Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis
Stephanie Lake aff001; Zach Walsh aff003; Thomas Kerr aff001; Ziva D. Cooper aff005; Jane Buxton aff002; Evan Wood aff001; Mark A. Ware aff007; M. J. Milloy aff001
Působiště autorů: British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada aff001; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada aff002; Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada aff003; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada aff004; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, United States of America aff005; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada aff006; Department of Family Medicine, McGill University, Montreal, Québec, Canada aff007; Department of Anesthesia, McGill University, Montreal, Québec, Canada aff008
Vyšlo v časopise: Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis. PLoS Med 16(11): e1002967. doi:10.1371/journal.pmed.1002967
Kategorie: Research Article
Ecological research suggests that increased access to cannabis may facilitate reductions in opioid use and harms, and medical cannabis patients describe the substitution of opioids with cannabis for pain management. However, there is a lack of research using individual-level data to explore this question. We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain.
Methods and findings
This study included data from people in 2 prospective cohorts of PWUD in Vancouver, Canada, who reported major or persistent pain from June 1, 2014, to December 1, 2017 (n = 1,152). We used descriptive statistics to examine reasons for cannabis use and a multivariable generalized linear mixed-effects model to estimate the relationship between daily (once or more per day) cannabis use and daily illicit opioid use. There were 424 (36.8%) women in the study, and the median age at baseline was 49.3 years (IQR 42.3–54.9). In total, 455 (40%) reported daily illicit opioid use, and 410 (36%) reported daily cannabis use during at least one 6-month follow-up period. The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%). After adjusting for demographic characteristics, substance use, and health-related factors, daily cannabis use was associated with significantly lower odds of daily illicit opioid use (adjusted odds ratio 0.50, 95% CI 0.34–0.74, p < 0.001). Limitations of the study included self-reported measures of substance use and chronic pain, and a lack of data for cannabis preparations, dosages, and modes of administration.
We observed an independent negative association between frequent cannabis use and frequent illicit opioid use among PWUD with chronic pain. These findings provide longitudinal observational evidence that cannabis may serve as an adjunct to or substitute for illicit opioid use among PWUD with chronic pain.
Cannabis – Drug users – Heroin – Neuropathic pain – Opioids – Pain management – Recreational drug use
1. Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: apparent opioid-related deaths in Canada (released September 2018). Ottawa: Public Health Agency of Canada; 2018 [cited 2018 Dec 3]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-related-deaths-released-september-2018.html.
2. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths—United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2018;67(51/52):1419–26.
3. British Columbia Coroners Service. Fentanyl-detected illicit drug overdose deaths: January 1, 2012 to March 31, 2019. Government of British Columbia; 2019 [cited 2019 Oct 24]. Available from:https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/fentanyl-detected-overdose.pdf.
4. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821–6. doi: 10.1001/jamapsychiatry.2014.366 24871348
5. Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559–74. doi: 10.1146/annurev-publhealth-031914-122957 25581144
6. Voon P, Callon C, Nguyen P, Dobrer S, Montaner JSG, Wood E, et al. Denial of prescription analgesia among people who inject drugs in a Canadian setting. Drug Alcohol Rev. 2015;34(2):221–8. doi: 10.1111/dar.12226 25521168
7. Dahlman D, Kral AH, Wenger L, Hakansson A, Novak SP. Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs. Subst Abuse Treat Prev Policy. 2017;12(1):29. doi: 10.1186/s13011-017-0112-7 28558841
8. British Columbia Centre on Substance Use. Drug checking in British Columbia: March 2019. Vancouver: British Columbia Centre on Substance Use; 2019 [cited 2019 Apr 9]. Available from: http://www.bccsu.ca/wp-content/uploads/2019/04/2019-03-BC-Drug-Checking-Report-Mar2019.pdf. Cited 2019 April 9.
9. Voon P, Callon C, Nguyen P, Dobrer S, Montaner J, Wood E, et al. Self-management of pain among people who inject drugs in Vancouver. Pain Manag. 2014;4(1):27–35. doi: 10.2217/pmt.13.62 24641341
10. Dormer D. Why overdose may be the wrong word when it comes to cannabis. CBC News. 2018 Sep 11 [cited 2019 Jun 5]. Available from: https://www.cbc.ca/news/canada/calgary/cannabis-overdose-toxicity-marijuana-1.4816654.
11. Fumano D. Pop-up Vancouver pot dispensary an ‘outside the box’ approach to opioid crisis: Vancouver Sun. 2017 Aug 28 [cited 2017 Nov 30]. Available from: http://vancouversun.com/news/local-news/pop-up-vancouver-pot-dispensary-an-outside-the-box-approach-to-opioid-crisis.
12. National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington (DC): National Academies Press; 2017 [cited 2017 Jan 31]. Available from: http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx.
13. Kim JH, Santaella-Tenorio J, Mauro CM, Cerda M, Keyes KM, Hasin D, et al. State medical marijuana laws and the prevalence of opioids detected among fatally injured drivers. Am J Public Health. 2016;106:2032–7. doi: 10.2105/AJPH.2016.303426 27631755
14. Bradford AC, Bradford WD. Medical marijuana laws may be associated with a decline in the number of prescriptions for Medicaid enrollees. Health Aff (Millwood). 2017;36(5):945–51. doi: 10.1377/hlthaff.2016.1135 28424215
15. Bradford AC, Bradford WD, Abraham A, Bagwell Adams G. Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population. JAMA Intern Med. 2018;178(5):667–72. doi: 10.1001/jamainternmed.2018.0266 29610897
16. Shi Y, Liang D, Bao Y, An R, Wallace MS, Grant I. Recreational marijuana legalization and prescription opioids received by Medicaid enrollees. Drug Alcohol Depend. 2019;194:13–9. doi: 10.1016/j.drugalcdep.2018.09.016 30390550
17. Liang D, Bao Y, Wallace M, Grant I, Shi Y. Medical cannabis legalization and opioid prescriptions: evidence on US Medicaid enrollees during 1993–2014. Addiction. 2018;113(11):2060–70. doi: 10.1111/add.14382 29989239
18. Shi Y. Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever. Drug Alcohol Depend. 2017;173:144–50. doi: 10.1016/j.drugalcdep.2017.01.006 28259087
19. Powell D, Pacula RL, Jacobson M. Do medical marijuana laws reduce addictions and deaths related to pain killers? J Health Econ. 2018;58:29–42. doi: 10.1016/j.jhealeco.2017.12.007 29408153
20. Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999–2010. JAMA Intern Med. 2014;174(10):1668–73. doi: 10.1001/jamainternmed.2014.4005 25154332
21. Livingston MD, Barnett TE, Delcher C, Wagenaar AC. Recreational cannabis legalization and opioid-related deaths in Colorado, 2000–2015. Am J Public Health. 2017;107(11):1827–9. doi: 10.2105/AJPH.2017.304059 29019782
22. Finney JW, Humphreys K, Harris AS. What ecologic analyses cannot tell us about medical marijuana legalization and opioid pain medication mortality. JAMA Intern Med. 2015;175(4):655–6. doi: 10.1001/jamainternmed.2014.8006 25844747
23. Nielsen S, Sabioni P, Trigo JM, Ware MA, Betz-Stablein BD, Murnion B, et al. Opioid-sparing effect of cannabinoids: a systematic review and meta-analysis. Neuropsychopharmacology. 2017;42(9):1752–65. doi: 10.1038/npp.2017.51 28327548
24. Reiman A, Welty M, Solomon P. Cannabis as a substitute for opioid-based pain medication: patient self-report. Cannabis Cannabinoid Res. 2017;2(1):160–6. doi: 10.1089/can.2017.0012 28861516
25. Lucas P, Walsh Z. Medical cannabis access, use, and substitution for prescription opioids and other substances: a survey of authorized medical cannabis patients. Int J Drug Policy. 2017;42(Suppl C):30–5. doi: 10.1016/j.drugpo.2017.01.011 28189912
26. Lucas P, Walsh Z, Crosby K, Callaway R, Belle-Isle L, Kay R, et al. Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: the impact of contextual factors. Drug Alcohol Rev. 2015;35(3):326–33. doi: 10.1111/dar.12323 26364922
27. Lucas P, Reiman A, Earleywine M, McGowan SK, Oleson M, Coward MP, et al. Cannabis as a substitute for alcohol and other drugs: a dispensary-based survey of substitution effect in Canadian medical cannabis patients. Addiction Res Theory. 2013;21(5):435–42. doi: 10.3109/16066359.2012.733465
28. Reiman A. Cannabis as a substitute for alcohol and other drugs. Harm Reduct J. 2009;6:35. doi: 10.1186/1477-7517-6-35 19958538
29. Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain. 2016;17(6):739–44. doi: 10.1016/j.jpain.2016.03.002 27001005
30. Baron EP, Lucas P, Eades J, Hogue O. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort. J Headache Pain. 2018;19(1):37. doi: 10.1186/s10194-018-0862-2 29797104
31. Piper BJ, Beals ML, Abess AT, Nichols SD, Martin MW, Cobb CM, et al. Chronic pain patients’ perspectives of medical cannabis. Pain. 2017;158(7):1373–9. doi: 10.1097/j.pain.0000000000000899 28328576
32. Corroon JM Jr, Mischley LK, Sexton M. Cannabis as a substitute for prescription drugs—a cross-sectional study. J Pain Res. 2017;10:989–98. doi: 10.2147/JPR.S134330 28496355
33. Degenhardt L, Lintzeris N, Campbell G, Bruno R, Cohen M, Farrell M, et al. Experience of adjunctive cannabis use for chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study. Drug Alcohol Depend. 2015;147:144–50. doi: 10.1016/j.drugalcdep.2014.11.031 25533893
34. Vigil JM, Stith SS, Adams IM, Reeve AP. Associations between medical cannabis and prescription opioid use in chronic pain patients: a preliminary cohort study. PLoS ONE. 2017;12(11):e0187795. doi: 10.1371/journal.pone.0187795 29145417
35. Campbell G, Hall WD, Peacock A, Lintzeris N, Bruno R, Larance B, et al. Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study. Lancet Public Health. 2018;3(7):e341–50. doi: 10.1016/S2468-2667(18)30110-5 29976328
36. C3PNO. V-DUS. C3PNO; 2018 [cited 2019 Aug 27]. Available from: https://www.c3pno.org/C3PNOWebApplication/cohorts/v-dus.
37. C3PNO. ACCESS. C3PNO; 2018 [cited 2019 Aug 27]. Available from: https://www.c3pno.org/C3PNOWebApplication/cohorts/access.
38. Lake SL. Cannabis use and opioid-related health outcomes among people who use drugs. Ottawa: Canadian Institutes of Health Research; 2017 [cited 2019 Aug 27]. Available from: http://webapps.cihr-irsc.gc.ca/decisions/p/project_details.html?applId=365466&lang=en.
39. Woo A, Lechner B, Fu T, Wong CS, Chiu N, Lam H, et al. Cut points for mild, moderate, and severe pain among cancer and non-cancer patients: a literature review. Ann Palliat Med. 2015;4(4):176–83. doi: 10.3978/j.issn.2224-5820.2015.09.04 26541396
40. Olfson M, Wall MM, Liu SM, Blanco C. Cannabis use and risk of prescription opioid use disorder in the United States. Am J Psychiatry. 2018;175(1):47–53. doi: 10.1176/appi.ajp.2017.17040413 28946762
41. Sohler NL, Starrels JL, Khalid L, Bachhuber MA, Arnsten JH, Nahvi S, et al. Cannabis use is associated with lower odds of prescription opioid analgesic use among HIV-infected individuals with chronic pain. Subst Use Misuse. 2018;53(10):1602–7. doi: 10.1080/10826084.2017.1416408 29338578
42. Bigand T, Wilson M, Riedy S, Lewis J. Cannabis use is related to self-efficacy but not sleep or pain symptoms: a survey of adults prescribed opioids for pain or opioid use disorders. J Pain. 2018;19(3 Suppl 1):S28.
43. Kral AH, Wenger L, Novak SP, Chu D, Corsi KF, Coffa D, et al. Is cannabis use associated with less opioid use among people who inject drugs? Drug Alcohol Depend. 2015;153:236–41. doi: 10.1016/j.drugalcdep.2015.05.014 26051162
44. Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119–32. doi: 10.1016/S1087-0792(03)00044-3 15033151
45. Hah JM, Sturgeon JA, Zocca J, Sharifzadeh Y, Mackey SC. Factors associated with prescription opioid misuse in a cross-sectional cohort of patients with chronic non-cancer pain. J Pain Res. 2017;10:979–87. doi: 10.2147/JPR.S131979 28496354
46. Kundermann B, Krieg J-C, Schreiber W, Lautenbacher S. The effects of sleep deprivation on pain. Pain Res Manage. 2004;9(1):25–32. doi: 10.1155/2004/949187 15007400
47. Burke NN, Finn DP, McGuire BE, Roche M. Psychological stress in early life as a predisposing factor for the development of chronic pain: clinical and preclinical evidence and neurobiological mechanisms. J Neurosci Res. 2017;95(6):1257–70. doi: 10.1002/jnr.23802 27402412
48. Woodhams SG, Sagar DR, Burston JJ, Chapman V. The role of the endocannabinoid system in pain. Handb Exp Pharmacol. 2015;227:119–43. doi: 10.1007/978-3-662-46450-2_7 25846617
49. Welch SP. Interaction of the cannabinoid and opioid systems in the modulation of nociception. Int Rev Psychiatry. 2009;21(2):143–51. doi: 10.1080/09540260902782794 19367508
50. Smith PB, Welch SP, Martin BR. Interactions between delta 9-tetrahydrocannabinol and kappa opioids in mice. J Pharmacol Exp Ther. 1994;268(3):1381–7. 8138952
51. Mason DJ Jr, Lowe J, Welch SP. Cannabinoid modulation of dynorphin A: correlation to cannabinoid-induced antinociception. Eur J Pharmacol. 1999;378(3):237–48. doi: 10.1016/s0014-2999(99)00479-3 10493099
52. Cooper ZD, Bedi G, Ramesh D, Balter R, Comer SD, Haney M. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. Neuropsychopharmacology. 2018;43(10):2046–55. doi: 10.1038/s41386-018-0011-2 29463913
53. Hurd YL, Spriggs S, Alishayev J, Winkel G, Gurgov K, Kudrich C, et al. Cannabidiol for the reduction of cue-induced craving and anxiety in drug-abstinent individuals with heroin use disorder: a double-blind randomized placebo-controlled trial. Am J Psychiatry. 2019 May 21. doi: 10.1176/appi.ajp.2019.18101191 31109198
54. Hurd Y. Cannabidiol: swinging the marijuana pendulum from ‘weed’ to medication to treat the opioid epidemic. Trends Neurosci. 2017;40(3):124–7. doi: 10.1016/j.tins.2016.12.006 28162799
55. Wenger LD, Lopez AM, Comfort M, Kral AH. The phenomenon of low-frequency heroin injection among street-based urban poor: drug user strategies and contexts of use. Int J Drug Policy. 2014;25(3):471–9. doi: 10.1016/j.drugpo.2014.02.015 24690452
56. Darke S. Self-report among injecting drug users: a review. Drug Alcohol Depend. 1998;51(3):253–63. doi: 10.1016/s0376-8716(98)00028-3 9787998
57. Philpot LM, Ebbert JO, Hurt RT. A survey of the attitudes, beliefs and knowledge about medical cannabis among primary care providers. BMC Fam Pract. 2019;20(1):17. doi: 10.1186/s12875-019-0906-y 30669979
Článek vyšel v časopise
2019 Číslo 11
- Příznivý vliv Armolipidu Plus na hladinu cholesterolu a zánětlivé parametry u pacientů s chronickým subklinickým zánětem
- Berberin: přírodní hypolipidemikum se slibnými výsledky
- Nutraceutikum Armolipid Plus podle klinických důkazů zlepšuje lipidový profil − metaanalýza
- Doplňky stravy v terapii mírné a středně závažné dyslipidémie
- Červená fermentovaná rýže účinně snižuje hladinu LDL cholesterolu jako vhodná alternativa ke statinové terapii
Nejčtenější v tomto čísle
- Prescription of benzodiazepines, z-drugs, and gabapentinoids and mortality risk in people receiving opioid agonist treatment: Observational study based on the UK Clinical Practice Research Datalink and Office for National Statistics death records
- Oxygen systems to improve clinical care and outcomes for children and neonates: A stepped-wedge cluster-randomised trial in Nigeria
- Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis
- Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study
Zvyšte si kvalifikaci online z pohodlí domova
Deprese u dětí a adolescentůnový kurz