Need to Improve Dose Measurements in Studies of Marijuana Use for Pain.
Need to Improve Dose Measurements in Studies of Marijuana Use for Pain.
复制标题
需要改进大麻止痛研究中的剂量测量。
DOI：
10.1097/qai.0000000000002238
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Cook,RobertL
中科院分区：
文献类型：
--
作者：
Sajdeya,Ruba;Cook,RobertL
To the Editors: We read with great interest the article “Marijuana use and its associations with pain, opioid dose, and HIV viral suppression among persons living with HIV on chronic opioid therapy” by Merlin et al. 1 The authors should be acknowledged for addressing the important topic of evaluating potential alternative treatments to chronic opioid therapy for chronic pain in people living with HIV (PLWH). 2 In addition, the current interest in the use of marijuana to improve multiple outcomes among PLWH makes the topic timely in current practices. 3 Nevertheless, we believe 2 issues that were not discussed in the article could have a significant impact on the findings and related conclusions regarding marijuana’s impact on pain and opioid use. These include missing information on the dose of marijuana and the types of pain experienced by these study participants. First, the authors reported frequency but not quantity of marijuana used by participants nor the relative amounts of components of marijuana such as cannabidiol (CBD) or Δ9 tetrahydrocannabinol (THC). Several previous studies have suggested that doses higher than 2.4 mg/kg/d are needed to achieve efficacy of cannabidiol (CBD) effects on chronic pain4 and not the mere use of marijuana. Such doses may have not been achieved in most of the study participants, given that the majority of past year users described their use pattern as “only a few times” within the past year (32.8%) and only 14.8% of marijuana users were daily users. 1 In the study by Noyes et al, advanced cancer patients who received 15–20 mg of tetrahydrocannabinol (THC) reported significant pain relief compared with those who received 0, 5, or 10 mg, 5 supporting the claim of needing to use a specified higher dose. On the other hand, higher doses are not always better, as some data suggest a presence of an adverse dose–response relationship between marijuana effects and pain relief. 6 The inconsistency of use patterns among participants and the lack of dose measurement stand as barriers to assessing the true association of marijuana use and opioid-related outcomes. Second, the effect of marijuana use on chronic pain was assessed collectively, without differentiating between different types of chronic pain. These include but are not limited to neuropathic, cancer-associated, central, and inflammation-induced pain, each of which may have different responses to marijuana intake depending on the mechanism of action involved. 7 Different distributions of types of pain could affect results of marijuana outcomes for some types but not others. The findings of Merlin et al highlight the important need for more research on the potential role of marijuana on pain and opioid dose in PLWH who are on chronic opioid therapy. As the investigators emphasized, there may be potential adverse consequences of marijuana use among PLWH with chronic pain. Still, we encourage future researchers to compare different doses of marijuana and to better characterize different types of pain syndromes, as we seek to understand the potential impact of marijuana use on pain, opioid-related outcomes.
