
| | - Aakash Bhargava
- Hartford HealthCare Headache Center (BS, CG, AB, BMG, AV), Ayer Neuroscience Institute, West Hartford; Olin Neuropsychiatric Research Center (GDP), Institute of Living, Hartford; Department of Psychiatry and Neuroscience (GDP), Yale School of Medicine, New Haven; Department of Research (DB), Hartford Hospital/Hartford HealthCare; Department of Neurology (BMG, AV), University of Connecticut School of Medicine, Farmington; and Division of Health Psychology (AV), The Institute of Living/Hartford Hospital, CT
| | - Brian M Grosberg
- Hartford HealthCare Headache Center (BS, CG, AB, BMG, AV), Ayer Neuroscience Institute, West Hartford; Olin Neuropsychiatric Research Center (GDP), Institute of Living, Hartford; Department of Psychiatry and Neuroscience (GDP), Yale School of Medicine, New Haven; Department of Research (DB), Hartford Hospital/Hartford HealthCare; Department of Neurology (BMG, AV), University of Connecticut School of Medicine, Farmington; and Division of Health Psychology (AV), The Institute of Living/Hartford Hospital, CT
| | - Allison Verhaak
- Hartford HealthCare Headache Center (BS, CG, AB, BMG, AV), Ayer Neuroscience Institute, West Hartford; Olin Neuropsychiatric Research Center (GDP), Institute of Living, Hartford; Department of Psychiatry and Neuroscience (GDP), Yale School of Medicine, New Haven; Department of Research (DB), Hartford Hospital/Hartford HealthCare; Department of Neurology (BMG, AV), University of Connecticut School of Medicine, Farmington; and Division of Health Psychology (AV), The Institute of Living/Hartford Hospital, CT
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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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Shkodina AD, Bardhan M, Chopra H, Anyagwa OE, Pinchuk VA, Hryn KV, Kryvchun AM, Boiko DI, Suresh V, Verma A, Delva MY. Pharmacological and Non-pharmacological Approaches for the Management of Neuropathic Pain in Multiple Sclerosis. CNS Drugs 2024; 38:205-224. [PMID: 38421578 DOI: 10.1007/s40263-024-01072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Multiple sclerosis is a chronic inflammatory disease that affects the central nervous system and can cause various types of pain including ongoing extremity pain, Lhermitte's phenomenon, trigeminal neuralgia, and mixed pain. Neuropathic pain is a major concern for individuals with multiple sclerosis as it is directly linked to myelin damage in the central nervous system and the management of neuropathic pain in multiple sclerosis is challenging as the options available have limited efficacy and can cause unpleasant side effects. The literature search was conducted across two databases, PubMed, and Google Scholar. Eligible studies included clinical trials, observational studies, meta-analyses, systematic reviews, and narrative reviews. The objective of this article is to provide an overview of literature on pharmacological and non-pharmacological strategies employed in the management of neuropathic pain in multiple sclerosis. Pharmacological options include cannabinoids, muscle relaxants (tizanidine, baclofen, dantrolene), anticonvulsants (benzodiazepines, gabapentin, phenytoin, carbamazepine, lamotrigine), antidepressants (duloxetine, venlafaxine, tricyclic antidepressants), opioids (naltrexone), and botulinum toxin variants, which have evidence from various clinical trials. Non-pharmacological approaches for trigeminal neuralgia may include neurosurgical methods. Non-invasive methods, physical therapy, and psychotherapy (cognitive behavioral therapy, acceptance and commitment therapy and mindfulness-based stress reduction) may be recommended for patients with neuropathic pain in multiple sclerosis. The choice of treatment depends on the severity and type of pain as well as other factors, such as patient preferences and comorbidities. There is a pressing need for healthcare professionals and researchers to prioritize the development of better strategies for managing multiple sclerosis-induced neuropathic pain.
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Affiliation(s)
- Anastasiia D Shkodina
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
| | - Mainak Bardhan
- Neuro Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, 8900 N. Kendall Drive, Miami, FL, 33176, USA.
| | - Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, 602105, Tamil Nadu, India
| | | | - Viktoriia A Pinchuk
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
| | - Kateryna V Hryn
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
| | - Anzhelina M Kryvchun
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
| | - Dmytro I Boiko
- Department of Psychiatry, Narcology and Medical Psychology, Poltava State Medical University, Poltava, Ukraine
| | - Vinay Suresh
- King George's Medical University, Lucknow, India
| | - Amogh Verma
- Rama Medical College Hospital and Research Centre, Hapur, India
| | - Mykhailo Yu Delva
- Department of Neurological diseases, Poltava State Medical University, Poltava, Ukraine
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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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11
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Nguyen HV, Grootendorst P, Mital S, Bishop L, McGinty EE. Changes in Medical Cannabis Use After Recreational Cannabis Legalization in Canada. Cannabis Cannabinoid Res 2024; 9:335-342. [PMID: 36720084 DOI: 10.1089/can.2022.0227] [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] [Indexed: 02/02/2023] Open
Abstract
Background: As part of its recreational cannabis legalization in October 2018, Canada imposed an excise tax of 10% (or $1 a gram, whichever is higher) on both recreational and medical cannabis. There is little evidence to inform the ongoing debate on whether the legalization had adverse impacts on medical cannabis use. Methods: We used an interrupted time series design and data on medical cannabis shipments (i.e., mail-order deliveries of cannabis from a licensed producer to a patient authorized to obtain medical cannabis) in Canada between quarter 1 of 2014 and quarter 1 of 2020. We examined changes in medical cannabis shipments after Canada's recreational cannabis legalization both across Canada and for each province. As this study used publicly available, province-level aggregate data, ethics approval was not required. Results: Recreational cannabis legalization was associated with significant reductions in medical cannabis use in 7 out of 10 Canadian provinces. Compared with the counterfactual estimated from prelegalization trends, the reduction in quarter 1 of 2020 varied from 500 shipments per 100,000 population (95% CI=312-688 shipments per 100,000 population) or 32% (95% CI=22-43%) in Newfoundland and Labrador to 3,778 shipments per 100,000 population (95% CI=2,972-4,585 shipments per 100,000 population) or 74% (95% CI=68-79%) in Alberta. At the national level, the number of medical cannabis shipments decreased by 823 per 100,000 population (95% CI=725-921 shipments per 100,000 population) or 48% (95% CI=45-52%). Conclusions: Recreational cannabis legalization was associated with reductions in medical cannabis use. Our findings call for policy attention to address possible adverse impacts of recreational cannabis legalization on medical cannabis users.
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Affiliation(s)
- Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, Canada
| | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Shweta Mital
- School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, Canada
| | - Lisa Bishop
- School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, Canada
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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12
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Cummings H, Ul Haq MZ, Dargham A, Shakeel N, Busse JW, Darzi AJ, Alvarez E. Individuals' Values and Preferences Regarding Medical Cannabis for Chronic Pain: A Descriptive Qualitative Study. J Pain Res 2024; 17:21-34. [PMID: 38192366 PMCID: PMC10771731 DOI: 10.2147/jpr.s432823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Background Cannabis for medical purposes has been legal in Canada since 2001; however, physicians receive no formal training in this modality, and clinical use of cannabis remains controversial. This study aims to explore the values and preferences of people living with chronic pain (PLwCP) in using medical cannabis for chronic pain to inform guideline development and shared decision-making in clinical practice. Methods We conducted a descriptive qualitative study using in-depth interviews with PLwCP. Using a deductive/inductive approach, we developed concepts and themes related to values and preferences of PLwCP on their use (or avoidance) of medical cannabis for chronic pain. Results We interviewed 52 PLwCP, including current medical cannabis users (40), previous users (10) and non-users (2). Most PLwCP who used cannabis therapeutically reported the need for experimentation to determine what cannabis products, routes, and doses worked for them. Perceived benefits of medical cannabis among current users included relief from pain, better sleep, and improved mental health. Reasons for discontinuing use of medical cannabis included lack of improvement in pain or sleep or undesirable side effects. Cannabidiol (CBD) dominant products were reported to result in minimal adverse effects (eg, physical or mental impairment) compared to tetrahydrocannabinol (THC) dominant products. Perceived barriers or facilitators to use included social acceptability, availability or access, cost, and attitudes and knowledge among healthcare providers. Participants noted different routes of cannabis use including oral routes that provided longer-lasting pain relief with a slower onset and inhaled routes with a more rapid onset with shorter-lived effects. Conclusion Participants' decisions to use medical cannabis for chronic pain were varied, which suggests these decisions are likely to be sensitive to individuals' values and preferences. There is a call for further research and information-sharing to help PLwCP understand the complexities of cannabis use for medical purposes, including ideal dosing and timing.
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Affiliation(s)
- Hanson Cummings
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Moizza Zia Ul Haq
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Amne Dargham
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nauman Shakeel
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
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13
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Freitag EW, Zolotov Y, Annam J, Labins J, Yamada JM, Jillani SM, Arnsten JH, Slawek DE. Available but inaccessible: patient experiences during the first 2 years of a primary care-based medical cannabis program at an academic medical center. Harm Reduct J 2024; 21:1. [PMID: 38166921 PMCID: PMC10763347 DOI: 10.1186/s12954-023-00919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Medical cannabis use and public acceptance in the United States have increased over the past 25 years. However, access to medical cannabis remains limited, particularly for underserved populations. To understand how patients experience medical cannabis accessibility, we measured medical cannabis use and barriers to use after medical cannabis certification in an urban safety-net academic medical center. METHODS We conducted a retrospective cohort study among patients seen in Montefiore's Medical Cannabis Program (MMCP) from 2017 to 2019. Patient demographic and clinical characteristics, as well purchase history of medical cannabis, were extracted from electronic medical records. We also administered a phone questionnaire to a subset of patients to assess usage patterns, effectiveness, and barriers to medical cannabis use. RESULTS Among 562 patients who were newly certified for medical cannabis between 2017 and 2019, 45% purchased medical cannabis, while 55% did not. Patients who purchased medical cannabis were more likely to be white and have private insurance or Medicare. Unregulated cannabis use and current tobacco use were less common among those who purchased medical cannabis. In multivariable logistic regression analysis, unregulated cannabis use remained negatively associated with purchasing medical cannabis. Patients reported that affordability and dispensary accessibility were their main barriers to purchasing medical cannabis. CONCLUSION Among patients certified for medical cannabis use, fewer than half purchased medical cannabis after certification. Improving access to medical cannabis is crucial for ensuring equitable access to regulated cannabis, and to reducing unregulated cannabis use.
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Affiliation(s)
| | - Yuval Zolotov
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Jayabhargav Annam
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Jaqueline Labins
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Jaclyn M Yamada
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Syeda Masharab Jillani
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Deepika E Slawek
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA.
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14
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Scott JR, Williams DA, Harte SE, Harris RE, Litinas E, Sisley S, Clauw DJ, Boehnke KF. Relationship Between Nociplastic Pain Involvement and Medication Use, Symptom Relief, and Adverse Effects Among People Using Medical Cannabis for Chronic Pain. Clin J Pain 2024; 40:1-9. [PMID: 37823303 DOI: 10.1097/ajp.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Cannabis is increasingly being used for chronic pain management, but cannabis' effects remain poorly characterized in chronic nociplastic pain (NPP), which is posited to be caused by disturbances in nervous system pain processing. In this cross-sectional study (n=1213), we used the 2011 Fibromyalgia (FM) Survey Criteria as a surrogate measure for degree of NPP among individuals using medical cannabis for chronic pain. METHODS Using a quartile-split, we investigated associations between the degree of NPP and medication use, cannabis use characteristics, and symptom relief. Continuous variables were assessed using one-way analysis of variance and categorical variables with Pearson χ 2 test and binomial logistic regression for calculation of odds ratios. RESULTS Participants were predominately female (59%), with a mean ± SD age of 49.4±13.6 years. Higher FM scores were associated with less self-reported improvement in pain and health since initiating medical cannabis use, as well as more cannabis-related side effects. Paradoxically, higher FM scores were also associated with higher usage of concomitant medication use (including opioids and benzodiazepines) but also with substituting cannabis for significantly more medication classes, including opioids and benzodiazepines. DISCUSSION This article presents evidence that individuals in higher NPP quartiles have higher analgesic intake, higher odds of substituting cannabis for medications, higher side effect burden, and lower therapeutic effect from cannabis. These seemingly contradictory findings may reflect higher symptom burden, polypharmacy at baseline, or that NPP may be challenging to treat with cannabis. Further research is necessary to further explain cannabinoid effects in NPP.
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Affiliation(s)
- J Ryan Scott
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | | | | | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Kevin F Boehnke
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
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15
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Boehnke KF, Wu CL, Clauw DJ. Thoughtfully Integrating Cannabis Products Into Chronic Pain Treatment. Anesth Analg 2024; 138:5-15. [PMID: 38100797 PMCID: PMC10730114 DOI: 10.1213/ane.0000000000005904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Cannabis products (CPs) and cannabis-based medicines (CBMs) are becoming increasingly available and are commonly used for pain management. The growing societal acceptance of cannabis and liberalization of cannabis laws allows patients to access CPs with minimal clinical oversight. While there is mechanistic plausibility that CPs and CBMs may be useful for pain management, the clinical trial literature is limited and does not refute or support the use of CBMs for pain management. Complicating matters, a large and growing body of observational literature shows that many people use CPs for pain management and in place of other medications. However, products and dosing regimens in existing trials are not generalizable to the current cannabis market, making it difficult to compare and reconcile these 2 bodies of literature. Given this complexity, clinicians need clear, pragmatic guidance on how to appropriately educate and work with patients who are using CBMs for pain management. In this review, we narratively synthesize the evidence to enable a clear view of current landscape and provide pragmatic advice for clinicians to use when working with patients. This advice revolves around 3 principles: (1) maintaining the therapeutic alliance; (2) harm reduction and benefit maximization; and (3) pragmatism, principles of patient-centered care, and use of best clinical judgment in the face of uncertainty. Despite the lack of certainty CPs and chronic pain management use, we believe that following these principles can make most of the clinical opportunity presented by discussions around CPs and also enhance the likelihood of clinical benefit from CPs.
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Affiliation(s)
- Kevin F. Boehnke
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher L. Wu
- Department of Anesthesiology, Pain Medicine and Critical Care; Hospital for Special Surgery; New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel J. Clauw
- Anesthesiology Department, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
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16
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Canals PC, Aguilar AG, Carter GT, Shields CM, Westerkamp A, D'Elia M, Aldrich J, Moore RN, Moore AT, Piper BJ. Patient Reported Outcomes Using Medical Cannabis for Managing Pain in Charcot-Marie-Tooth Disease. Am J Hosp Palliat Care 2023; 40:1163-1167. [PMID: 36793224 DOI: 10.1177/10499091231158388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Objective: Chronic pain is a major problem for patients with Charcot-Marie-Tooth (CMT) disease. This exploratory study examined patient reported efficacy of medical cannabis for pain management in this population. Methods: Participants (N = 56; 71.4% female; Age = 48.9, SD = 14.6; 48.5% CMT1) were recruited though the Hereditary Neuropathy Foundation. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects. Results: Nearly all (90.9%) of respondents reported experiencing pain, including all (100%) females and 72.7% of males (chi-square P < .05) with 91.7% of respondents indicating cannabis provided at least 50% pain relief. The most frequent response was an 80% reduction in pain. Moreover, 80.0% of respondents reported using less opiates, 69% noted using less sleep medication, and 50.0% reported using less anxiety/antidepressant medications. Negative side effects were noted by 23.5% of respondents. However, almost all (91.7%) of that subgroup did not have plans to stop consuming cannabis. One-third (33.9%) possessed a medical cannabis certificate. Patient perceptions of their physicians' attitudes regarding patient medical cannabis use greatly impacted whether respondents informed their providers of their usage. Conclusion: The vast majority of patients with CMT reported that cannabis was effective to manage pain symptoms. These data support the need for prospective, randomized, controlled trials using standardized dosing protocols to further delineate and optimize the potential use of cannabis to treat pain related to CMT.
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Affiliation(s)
- Priscilla C Canals
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Alexia G Aguilar
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Gregory T Carter
- Providence St Luke's Rehabilitation Medical Center, Hereditary Neuropathy Foundation Center of Excellence, Spokane, WA, USA
| | | | | | | | - Joy Aldrich
- Hereditary Neuropathy Foundation, New York, NY, USA
| | | | | | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
- Center for Pharmacy Innovation and Outcomes, Precision Health Center, Forty Fort, PA, USA
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17
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Nguyen JD, Grant Y, Yang C, Gutierrez A, Taffe MA. Oxycodone Self-Administration in Female Rats is Enhanced by ∆ 9-tetrahydrocannabinol, but not by Cannabidiol, in a Progressive Ratio Procedure. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.26.564282. [PMID: 37961225 PMCID: PMC10634900 DOI: 10.1101/2023.10.26.564282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Epidemiological evidence suggests that the legalization of cannabis may reduce opioid-related harms. Preclinical evidence of neuropharmacological interactions of endogenous cannabinoid and opioid systems prompts further investigation of cannabinoids as potential therapeutics for the non-medical use of opioids. In these studies female rats, previously trained to self-administer oxycodone (0.15 mg/kg/infusion) intravenously in 6 h sessions, were allowed to self-administer oxycodone after exposure to cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) by vapor inhalation and THC by injection (5.0-20 mg/kg, i.p.). Self-administration was characterized under Progressive Ratio (PR) and Fixed Ratio (FR) 1 schedules of reinforcement in 3 h sessions. THC decreased IVSA of oxycodone in a FR procedure but increased reward seeking in a PR procedure. CBD decreased the IVSA of oxycodone in the FR but not the PR procedure. The results are consistent with an anti-reward effect of CBD but suggest THC acts to increase the reinforcing efficacy of oxycodone in this procedure.
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Affiliation(s)
- Jacques D. Nguyen
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Yanabel Grant
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
| | - Celine Yang
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
| | - Arnold Gutierrez
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
| | - Michael A. Taffe
- Department of Psychiatry, University of California, San Diego; La Jolla, CA, USA
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18
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Boehnke KF, Martel MO, Smith T, He Y, Bergmans RS, Kruger DJ, Andwele M, Bevan S, Williams DA, Fitzcharles M. Medicinal Cannabis Use for Rheumatic Conditions in the US Versus Canada: Rationale for Use and Patient-Health Care Provider Interactions. ACR Open Rheumatol 2023; 5:443-453. [PMID: 37519131 PMCID: PMC10502834 DOI: 10.1002/acr2.11592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Understanding how medical cannabis (MC) use is integrated into medical practice for rheumatic disease management is essential. We characterized rationale for MC use, patient-physician interactions around MC, and MC use patterns among people with rheumatic conditions in the US and Canada. METHODS We surveyed 3406 participants with rheumatic conditions in the US and Canada, with 1727 completing the survey (50.7% response rate). We assessed disclosure of MC use to health care providers, MC authorization by health care providers, and MC use patterns and investigated factors associated with MC disclosure to health care providers in the US versus Canada. RESULTS Overall, 54.9% of US respondents and 78.0% of Canadians reported past or current MC use, typically because of inadequate symptom relief from other medications. Compared to those in Canada, fewer US participants obtained MC licenses, disclosed MC use to their health care providers, or asked advice on how to use MC (all P values <0.001). Overall, 47.4% of Canadian versus 28.2% of US participants rated their medical professionals as their most trusted information source. MC legality in state of residence was associated with 2.49 greater odds of disclosing MC use to health care providers (95% confidence interval: 1.49-4.16, P < 0.001) in the US, whereas there were no factors associated with MC disclosure in Canada. Our study is limited by our convenience sampling strategy and cross-sectional design. CONCLUSION Despite widespread availability, MC is poorly integrated into rheumatic disease care, with most patients self-directing use with minimal or no clinical oversight. Concerted efforts to integrate MC into education and clinical policy is critical.
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Affiliation(s)
| | | | | | - Ying He
- University of MichiganAnn Arbor
| | | | | | | | - Sian Bevan
- Arthritis Society CanadaTorontoOntarioCanada
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19
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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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20
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Kaufmann CN, Malhotra A, Yang KH, Han BH, Nafsu R, Lifset ET, Nguyen K, Sexton M, Moore AA. Cannabis use for Sleep Disturbance Among Older Patients in a Geriatrics Clinic. Int J Aging Hum Dev 2023; 97:3-17. [PMID: 36226368 PMCID: PMC10097827 DOI: 10.1177/00914150221128971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cannabis use is growing among older adults to manage medical concerns including poor sleep. In this study, we characterized how patients seen at a geriatrics clinic use cannabis to address sleep disturbance. Specifically, we conducted an anonymous survey of 568 adults, including 83 who reported cannabis use within the past 3 years, to inquire about such use. We compared cannabis use characteristics between those using it for sleep disturbance versus all other conditions. We considered a p-value <.10 to be statistically significant. Among the cannabis users in our sample, 29% reported using cannabis for sleep disturbance (N = 24). They were more likely than other users to be female (p = .07), consume cannabis more frequently (p = .01), use products containing tetrahydrocannabinol (THC) (vs. cannabidiol [CBD]-only; p < .01), and use cannabis to target more symptoms (p < .01). As cannabis use continues to grow in older populations, it is essential to delineate better how cannabis may be used safely and effectively to improve older adults' sleep health.
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Affiliation(s)
- Christopher N. Kaufmann
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Atul Malhotra
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kevin H. Yang
- Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego, La Jolla, CA, USA
| | - Benjamin H. Han
- Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego, La Jolla, CA, USA
| | - Reva Nafsu
- Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego, La Jolla, CA, USA
| | - Ella T. Lifset
- Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego, La Jolla, CA, USA
| | - Khai Nguyen
- Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego, La Jolla, CA, USA
| | - Michelle Sexton
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Alison A. Moore
- Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego, La Jolla, CA, USA
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21
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Cooke ME, Potter KW, Jashinski J, Pascale M, Schuster RM, Tervo-Clemmens B, Hoeppner BB, Pachas GN, Evins AE, Gilman JM. Development of cannabis use disorder in medical cannabis users: A 9-month follow-up of a randomized clinical trial testing effects of medical cannabis card ownership. Front Psychiatry 2023; 14:1083334. [PMID: 36960460 PMCID: PMC10027723 DOI: 10.3389/fpsyt.2023.1083334] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
Background Evidence for long-term effectiveness of commercial cannabis products used to treat medical symptoms is inconsistent, despite increasingly widespread use. Objective To prospectively evaluate the effects of using cannabis on self-reported symptoms of pain, insomnia, anxiety, depression, and cannabis use disorder (CUD) after 12 months of use. Methods This observational cohort study describes outcomes over 9 months following a 12-week randomized, waitlist-controlled trial (RCT: NCT03224468) in which adults (N = 163) who wished to use cannabis to alleviate insomnia, pain, depression, or anxiety symptoms were randomly assigned to obtain a medical marijuana card immediately (immediate card acquisition group) or to delay obtaining a card for 12 weeks delay (delayed card acquisition group). During the 9-month post-randomization period, all participants could use cannabis as they wished and choose their cannabis products, doses, and frequency of use. Insomnia, pain, depression, anxiety, and CUD symptoms were assessed over the 9-month post-randomization period. Results After 12 months of using cannabis for medical symptoms, 11.7% of all participants (n = 19), and 17.1% of those using cannabis daily or near-daily (n = 6) developed CUD. Frequency of cannabis use was positively correlated with pain severity and number of CUD symptoms, but not significantly associated with severity of self-reported insomnia, depression, or anxiety symptoms. Depression scores improved throughout the 9 months in all participants, regardless of cannabis use frequency. Conclusions Frequency of cannabis use was not associated with improved pain, anxiety, or depression symptoms but was associated with new-onset cannabis use disorder in a significant minority of participants. Daily or near-daily cannabis use appears to have little benefit for these symptoms after 12 months of use.
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Affiliation(s)
- Megan E. Cooke
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Kevin W. Potter
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Julia Jashinski
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Michael Pascale
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Randi M. Schuster
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Brenden Tervo-Clemmens
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Bettina B. Hoeppner
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Gladys N. Pachas
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - A. Eden Evins
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jodi M. Gilman
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
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22
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Shah S, Schwenk ES, Sondekoppam RV, Clarke H, Zakowski M, Rzasa-Lynn RS, Yeung B, Nicholson K, Schwartz G, Hooten WM, Wallace M, Viscusi ER, Narouze S. ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids. Reg Anesth Pain Med 2023; 48:97-117. [PMID: 36596580 DOI: 10.1136/rapm-2022-104013] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear. METHODS In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement. RESULTS Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes. CONCLUSIONS Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.
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Affiliation(s)
- Shalini Shah
- Dept of Anesthesiology & Perioperative Care, UC Irvine Health, Orange, California, USA
| | - Eric S Schwenk
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Hance Clarke
- Anesthesiology and Pain Medicine, Univ Toronto, Toronto, Ontario, Canada
| | - Mark Zakowski
- Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Brent Yeung
- Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, USA
| | | | - Gary Schwartz
- AABP Integrative Pain Care, Melville, New York, USA.,Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Mark Wallace
- Anesthesiology, Division of Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Eugene R Viscusi
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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23
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Suraev A, Mills L, Abelev SV, Arkell TR, Lintzeris N, McGregor IS. Medical Cannabis Use Patterns for Sleep Disorders in Australia: Results of the Cross-Sectional CAMS-20 Survey. Nat Sci Sleep 2023; 15:245-255. [PMID: 37090897 PMCID: PMC10120832 DOI: 10.2147/nss.s390583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/20/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Sleep disorders are the third most common indication for the prescription of medical cannabis products in Australia, after pain and anxiety. While the use of cannabis for medical purposes is growing in Australia, underlying consumer behaviours and patterns of use, particularly around sleep disorders, are poorly understood. Methods We conducted a subanalysis of the cross-sectional "Cannabis as Medicine Survey" 2020-2021 (CAMS-20) (N = 1600), to explore the characteristics of a sample of Australians who were using prescribed and/or illicit medical cannabis to treat a self-reported sleep disorder. Results When asked to specify up to seven different conditions they were treating with medical cannabis, a total of 1030 (64%) respondents [mean (SD) 44.9 (13.6) years] selected a sleep disorder, with "insomnia disorder" (85.5%), 'sleep-related movement disorders' (26%) and 'sleep-related breathing disorders' (11.1%) the most common subtypes. Only 165 (16.8%) respondents selected a self-reported sleep disorder as the main health condition being treated. Relative to other health conditions, use of medical cannabis for a self-reported sleep disorder was associated with younger age, increased likelihood of using both prescribed and illicit forms of medical cannabis, inhaled routes of administration, and THC-dominant products. Most respondents reported a reduction in the use of benzodiazepines and alcohol since starting medical cannabis. Binary logistic regression showed that respondents who predominantly used inhaled routes of administration, and concomitant use of medical cannabis for pain, mental health and/or substance use disorder, or a gastrointestinal disorder, were significantly more likely to also use medical cannabis to treat a self-reported sleep disorder. Conclusion Overall, these results suggest that self-reported sleep disorders are often being treated with medical cannabis alongside other health conditions (often pain or a mental health disorder) and that use of inhaled methods, THC-dominant products, and illicit sources of medical cannabis are common among people with self-reported sleep disorders in Australia.
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Affiliation(s)
- Anastasia Suraev
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
| | - Llewellyn Mills
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, NSW, Australia
- Department of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah V Abelev
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
| | - Thomas R Arkell
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, NSW, Australia
- Department of Addiction Medicine, Faculty Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Iain S McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, NSW, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- Correspondence: Iain S McGregor, The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Level 6, Building M02F, 94 Mallett Street Camperdown, Sydney, NSW, 2050, Australia, Tel +612 9351 0883, Email
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24
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Clarke H, Fitzcharles M. The evolving culture of medical cannabis in Canada for the management of chronic pain. Front Pharmacol 2023; 14:1153584. [PMID: 37089954 PMCID: PMC10119390 DOI: 10.3389/fphar.2023.1153584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
Although used therapeutically for millennia, cannabis has been a prohibited substance worldwide for most of the 20th Century. With revision of prohibitive regulations in many jurisdictions during the past 2 decades, cannabis is increasingly available to patients as a potential treatment option for various symptoms. Pain relief, sleep promotion and alleviation of distress, depression and anxiety are the most common reasons for cannabis use. Canada has been at the forefront of medical cannabis (MC) legislation revisions to enable and facilitate access for therapeutic use. Although initially viewed with caution and stigma, attitudes to cannabis in general have changed. Medical cannabis is identified as the herbal plant product sourced from a grower/producer and is not at present a regulated pharmaceutical product. Medical cannabis use is currently prevalent in Canada but has bypassed the rigorous study required for usual drug approval. Although uptake has been enthusiastic by patients, the medical community has voiced cautions and concerns. Access to medical cannabis is fairly easy once an approval document is obtained from a healthcare professional, but without obligation for medical or pharmacy oversight. The greatest concern is a dearth of sound clinical evidence for effects and harms. Emerging concerns include prevalent patient self-management with information based on personal research, an abundance of on-line information which may not always be accurate, the emergence of designated "cannabis clinics," potential risks to society due to accidents, and high cost of the legal medical product leading to access via the recreational market. With cannabis now entrenched in Canadian healthcare, physicians must be sufficiently knowledgeable to provide guidance that is evidence-based and will ensure personal and societal harm reduction. Examination of the changing culture of medical cannabis in Canada will provide insight for countries that may be anticipating similar revisions of cannabis regulations to allow cannabis access for their patient population and learn from the issues created by recreational legalization.
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Affiliation(s)
- H. Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, ON, Canada
| | - M. Fitzcharles
- Department of Rheumatology, McGill University, Montreal, QC, Canada
- Alan Edwards Pain Management Unit, McGill University, Montreal, QC, Canada
- *Correspondence: M. Fitzcharles,
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25
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Holman A, Kruger DJ, Lucas P, Ong K, Bergmans RS, Boehnke KF. Healthcare provider and medical cannabis patient communication regarding referral and medication substitution: the Canadian context. J Cannabis Res 2022; 4:32. [PMID: 35698183 PMCID: PMC9195481 DOI: 10.1186/s42238-022-00141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background Patients use medical cannabis for a wide array of illnesses and symptoms, and many substitute cannabis for pharmaceuticals. This substitution often occurs without physician oversight, raising patient safety concerns. We aimed to characterize substitution and doctor-patient communication patterns in Canada, where there is a mature market and national regulatory system for medical cannabis. Methods We conducted an anonymous, cross-sectional online survey in May 2021 for seven days with adult Canadian federally-authorized medical cannabis patients (N = 2697) registered with two global cannabis companies to evaluate patient perceptions of Primary Care Provider (PCP) knowledge of medical cannabis and communication regarding medical cannabis with PCPs, including PCP authorization of licensure and substitution of cannabis for other medications. Results Most participants (62.7%, n = 1390) obtained medical cannabis authorization from their PCP. Of those who spoke with their PCP about medical cannabis (82.2%, n = 2217), 38.6% (n = 857) reported that their PCP had “very good” or “excellent” knowledge of medical cannabis and, on average, were moderately confident in their PCP’s ability to integrate medical cannabis into treatment. Participants generally reported higher ratings for secondary care providers, with 82.8% (n = 808) of participants rating their secondary care provider’s knowledge about medical cannabis as “very good” or “excellent.” Overall, 47.1% (n = 1269) of participants reported substituting cannabis for pharmaceuticals or other substances (e.g., alcohol, tobacco/nicotine). Of these, 31.3% (n = 397) reported a delay in informing their PCP of up to 6 months or more, and 34.8% (n = 441) reported that their PCP was still not aware of their substitution. Older, female participants had higher odds of disclosing cannabis substitution to their PCPs. Conclusion Most of the surveyed Canadian medical cannabis patients considered their PCPs knowledgeable about cannabis and were confident in their PCPs’ ability to integrate cannabis into treatment plans. However, many surveyed patients substituted cannabis for other medications without consulting their PCPs. These results suggest a lack of integration between mainstream healthcare and medical cannabis that may be improved through physician education and clinical experience. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-022-00141-0.
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26
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Townsend CB, Liss F, Langman C, Mazur D, Stache SA, Sharma S, Stolzenberg DS, Srinivasan M, Pedowitz D, Namdari S, Wang ML, Greis AC, Ilyas AM. Perspectives of Orthopedic Patients on Medical Cannabis: A Survey of More Than 2500 Patients. Orthopedics 2022; 45:e309-e314. [PMID: 36098574 DOI: 10.3928/01477447-20220907-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nationwide perspectives on cannabis have changed dramatically over recent decades. Although cannabis remains illegal at the federal level, medical cannabis (MC) is now legal in most states, and research has continued to show its effectiveness in a variety of medical conditions. However, both perception and acceptance of MC by the general public are evolving and remain poorly understood. Treating patients effectively with these novel therapeutics requires an understanding of the complex interplay of social and legal factors that could affect patient use. This cross-sectional survey study of more than 2500 patients sought to assess current patient perspectives on MC and to investigate factors related to its use that may represent barriers to broader patient use. Most respondents would consider using MC for chronic pain or other medical conditions. Most respondents were aware of the legal status of MC in their state, and 9 of 10 respondents believed that MC should be legal throughout the United States. General public knowledge of the utility of MC is an area needing improvement because older patients were significantly less likely to believe that MC is safe to use or that MC is safer than prescription opioids. As has been reported in previous literature, social stigma and cost appear to remain barriers for patient use of MC. Our findings provide further insight into current patient perspectives on MC, aiding both medical providers and researchers as we continue to provide access to and research MC. [Orthopedics. 2022;45(6):e309-e314.].
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27
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Kimless D, Caloura M, Markos V, Ryan J, Abbonizio S, Janicki S. An Observational Cross-Sectional Survey Exploring the Indications for and Responses to Medical Marijuana Use in Certified Patients in Pennsylvania. J Prim Care Community Health 2022; 13:21501319221129734. [PMID: 36226444 PMCID: PMC9561639 DOI: 10.1177/21501319221129734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Medical cannabis programs across the country vary and differ in their qualifying conditions for medical cannabis use. This has led to a gap in knowledge regarding the specific needs of cannabis patients, including the most common reason patients seek medical cannabis. The purpose of this study was to examine the current needs of medical cannabis patients in order to better inform future research, and to evaluate potential needs in policy changes in states with more restrictive qualifying conditions for medical cannabis use. METHODS A cross-sectional survey study was administered (n = 207) at a Laurel Harvest Labs dispensary in Pennsylvania. Participants were qualified medical cannabis users and were recruited as a convenience sample when entering the dispensary. The survey asked questions regarding participant demographics, medical cannabis qualifying conditions, usage, methods of administration, adverse effects, tolerance, and impact of medical cannabis on medication, alcohol, and tobacco use. Chi-squared or Fisher's exact tests were conducted for analyses involving categorical data. RESULTS The mean age of respondents was 36.7 years (SD = 12.8), and the majority were male (61.4%) and white (84.7%). Respondents self-reported that anxiety disorder was the most common qualifying medical condition and the most common comorbid condition (50.1%; 69.3%) for medical cannabis use. Additionally, approximately 95% of users reported having no adverse effects from using medical cannabis, and 90% of users preferred inhalation through vaporization as the preferred method of consumption. More than 50% of participants reported an improvement in their symptoms where only 20% of users reported being tolerant to their current dose. More than 70% of respondents reported that obtaining medical cannabis was "easy" and 54% of users reported that the cost of medical cannabis was not a barrier to access. CONCLUSIONS Anxiety disorder is a prevalent condition for which medical cannabis is used; however, many states do not recognize anxiety disorder as a qualifying condition for medical cannabis. Further research on medical cannabis use for anxiety disorders is needed to evaluate proper dosing and responses to treatment.
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Affiliation(s)
| | - Matthew Caloura
- Laurel Harvest Labs, Lancaster, PA,
USA,Matthew Caloura, Laurel Harvest Labs, 119 S
Tree Drive, Lancaster, PA 17601, USA.
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28
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Lavender I, McGregor IS, Suraev A, Grunstein RR, Hoyos CM. Cannabinoids, Insomnia, and Other Sleep Disorders. Chest 2022; 162:452-465. [PMID: 35537535 DOI: 10.1016/j.chest.2022.04.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/20/2023] Open
Abstract
Sleep disturbances are often cited as a primary reason for medicinal cannabis use, and there is increasing clinical interest in the therapeutic potential of cannabinoids in treating sleep disorders. Burgeoning evidence suggests a role of the endocannabinoid system in regulating the circadian sleep-wake cycle, highlighting a potential avenue for developing novel therapeutics. Despite widespread use of cannabis products as sleep aids globally, robustly designed studies verifying efficacy in sleep-disordered populations are limited. Although some study outcomes have suggested cannabinoid utility in insomnia disorder and sleep apnea, most studies to date are limited by small sample sizes, lack of rigorously controlled study designs, and high risk of bias. This critical review summarizes the current evidence for the use of cannabinoids as a treatment for sleep disorders and provides an overview of endocannabinoid modulation of sleep-wake cycles, as well as the sleep-modulating effects of plant-derived cannabinoids such as delta-9-tetrahydrocannbinol, cannabidiol, and cannabinol. The review also discusses practical considerations for clinicians regarding cannabinoid formulations, routes of administration, respiratory concerns, dosing, potential side effects, drug interactions, and effects relevant to driving, tolerance, and withdrawal. Although current interest in, and uptake of, medicinal cannabis use for sleep disorders may have surpassed the evidence base, there is a strong rationale for continued investigation into the therapeutic potential of cannabinoids.
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Affiliation(s)
- Isobel Lavender
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia; Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Iain S McGregor
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia; Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Anastasia Suraev
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia; Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
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29
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Zongo A, Lee C, El-Mourad J, Dyck JRB, Hyshka E, Hanlon JG, Eurich DT. Substance Use Disorders and Psychoactive Drug Poisoning in Medically Authorized Cannabis Patients: Longitudinal Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:544-552. [PMID: 34806435 PMCID: PMC9234898 DOI: 10.1177/07067437211060597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Poisoning from psychoactive drugs and substance use disorders (SUD) have been reported among non-medical cannabis users. However, little is known about medical cannabis users and their risk for poisoning and/or development of SUD. This study assessed the risk of emergency department (ED) visits or hospitalization for 1) poisoning by psychoactive drugs and 2) mental/behavioural disorders due to the use of psychoactive drugs and other substances, in medically authorized cannabis patients in Ontario, Canada from 2014-2017. METHODS A cohort study of adult patients authorized for medical cannabis that were matched to population-based controls. ED visit/hospitalization were assessed with a main diagnostic code for: 1) poisoning by psychoactive drugs; 2) mental and behavioural disorder due to psychoactive drugs or other substance use. Conditional Cox proportional hazards regressions were conducted. RESULTS 18,653 cannabis patients were matched to 51,243 controls. During a median follow-up of 243 days, the incidence rate for poisoning was 4.71 per 1,000 person-years (95%CI: 3.71-5.99) for cases and 1.73 per 1,000 person-years (95% CI: 1.36-2.19) for controls. The adjusted hazard ratio (aHR) was 2.45 (95%CI: 1.56-3.84). For mental/behavioural disorders, the incident rates were 8.89 (95% CI: 7.47-10.57) and 5.01 (95% CI: 4.36-5.76) in the cannabis and the controls group. The aHR was 2.27 (95%CI: 1.66-3.11). No difference was observed between males and females (P-value for interaction > 0.05). CONCLUSIONS Our study observed a short-term increased risk of ED visit/hospitalization for poisoning or for mental/behavioural disorders (from use of psychoactive drugs and other substances)- in medically authorized cannabis patients.
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Affiliation(s)
- Arsène Zongo
- Faculty of Pharmacy, 4440Université Laval, Quebec City, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, Canada
| | - Cerina Lee
- School of Public Health, 3158University of Alberta, Edmonton, Canada
| | - Jihane El-Mourad
- Faculty of Pharmacy, 4440Université Laval, Quebec City, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, 3158University of Alberta, Edmonton, Canada
| | - Elaine Hyshka
- School of Public Health, 3158University of Alberta, Edmonton, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, 177410University of Toronto, Ontario, Canada.,Department of Anaesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Dean T Eurich
- School of Public Health, 3158University of Alberta, Edmonton, Canada
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Troup LJ, Erridge S, Ciesluk B, Sodergren MH. Perceived Stigma of Patients Undergoing Treatment with Cannabis-Based Medicinal Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127499. [PMID: 35742748 PMCID: PMC9223559 DOI: 10.3390/ijerph19127499] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 01/19/2023]
Abstract
Cannabis-based medicinal products (CBMPs) are prescribed with increasing frequency. This study aimed to investigate the perceived stigma attached to patients prescribed CBMPs in the UK to establish its prevalence. A qualitative survey was developed by an expert multidisciplinary group and data were collected via Qualtrics. In total, 2319 patients on CBMP therapy were invited to take part in this study. 450 (19.4%) participants completed the questionnaire. In total, 81.3% (n = 366), 76.9% (n = 346), and 61.3% (n = 276) of participants reported feeling very comfortable or comfortable telling friends, family, and medical professionals, respectively, about their treatment. Participants thought that friends (n = 372; 82.7%) and family (n = 339; 75.3%) were very approving or somewhat approving of their CBMP prescription. However, participants thought that only 37.8% (n = 170) of healthcare professionals and 32.9% (n = 148) of society in general were very approving or somewhat approving of their CBMP prescription. 57.1% (n = 257), 55.3% (n = 249), and 40.2% (n = 181) of participants were afraid of what the police or criminal justice system, other government agencies, and healthcare professionals might think about their treatment. This study highlights those patients treated with CBMPs experience a high prevalence of perceived stigma from many corners of society. Future work should be undertaken to explore strategies to reduce perceived stigma at an individual and community level to avoid discrimination of patients, likely increasing appropriate access.
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Affiliation(s)
- Lucy J. Troup
- Division of Psychology, School of Education and Social Sciences, University of the West of Scotland, Paisley PA1 2BE, UK;
- Correspondence:
| | - Simon Erridge
- Medical Cannabis Research Group, Imperial College London, London SW7 2BX, UK; (S.E.); (M.H.S.)
- Sapphire Medical Clinics, London W1G 9PF, UK
| | - Beata Ciesluk
- Division of Psychology, School of Education and Social Sciences, University of the West of Scotland, Paisley PA1 2BE, UK;
| | - Mikael H. Sodergren
- Medical Cannabis Research Group, Imperial College London, London SW7 2BX, UK; (S.E.); (M.H.S.)
- Sapphire Medical Clinics, London W1G 9PF, UK
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31
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Panday J, Taneja S, Popoola A, Pack R, Greyson D, McDonald SD, Black M, Murray-Davis B, Darling E, Vanstone M. Clinician responses to cannabis use during pregnancy and lactation: a systematic review and integrative mixed-methods research synthesis. Fam Pract 2022; 39:504-514. [PMID: 34791187 PMCID: PMC9155166 DOI: 10.1093/fampra/cmab146] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Perinatal cannabis use is increasing, and clinician counselling is an important aspect of reducing the potential harm of cannabis use during pregnancy and lactation. To understand current counselling practices, we conducted a systematic review and integrative mixed-methods synthesis to determine "how do perinatal clinicians respond to pregnant and lactating patients who use cannabis?" METHODS We searched 6 databases up until 2021-05-31. Eligible studies described the attitudes, perceptions, or beliefs of perinatal clinician about cannabis use during pregnancy or lactation. Eligible clinicians were those whose practice particularly focusses on pregnant and postpartum patients. The search was not limited by study design, geography, or year. We used a convergent integrative analysis method to extract relevant findings for inductive analysis. RESULTS Thirteen studies were included; describing perspectives of 1,366 clinicians in 4 countries. We found no unified approach to screening and counselling. Clinicians often cited insufficient evidence around the effects of perinatal cannabis use and lacked confidence in counselling about use. At times, this meant clinicians did not address cannabis use with patients. Most counselled for cessation and there was little recognition of the varied reasons that patients might use cannabis, and an over-reliance on counselling focussed on the legal implications of use. CONCLUSION Current approaches to responding to cannabis use might result in inadequate counselling. Counselling may be improved through increased education and training, which would facilitate conversations to mitigate the potential harm of perinatal cannabis use while recognizing the benefits patients perceive.
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Affiliation(s)
- Janelle Panday
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Shipra Taneja
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Anuoluwa Popoola
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Rachael Pack
- Center for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Devon Greyson
- Department of Communication, University of Massachusetts Amherst, Amherst, United States.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada.,Department of Radiology, McMaster University, Hamilton, Canada
| | - Morgan Black
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Beth Murray-Davis
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada.,Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Canada
| | - Elizabeth Darling
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada.,Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada.,Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, McMaster University, Hamilton, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Canada
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32
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Charoenporn V, Charernboon T, Mackie CJ. Medical Cannabis as a Substitute for Prescription Agents: A Systematic Review and Meta-analysis. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2070870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Veevarin Charoenporn
- Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- National Addictions Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Thammanard Charernboon
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand
| | - Clare J Mackie
- National Addictions Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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33
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Sejbuk M, Mirończuk-Chodakowska I, Witkowska AM. Sleep Quality: A Narrative Review on Nutrition, Stimulants, and Physical Activity as Important Factors. Nutrients 2022; 14:nu14091912. [PMID: 35565879 PMCID: PMC9103473 DOI: 10.3390/nu14091912] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 01/10/2023] Open
Abstract
Sleep is a cyclically occurring, transient, and functional state that is controlled primarily by neurobiological processes. Sleep disorders and insomnia are increasingly being diagnosed at all ages. These are risk factors for depression, mental disorders, coronary heart disease, metabolic syndrome, and/or high blood pressure. A number of factors can negatively affect sleep quality, including the use of stimulants, stress, anxiety, and the use of electronic devices before sleep. A growing body of evidence suggests that nutrition, physical activity, and sleep hygiene can significantly affect the quality of sleep. The aim of this review was to discuss the factors that can affect sleep quality, such as nutrition, stimulants, and physical activity.
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Affiliation(s)
- Monika Sejbuk
- Correspondence: ; Tel.: +48-85-686-5088; Fax: +48-85-686-5089
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Kuhathasan N, Minuzzi L, MacKillop J, Frey BN. An investigation of cannabis use for insomnia in depression and anxiety in a naturalistic sample. BMC Psychiatry 2022; 22:303. [PMID: 35484520 PMCID: PMC9052466 DOI: 10.1186/s12888-022-03948-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/21/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Little is known about cannabis use for insomnia in individuals with depression, anxiety, and comorbid depression and anxiety. To develop a better understanding of distinct profiles of cannabis use for insomnia management, a retrospective cohort study was conducted on a large naturalistic sample. METHODS Data were collected using the medicinal cannabis tracking app, Strainprint®, which allows users to monitor and track cannabis use for therapeutic purposes. The current study examined users managing insomnia symptoms in depression (n = 100), anxiety (n = 463), and comorbid depression and anxiety (n = 114), for a total of 8476 recorded sessions. Inferential analyses used linear mixed effects modeling to examine self-perceived improvement across demographic variables and cannabis product variables. RESULTS Overall, cannabis was perceived to be efficacious across all groups, regardless of age and gender. Dried flower and oral oil were reported as the most used and most efficacious product forms. In the depression group, all strains were perceived to be efficacious and comparisons between strains revealed indica-dominant (Mdiff = 1.81, 95% CI 1.26-2.36, Padj < .001), indica hybrid (Mdiff = 1.34, 95% CI 0.46-2.22, Padj = .045), and sativa-dominant (Mdiff = 1.83, 95% CI 0.68-2.99, Padj = .028) strains were significantly more efficacious than CBD-dominant strains. In anxiety and comorbid conditions, all strain categories were perceived to be efficacious with no significant differences between strains. CONCLUSIONS In terms of perceptions, individuals with depression, anxiety, and both conditions who use cannabis for insomnia report significant improvements in symptom severity after cannabis use. The current study highlights the need for placebo-controlled trials investigating symptom improvement and the safety of cannabinoids for sleep in individuals with mood and anxiety disorders.
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Affiliation(s)
- Nirushi Kuhathasan
- grid.416721.70000 0001 0742 7355Mood Disorders Program and Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada ,grid.25073.330000 0004 1936 8227Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
| | - Luciano Minuzzi
- grid.416721.70000 0001 0742 7355Mood Disorders Program and Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
| | - James MacKillop
- grid.25073.330000 0004 1936 8227Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada ,grid.25073.330000 0004 1936 8227Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
| | - Benicio N. Frey
- grid.416721.70000 0001 0742 7355Mood Disorders Program and Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada ,grid.25073.330000 0004 1936 8227Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
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Longoria V, Parcel H, Toma B, Minhas A, Zeine R. Neurological Benefits, Clinical Challenges, and Neuropathologic Promise of Medical Marijuana: A Systematic Review of Cannabinoid Effects in Multiple Sclerosis and Experimental Models of Demyelination. Biomedicines 2022; 10:539. [PMID: 35327341 PMCID: PMC8945692 DOI: 10.3390/biomedicines10030539] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 12/22/2022] Open
Abstract
Despite current therapeutic strategies for immunomodulation and relief of symptoms in multiple sclerosis (MS), remyelination falls short due to dynamic neuropathologic deterioration and relapses, leading to accrual of disability and associated patient dissatisfaction. The potential of cannabinoids includes add-on immunosuppressive, analgesic, neuroprotective, and remyelinative effects. This study evaluates the efficacy of medical marijuana in MS and its experimental animal models. A systematic review was conducted by a literature search through PubMed, ProQuest, and EBSCO electronic databases for studies reported since 2007 on the use of cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) in MS and in experimental autoimmune encephalomyelitis (EAE), Theiler's murine encephalomyelitis virus-induced demyelinating disease (TMEV-IDD), and toxin-induced demyelination models. Study selection and data extraction were performed by 3 reviewers, and 28 studies were selected for inclusion. The certainty of evidence was appraised using the Cochrane GRADE approach. In clinical studies, there was low- and moderate-quality evidence that treatment with ~1:1 CBD/THC mixtures as a nabiximols (Sativex®) oromucosal spray reduced numerical rating scale (NRS) scores for spasticity, pain, and sleep disturbance, diminished bladder overactivity, and decreased proinflammatory cytokine and transcription factor expression levels. Preclinical studies demonstrated decreases in disease severity, hindlimb stiffness, motor function, neuroinflammation, and demyelination. Other experimental systems showed the capacity of cannabinoids to promote remyelination in vitro and by electron microscopy. Modest short-term benefits were realized in MS responders to adjunctive therapy with CBD/THC mixtures. Future studies are recommended to investigate the cellular and molecular mechanisms of cannabinoid effects on MS lesions and to evaluate whether medical marijuana can accelerate remyelination and retard the accrual of disability over the long term.
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Affiliation(s)
- Victor Longoria
- Basic Medical Sciences, St. Vincent Campus, Saint James School of Medicine, 1480 Renaissance Drive, Park Ridge, IL 60068, USA; (V.L.); (H.P.); (B.T.); (A.M.)
| | - Hannah Parcel
- Basic Medical Sciences, St. Vincent Campus, Saint James School of Medicine, 1480 Renaissance Drive, Park Ridge, IL 60068, USA; (V.L.); (H.P.); (B.T.); (A.M.)
| | - Bameelia Toma
- Basic Medical Sciences, St. Vincent Campus, Saint James School of Medicine, 1480 Renaissance Drive, Park Ridge, IL 60068, USA; (V.L.); (H.P.); (B.T.); (A.M.)
| | - Annu Minhas
- Basic Medical Sciences, St. Vincent Campus, Saint James School of Medicine, 1480 Renaissance Drive, Park Ridge, IL 60068, USA; (V.L.); (H.P.); (B.T.); (A.M.)
| | - Rana Zeine
- School of Natural Sciences, Kean University, 1000 Morris Ave., Union, NJ 07083, USA
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36
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Association of medical cannabis licensure with prescription opioid receipt: A population-based, individual-level retrospective cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103502. [PMID: 34695720 PMCID: PMC8810578 DOI: 10.1016/j.drugpo.2021.103502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The endocannabinoid system has been implicated in physiological processes fundamental to pain, giving plausibility to the hypothesis that cannabis may be used as a substitute or complement to prescription opioids in the management of chronic pain. We examined the association of medical cannabis licensure with likelihood of prescription opioid receipt using administrative records. METHODS This study linked registry information for medical cannabis licensure with records from the prescription drug monitoring program from April 1, 2016 to March 31, 2019 to create a population-based, retrospective cohort in Rhode Island. We examined within-person changes in receipt of any opioid prescription and receipt of an opioid prescription with a morphine equivalent dose of 50 mg or more, and of 90 mg or more. RESULTS The sample included 5,296 participants with medical cannabis license. Medical cannabis licensure was not associated with the odds of filling any opioid prescription (OR: 0.99; 95% CI: 0.94-0.1.05) or the odds of filling a prescription with a morphine equivalent dose of 50 mg or more (OR: 0.93; 95% CI: 0.84-1.04) and 90 mg or more (OR: 0.99; 95% CI: 0.86-1.15). CONCLUSION Medical cannabis licensure was not associated with subsequent cessation and reduction in prescription opioid use. Re-scheduling of cannabis will allow for the conduct of randomized controlled trials to determine the efficacy of medical cannabis as an alternative to prescription opioid use or a complement to the use of lower doses of prescription opioids in patients with chronic pain.
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Ross J, Yamada J, Slawek D, Starrels JL, Cunningham CO, Arnsten JH. Increasing Access to Safe Medical Cannabis: Establishment of a Medical Cannabis Program in a Safety-Net Academic Medical Center. NEJM CATALYST INNOVATIONS IN CARE DELIVERY 2022; 3:10.1056/cat.21.0373. [PMID: 36172004 PMCID: PMC9512136 DOI: 10.1056/cat.21.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite numerous challenges, Montefiore Medical Center in New York City implemented a program aimed at providing comprehensive, evidence-based medical cannabis certifications to patients, including those who have been historically disenfranchised, and shares insights from five years of operation.
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Affiliation(s)
- Jonathan Ross
- Assistant Professor of Medicine, Montefiore Health System, Division of General Internal Medicine, Bronx, New York, USA,Assistant Professor of Medicine, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, New York, USA
| | - Jaclyn Yamada
- Resident, Northwell Health, New Hyde Park, New York, USA,Former medical student, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, New York, USA
| | - Deepika Slawek
- Assistant Professor of Medicine, Montefiore Health System, Division of General Internal Medicine, Bronx, New York, USA,Assistant Professor of Medicine, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, New York, USA
| | - Joanna L. Starrels
- Associate Professor of Medicine, Montefiore Health System, Division of General Internal Medicine, Bronx, New York, USA,Associate Professor of Medicine, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, New York, USA
| | - Chinazo O. Cunningham
- Professor of Medicine, Family and Social Medicine, and Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, New York, USA
| | - Julia H. Arnsten
- Professor of Medicine, Epidemiology & Population Health, and Psychiatry and Behavioral Sciences, Montefiore Health System, Division of General Internal Medicine, Bronx, New York, USA,Professor of Medicine, Epidemiology & Population Health, and Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, New York, USA
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38
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Kalaba M, Eglit GML, Feldner MT, Washer PD, Ernenwein T, Vickery AW, Ware MA. Longitudinal Relationship between the Introduction of Medicinal Cannabis and Polypharmacy: An Australian Real-World Evidence Study. Int J Clin Pract 2022; 2022:8535207. [PMID: 36448002 PMCID: PMC9663249 DOI: 10.1155/2022/8535207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/15/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recent studies recommend medicinal cannabis (MC) as a potential treatment for chronic pain (CP) when conventional therapies are not successful; however, data from Australia is limited. This real-world evidence study explored how the introduction of MC related to concomitant medication use over time. Long-term safety also was examined. METHODS Data were collected by the Emerald Clinics (a network of seven clinics located across Australia) as part of routine practice from Jan 2020 toJan 2021. Medications were classified by group: antidepressants, benzodiazepines, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and total number of medications. Adverse events (AEs) were collected at each visit and subsequently coded using the Medical Dictionary for Regulatory Activities version 23 into the system organ class (SOC) and preferred term (PT). A total of 535 patients were analyzed. RESULTS The most common daily oral dose was 10 mg for delta-9-tetrahydrocannabinol (THC) and 15 mg for cannabidiol (CBD). With the introduction of MC, patients' total number of medications consumed decreased over the course of one year; significant reductions in NSAIDs, benzodiazepines, and antidepressants were observed (p < .001). However, the number of prescribed opioid medications did not differ from baseline to the end of one year (p = .49). Only 6% of patients discontinued MC treatment during the study. A total of 600 AEs were reported in 310 patients during the reporting period and 97% of them were classified as nonserious. Discussion. Though observational in nature, these findings suggest MC is generally well-tolerated, consistent with the previous literature, and may reduce concomitant use of some medications. Due to study limitations, concomitant medication reductions cannot be causally attributed to MC. Nevertheless, these data underscore early signals that warrant further exploration in randomized trials.
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Affiliation(s)
- Maja Kalaba
- Canopy Growth Corporation, 1 Hershey Drive, Smiths Falls, ON K7A 3K8, Canada
| | - Graham M. L. Eglit
- Canopy Growth Corporation, 1 Hershey Drive, Smiths Falls, ON K7A 3K8, Canada
| | - Matthew T. Feldner
- Canopy Growth Corporation, 1 Hershey Drive, Smiths Falls, ON K7A 3K8, Canada
| | - Patrizia D. Washer
- Emyria Limited, D2 661 Newcastle Street, Leederville WA 6007, PO Box 1442, West Leederville, WA 6901, Australia
| | - Tracie Ernenwein
- Emyria Limited, D2 661 Newcastle Street, Leederville WA 6007, PO Box 1442, West Leederville, WA 6901, Australia
| | - Alistair W. Vickery
- Emyria Limited, D2 661 Newcastle Street, Leederville WA 6007, PO Box 1442, West Leederville, WA 6901, Australia
| | - Mark A. Ware
- Canopy Growth Corporation, 1 Hershey Drive, Smiths Falls, ON K7A 3K8, Canada
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Pritchett CE, Flynn H, Wang Y, Polston JE. Medical Cannabis Patients Report Improvements in Health Functioning and Reductions in Opiate Use. Subst Use Misuse 2022; 57:1883-1892. [PMID: 36168127 DOI: 10.1080/10826084.2022.2107673] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Purpose: Opioid use rates have dropped as North American patients gain access to medical cannabis, indicating a harm reduction role, yet health outcomes remain mostly unexplored. This study presents self-reported medical cannabis use, perceptions of health functioning, and changes in opioid pain medication use in Florida medical cannabis patients.Methods: Patients (n = 2,183) recruited from medical dispensaries across Florida completed a 66-item cross-sectional survey that included demographic, health, and medication usage items, along with items from the Medical Outcomes Survey (SF-36) to assess health functioning before and after cannabis initiation.Results: Most participants were between the ages of 20 and 70 years of age (95%), over 54% were female, 47% were employed, and most (85%) were white. Commonly reported ailment groups were Pain and Mental Health combined (47.92%), Mental Health (28.86%) or Pain (9.07%). Health domains of bodily pain, physical functioning, and social functioning improved while limitations due to physical and emotional problems were unchanged. Most patients rated medical cannabis as being important to their quality of life. Many (60.98%) reported using pain medications prior to medical cannabis, 93.36% of these reported a change in pain medication after medical cannabis. The majority of participants (79%) reported either cessation or reduction in pain medication use following initiation of medical cannabis and 11.47% described improved functioning.Conclusions: The findings suggest that some medical cannabis patients decreased opioid use without harming quality of life or health functioning, soon after the legalization of medical cannabis. The public health implications of medical cannabis as an alternative pain medication are discussed.
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Affiliation(s)
| | - Heather Flynn
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Yuxia Wang
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA
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Sermet S, Li J, Bach A, Crawford RB, Kaminski NE. Cannabidiol selectively modulates interleukin (IL)-1β and IL-6 production in toll-like receptor activated human peripheral blood monocytes. Toxicology 2021; 464:153016. [PMID: 34740670 DOI: 10.1016/j.tox.2021.153016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 12/12/2022]
Abstract
Cannabidiol (CBD) is a major non-euphoric cannabis-derived compound that has become popular in its over-the-counter use. CBD possesses low affinity for cannabinoid receptors, while the primary molecular target(s) by which it mediates biological activity remain poorly defined. Individuals commonly self-medicate using CBD products with little knowledge of its specific immunopharmacological effects on the human immune system; however, research has established primarily in rodent models that CBD possesses immune modulating properties. The objective of this study was to evaluate whether CBD modulates the innate immune response by human primary monocytes activated through toll-like receptors (TLR) 1-9. Monocytes were activated through each TLR and treated with CBD (0.5-10 μM) for 22 h. Monocyte secretion profiles for 13 immune mediators were quantified including: IL-4, IL-2, IP-10, IL-1β, TNFα, MCP-1, IL-17a, IL-6, IL-10, IFNγ, IL-12p70, IL-8, and TGF-β1. CBD treatment significantly suppressed secretion of proinflammatory cytokine IL-1β by monocytes activated through most TLRs, apart from TLRs 3 and 8. Additionally, CBD treatment induced significant modulation of IL-6 production by monocytes activated through most TLRs, except for TLRs 1 and 3. Most other monocyte-derived factors assayed were refractory to CBD modulation. Overall, CBD selectively altered monocyte-derived IL-1β and IL-6 when activated through most TLRs. This study is of particular importance as it provides a direct and comprehensive assessment of the effects of CBD on TLR-activated primary human monocytes at a time when CBD containing products are being widely used by the public.
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Affiliation(s)
- Sera Sermet
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States
| | - Jinpeng Li
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Center for Research on Ingredient Safety, Michigan State University, East Lansing, MI, 48824, United States
| | - Anthony Bach
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Center for Research on Ingredient Safety, Michigan State University, East Lansing, MI, 48824, United States
| | - Robert B Crawford
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States
| | - Norbert E Kaminski
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, 48824, United States; Center for Research on Ingredient Safety, Michigan State University, East Lansing, MI, 48824, United States.
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Abstract
PURPOSE OF REVIEW Public acceptance of Cannabis sativa L. (cannabis) as a therapeutic option grows despite lags in both research and clinician familiarity. Cannabis-whether as a medical, recreational, or illicit substance-is and has been commonly used by patients. With ongoing decriminalization efforts, decreased perception of harms, and increased use of cannabis in the treatment of symptoms and disease, it is critical for clinicians to understand the rationale for specific therapies and their medical and practical implications for patients. In view of the opioid crisis, overall patient dissatisfaction, and lack of adherence to current chronic pain and headache therapies, this review provides up-to-date knowledge on cannabis as a potential treatment option for headache pain. RECENT FINDINGS Research into the use of cannabinoids for disease treatment have led to FDA-approved drugs for seizures, nausea, and vomiting caused by cancer chemotherapy; and for decreased appetite and weight loss in people with HIV/AIDS. For a wide variety of conditions and symptoms (including chronic pain), cannabis has gained increasing acceptance in society. The effects of cannabidiol (CBD) and tetrahydrocannabinol (THC) in pain pathways have been significantly elucidated. An increasing number of retrospective studies have shown a decrease in pain scores after administration of cannabinoids, as well as long-term benefits such as reduced opiate use. Yet, there is no FDA-approved cannabis product for headache or other chronic pain disorders. More is being done to determine who is likely to benefit from cannabis as well as to understand the long-term effects and limitations of the treatment. Cannabis can refer to a number of products derived from the plant Cannabis sativa L. Relatively well-tolerated, these products come in different configurations, types, and delivery forms. Specific formulations of the plant have been shown to be an effective treatment modality for chronic pain, including headache. It is important for clinicians to know which product is being discussed as well as the harms, benefits, contraindications, interactions, and unknowns in order to provide the best counsel for patients.
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Key Words
- CBD,
- Cannabidiol,
- Cannabis sativa,
- Chronic migraine,
- Chronic pain,
- Dispensary
- Endocannabinoid system,
- Legislation,
- Medical marijuana,
- Migraine treatment,
- Opioid crisis,
- Opioids,
- THC,
- Tetrahydrocannabinol,
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Poudel S, Quinonez J, Choudhari J, Au ZT, Paesani S, Thiess AK, Ruxmohan S, Hosameddin M, Ferrer GF, Michel J. Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature. Cureus 2021; 13:e17407. [PMID: 34589318 PMCID: PMC8459575 DOI: 10.7759/cureus.17407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/12/2022] Open
Abstract
Cannabis has been long used since ancient times for both medical and recreational use. Past research has shown that cannabis can be indicated for symptom management disorders, including cancer, chronic pain, headaches, migraines, and psychological disorders (anxiety, depression, and post-traumatic stress disorder). Active ingredients in cannabis that modulate patients' perceptions of their conditions include Δ9‐tetrahydrocannabinol (THC), cannabidiol (CBD), flavonoids, and terpenes. These compounds work to produce effects within the endocannabinoid system to decrease nociception and decrease symptom frequency. Research within the United States of America is limited to date due to cannabis being classified as a schedule one drug per the Drug Enforcement Agency. Few anecdotal studies have found a limited relationship between cannabis use and migraine frequency. The purpose of the review article is to document the validity of how medical cannabis can be utilized as an alternative therapy for migraine management. Thirty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: "Cannabis," "Medical Marijuana," "Headache," "Cannabis and Migraine," "Cannabis and Headache." This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin. Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.
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Affiliation(s)
- Sujan Poudel
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Jonathan Quinonez
- Neurology/Osteopathic Neuromuscular Medicine, Larkin Community Hospital, Miami, USA
| | - Jinal Choudhari
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Zachary T Au
- Family and Community Medicine, Larkin Community Hospital, Miami, Florida, USA
| | - Sylvia Paesani
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Armond K Thiess
- Division of Research and Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Samir Ruxmohan
- Neurology, Larkin Community Hospital, Miami, Florida, USA
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Zhang N, Woldeamanuel YW. Medication overuse headache in patients with chronic migraine using cannabis: A case-referent study. Headache 2021; 61:1234-1244. [PMID: 34370866 DOI: 10.1111/head.14195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine whether cannabis use predicts medication overuse headache (MOH) in patients with chronic migraine (CM). METHODS Electronic chart review was conducted by combining the terms "CM," "medication overuse," "cannabis," "cannabidiol," and "tetrahydrocannabinol" for patients seen at our headache clinics from 2015 to 2019. Of 729 charts consecutively screened, 368 met our inclusion criteria, that is, adult patients with CM with ≥1-year CM duration. The following variables were extracted from the included patient charts: MOH diagnosis, age, sex, migraine frequency, current CM duration, current cannabis use duration, overused acute migraine medications, current MOH duration, and types of cannabis products used. Logistic regression was used to identify variables predicting MOH while controlling for remaining predictors. Agglomerative hierarchical clustering (AHC) was conducted to explore natural clusters using all predictor variables. RESULTS There were 212 patients with CM and MOH (cases; median age 43 years, interquartile range [IQR] 33-54; 177 [83%] females) and 156 patients with CM without MOH (referents; median age 40 years, IQR 31-49; 130 [83%] females). MOH was present in 81% (122/150) of current cannabis users compared with 41% (90/218) in those without cannabis use-adjusted odds ratio 6.3 (95% CI: 3.56 to 11.1, p < 0.0001). Current cannabis use was significantly associated with opioid use (Spearman's rho 0.26, p < 0.0001). Both current cannabis use (rho 0.40, p < 0.0001) and opioid use (rho 0.36, p < 0.0001) were significantly associated with MOH. Similarly, AHC revealed two major natural clusters. Cluster I patients featured 9.3 times higher current cannabis use, 9.2 times higher current opioid use, and 1.8 times higher MOH burden than those in Cluster II (p < 0.0001). CONCLUSION Cannabis use was significantly associated with increased prevalence of MOH in CM. Bidirectional cannabis-opioid association was observed-use of one was associated with use of the other. Advising patients with CM and MOH to reduce cannabis use may help treat MOH effectively.
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Affiliation(s)
- Niushen Zhang
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Yohannes W Woldeamanuel
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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Choi NG, Choi BY, Marti CN, DiNitto DM. Is cannabis use associated with prescription psychotropic and pain reliever medication and other substance use among individuals aged 50+ with mental illness? Drug Alcohol Depend 2021; 225:108842. [PMID: 34186443 DOI: 10.1016/j.drugalcdep.2021.108842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite increasing rates of nonmedical and/or medical cannabis use in the 50+ age group, scant research exists on the associations between cannabis use and prescription medication use. In this study, we examined associations of use of prescription tranquilizers, sedatives, stimulants, and pain relievers, tobacco products, any/binge/heavy alcohol, and illicit drugs with cannabis use and use characteristics among U.S. adults aged 50+ years with past-year mental illness (n = 6454). METHODS Data are from the 2015-2019 National Survey on Drug Use and Health (NSDUH). We used logistic regression models to examine associations of past-month use of each substance with (1) cannabis use among all those with past-year mental illness, and (2) cannabis use characteristics among cannabis users, controlling for severity of mental illness and sociodemographic and health characteristics. RESULTS Of individuals aged 50+, 14.1 % had any past-year mental illness, and 9.7 % of those with mental illness, compared to 4.0 % of those without, reported past-month cannabis use. Compared to nonusers, cannabis users had higher odds of using each substance except antidepressants, with adjusted odds ratios ranging from 1.3 (sedatives) to 3.6 (illicit drugs). Compared to nonmedical cannabis users, medical users had 2-2.5 times higher likelihood of co-use of tranquilizers, sedatives, and prescription pain relievers but lower odds of binge and heavy alcohol use. CONCLUSIONS Cannabis users, especially medical cannabis users, are significantly more likely to use prescription psychotropic or pain medications. Healthcare professionals should assess for poly-substance use and potential adverse effects among older adults with mental illness.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78702, USA.
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, 19131, USA; Bayhealth Medical Center, Dover, DE, 19901, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78702, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78702, USA
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Noori A, Miroshnychenko A, Shergill Y, Ashoorion V, Rehman Y, Couban RJ, Buckley DN, Thabane L, Bhandari M, Guyatt GH, Agoritsas T, Busse JW. Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies. BMJ Open 2021; 11:e047717. [PMID: 34321302 PMCID: PMC8319983 DOI: 10.1136/bmjopen-2020-047717] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/05/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the efficacy and harms of adding medical cannabis to prescription opioids among people living with chronic pain. DESIGN Systematic review. DATA SOURCES CENTRAL, EMBASE and MEDLINE. MAIN OUTCOMES AND MEASURES Opioid dose reduction, pain relief, sleep disturbance, physical and emotional functioning and adverse events. STUDY SELECTION CRITERIA AND METHODS We included studies that enrolled patients with chronic pain receiving prescription opioids and explored the impact of adding medical cannabis. We used Grading of Recommendations Assessment, Development and Evaluation to assess the certainty of evidence for each outcome. RESULTS Eligible studies included five randomised trials (all enrolling chronic cancer-pain patients) and 12 observational studies. All randomised trials instructed participants to maintain their opioid dose, which resulted in a very low certainty evidence that adding cannabis has little or no impact on opioid use (weighted mean difference (WMD) -3.4 milligram morphine equivalent (MME); 95% CI (CI) -12.7 to 5.8). Randomised trials provided high certainty evidence that cannabis addition had little or no effect on pain relief (WMD -0.18 cm; 95% CI -0.38 to 0.02; on a 10 cm Visual Analogue Scale (VAS) for pain) or sleep disturbance (WMD -0.22 cm; 95% CI -0.4 to -0.06; on a 10 cm VAS for sleep disturbance; minimally important difference is 1 cm) among chronic cancer pain patients. Addition of cannabis likely increases nausea (relative risk (RR) 1.43; 95% CI 1.04 to 1.96; risk difference (RD) 4%, 95% CI 0% to 7%) and vomiting (RR 1.5; 95% CI 1.01 to 2.24; RD 3%; 95% CI 0% to 6%) (both moderate certainty) and may have no effect on constipation (RR 0.85; 95% CI 0.54 to 1.35; RD -1%; 95% CI -4% to 2%) (low certainty). Eight observational studies provided very low certainty evidence that adding cannabis reduced opioid use (WMD -22.5 MME; 95% CI -43.06 to -1.97). CONCLUSION Opioid-sparing effects of medical cannabis for chronic pain remain uncertain due to very low certainty evidence.PROSPERO registration numberCRD42018091098.
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Affiliation(s)
- Atefeh Noori
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote National Pain Center, McMaster University, Hamilton, Ontario, Canada
| | - Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yaadwinder Shergill
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vahid Ashoorion
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yasir Rehman
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rachel J Couban
- The Michael G. DeGroote National Pain Center, McMaster University, Hamilton, Ontario, Canada
| | - D Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of of General Internal Medicine, University of Geneva Faculty of Medicine, Geneve, Switzerland
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
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Kvamme SL, Pedersen MM, Rømer Thomsen K, Thylstrup B. Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample. Harm Reduct J 2021; 18:72. [PMID: 34246279 PMCID: PMC8272272 DOI: 10.1186/s12954-021-00520-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The use of cannabis as medicine (CaM) both prescribed and non-prescribed has increased markedly in the last decade, mirrored in a global shift in cannabis policy towards a more permissive stance. There is some evidence that cannabis functions as a substitute for prescription drugs, particularly opioids; however, more knowledge is needed on the motives of substitution users, their patterns of use, and perceived effects of substitution use. AIMS To explore who substitutes prescription drugs with cannabis, the type of prescription drugs substituted and the type of cannabis used, and the impact that substitution with cannabis has on prescription drug use as well as the motives for substitution in terms of experienced effects and side effects. METHODS A self-selected convenience sample was recruited through social media, public media, and patient organizations to take part in an anonymous online survey. Inclusion criteria were 18 years or older and use of cannabis (prescribed or non-prescribed) with a medical purpose. RESULTS The final sample included 2.841 respondents of which the majority (91%) used non-prescribed cannabis, and more than half (54.6%) had used CaM with the purpose of replacing a prescribed drug. Compared to non-substitution users, substitution users were more likely to be women and to use CaM in the treatment of chronic pain and other somatic conditions. Pain medication (67.2%), antidepressants (24.5%), and arthritis medication (20.7%) were the most common types of drugs replaced with CaM. Among substitution users, 38.1% reported termination of prescription drug use, and 45.9% a substantial decrease in prescription drug use. The most frequent type of cannabis used as a substitute was CBD-oil (65.2%), followed by 'hash, pot or skunk' (36.6%). More than half (65.8%) found CaM much more effective compared to prescription drugs, and 85.5% that the side effects associated with prescription drug use were much worse compared to use of CaM. CONCLUSION CaM is frequently used as a substitute for prescription drugs, particularly opioids. More research is needed on the long-term consequences of use of CaM, including the impact from low and high THC cannabis products on specific somatic and mental health conditions.
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Affiliation(s)
- Sinikka L Kvamme
- Center for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Building 1322. Bartholins Allé 10, 8000, Aarhus C, Denmark.
| | - Michael M Pedersen
- Center for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Building 1322. Bartholins Allé 10, 8000, Aarhus C, Denmark
| | - Kristine Rømer Thomsen
- Center for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Building 1322. Bartholins Allé 10, 8000, Aarhus C, Denmark
| | - Birgitte Thylstrup
- Center for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Artillerivej 90, 2. Floor, 2300, Copenhagen S, Denmark
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Schlag AK, Hindocha C, Zafar R, Nutt DJ, Curran HV. Cannabis based medicines and cannabis dependence: A critical review of issues and evidence. J Psychopharmacol 2021; 35:773-785. [PMID: 33593117 PMCID: PMC8278552 DOI: 10.1177/0269881120986393] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cannabis has been legalised for medical use in an ever-increasing number of countries. A growing body of scientific evidence supports the use of medical cannabis for a range of therapeutic indications. In parallel with these developments, concerns have been expressed by many prescribers that increased use will lead to patients developing cannabis use disorder. Cannabis use disorder has been widely studied in recreational users, and these findings have often been projected onto patients using medical cannabis. However, studies exploring medical cannabis dependence are scarce and the appropriate methodology to measure this construct is uncertain. This article provides a narrative review of the current research to discern if, how and to what extent, concerns about problems of dependence in recreational cannabis users apply to prescribed medical users. We focus on the main issues related to medical cannabis and dependence, including the importance of dose, potency, cannabinoid content, pharmacokinetics and route of administration, frequency of use, as well as set and setting. Medical and recreational cannabis use differs in significant ways, highlighting the challenges of extrapolating findings from the recreational cannabis literature. There are many questions about the potential for medical cannabis use to lead to dependence. It is therefore imperative to address these questions in order to be able to minimise harms of medical cannabis use. We draw out seven recommendations for increasing the safety of medical cannabis prescribing. We hope that the present review contributes to answering some of the key questions surrounding medical cannabis dependence.
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Affiliation(s)
- Anne K Schlag
- Drug Science, St Peter’s House, London, UK
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, London, UK
- University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre, London, UK
| | - Rayyan Zafar
- Drug Science, St Peter’s House, London, UK
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - David J Nutt
- Drug Science, St Peter’s House, London, UK
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
- University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre, London, UK
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Edwards D, Filbey FM. Are Sweet Dreams Made of These? Understanding the Relationship Between Sleep and Cannabis Use. Cannabis Cannabinoid Res 2021; 6:462-473. [PMID: 34143657 DOI: 10.1089/can.2020.0174] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: There is widespread literature on the interaction between cannabis use and sleep, yet the mechanisms that underlie this relationship are not well understood. Several factors lead to inconsistencies in this relationship suggesting a nuanced interaction between cannabis and sleep. An important question that remains to be addressed is the temporal relationship between disrupted sleep and cannabis use. This literature review summarizes the existing literature on the association between disrupted sleep and cannabis toward the goal of addressing the question of the chronology of these reported effects. Materials and Methods: We conducted a review of the literature using PubMed to summarize current knowledge on the association between cannabis use and sleep in humans. Results: We identified 31 studies on the association of cannabis use and sleep. The findings from these studies were mixed. Cannabis was associated with a variety of impacts on sleep ranging from beneficial effects, such as reduced sleep-onset latency, to negative outcomes, such as reduced sleep duration and suppressed rapid eye movement oscillations. The chronology of the interaction of cannabis and sleep was unclear, although much of the current literature focus on factors that modulate how cannabis impairs sleep after initial use. Conclusion: There was sufficient evidence to suggest that cannabis use alters circadian rhythms, and hence, negatively impacts sleep. The current literature is largely from studies utilizing self-report measures of sleep; thus, objective measures of sleep are needed. In addition, although there were no empirical studies on the temporal relationship between cannabis use and sleep, the majority of the literature focused on characterizing sleep impairment after cannabis use.
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Affiliation(s)
- Dalton Edwards
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas, USA
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas, USA
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Jugl S, Okpeku A, Costales B, Morris EJ, Alipour-Haris G, Hincapie-Castillo JM, Stetten NE, Sajdeya R, Keshwani S, Joseph V, Zhang Y, Shen Y, Adkins L, Winterstein AG, Goodin A. A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019. Med Cannabis Cannabinoids 2021; 4:21-42. [PMID: 34676348 PMCID: PMC8525213 DOI: 10.1159/000515069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Affiliation(s)
- Sebastian Jugl
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Aimalohi Okpeku
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Brianna Costales
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Earl J. Morris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Golnoosh Alipour-Haris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Juan M. Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | | | - Ruba Sajdeya
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Verlin Joseph
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yahan Zhang
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Yun Shen
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Lauren Adkins
- Health Sciences Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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50
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Mahabir VK, Smith CS, Vannabouathong C, Merchant JJ, Garibaldi AL. Comparing medical cannabis use in 5 US states: a retrospective database study. J Cannabis Res 2021; 3:15. [PMID: 34044878 PMCID: PMC8161659 DOI: 10.1186/s42238-021-00075-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background US states have been adopting their own medical cannabis laws since 1996. There is substantial variability in the medical cannabis programs between states, and these differences have not been thoroughly investigated in the literature. The objective of the study was to compare medical cannabis patient characteristics across five states to identify differences potentially caused by differing policies surrounding condition eligibility. Methods We conducted secondary analyses following a retrospective study of a registry database with data from 33 medical cannabis evaluation clinics in the US, owned and operated by CB2 Insights. This study narrowed the dataset to include patients from five states with the largest samples: Massachusetts (n = 27,892), Colorado (n = 16,434), Maine (n = 4591), Connecticut (n = 2643), and Maryland (n = 2403) to conduct an in-depth study of the characteristics of patients accessing medical cannabis in these states, including analysis of variance to compare average ages and number of conditions and chi-squared tests to compare proportions of patient characteristics between states. Results Average ages varied between the states, with the youngest average in Connecticut (42.2) and the oldest in Massachusetts (47.0). Males represented approximately 60% of the patients with data on gender in each state. The majority of patients in each state had cannabis experience prior to seeking medical certification. Primary medical conditions varied for each state, with chronic pain, anxiety, and back and neck problems topping the list in varying orders for Massachusetts, Maine, and Maryland. Colorado had 78.7% of patients report chronic pain as their primary condition, and 70.4% of patients in Connecticut reported post-traumatic stress disorder as their primary medical condition. Conclusion This study demonstrated the significant impact that policy has on patients’ access to medical cannabis in Massachusetts, Colorado, Maine, Connecticut, and Maryland utilizing real-world data. It highlights how qualifications differ between the five states and brings into question the routes through which patients in states with stricter regulations surrounding eligible conditions choose to seek treatment with cannabis. These patients may turn to alternative treatments, or to the illicit or recreational cannabis markets, where permitted. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-021-00075-z.
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Affiliation(s)
- V Kishan Mahabir
- CB2 Insights, 5045 Orbitor Dr, Building 11, Suite 300, Mississauga, ON, L4W 4Y4, Canada
| | - Christopher S Smith
- CB2 Insights, 5045 Orbitor Dr, Building 11, Suite 300, Mississauga, ON, L4W 4Y4, Canada.
| | | | - Jamil J Merchant
- CB2 Insights, 5045 Orbitor Dr, Building 11, Suite 300, Mississauga, ON, L4W 4Y4, Canada
| | - Alisha L Garibaldi
- CB2 Insights, 5045 Orbitor Dr, Building 11, Suite 300, Mississauga, ON, L4W 4Y4, Canada
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