Disagreement and Uncertainty Among Experts About how to Respond to Marijuana Use in Patients on Long-term Opioids for Chronic Pain: Results of a Delphi Study.
Disagreement and Uncertainty Among Experts About how to Respond to Marijuana Use in Patients on Long-term Opioids for Chronic Pain: Results of a Delphi Study.
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专家们对于如何应对长期使用阿片类药物治疗慢性疼痛的患者使用大麻的分歧和不确定性：德尔菲研究的结果。
DOI：
10.1093/pm/pnz153
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Merlin,JessicaS
中科院分区：
文献类型：
--
作者：
Starrels,JoannaL;Young,SarahR;Azari,SorayaS;Becker,WilliamC;JenniferEdelman,E;Liebschutz,JaneM;Pomeranz,Jamie;Roy,Payel;Saini,Shalini;Merlin,JessicaS
背景在长期阿片类药物治疗（LTOT）慢性疼痛的患者中，但缺乏证据来指导临床医生的反应。目的在接受LTOT的患者中产生关于大麻使用反应的专家共识。设计分析来自在线德尔菲研究。设置/SubjectsClinician专家在疼痛和阿片类药物管理在美国各地。MethodsParticipants产生管理策略，以应对大麻的使用不区分医疗和非医疗用途，然后将每种管理策略的重要性从1（一点也不重要）到9（非常重要）进行评级。建立了共识的先验规则，并使用案例探讨了分歧。自由文本的反应主题分析研究影响参与者的决策。ResultsOf 42名参与者，64%是内科医生的因素。人们一致认为，减少阿片类药物作为对大麻使用的最初反应并不重要。如果存在重复使用大麻的模式而没有临床怀疑大麻使用障碍（CUD），则对逐渐减少阿片类药物的重要性存在分歧，并且一致认为如果怀疑CUD，则逐渐减少的重要性不确定。三个主题影响了专家的看法的重要性逐渐减少：1）利益和危害的大麻为个别患者，2）一个频谱的信念的整体风险大麻的使用，和3）变量州法律或实践policy.ConclusionsExperts不同意，是不确定的阿片类药物逐渐减少的重要性，为患者使用大麻。专家们受到患者因素，提供者信念和大麻政策的影响，强调需要进一步研究。
BackgroundMarijuana use is common among patients on long-term opioid therapy (LTOT) for chronic pain, but there is a lack of evidence to guide clinicians’ response.ObjectiveTo generate expert consensus about responding to marijuana use among patients on LTOT.DesignAnalysis from an online Delphi study.Setting/SubjectsClinician experts in pain and opioid management across the United States.MethodsParticipants generated management strategies in response to marijuana use without distinction between medical and nonmedical use, then rated the importance of each management strategy from 1 (not at all important) to 9 (extremely important). A priori rules for consensus were established, and disagreement was explored using cases. Thematic analysis of free-text responses examined factors that influenced participants’ decision-making.ResultsOf 42 participants, 64% were internal medicine physicians. There was consensus that it is not important to taper opioids as an initial response to marijuana use. There was disagreement about the importance of tapering opioids if there is a pattern of repeated marijuana use without clinical suspicion for a cannabis use disorder (CUD) and consensus that tapering is of uncertain importance if there is suspicion for CUD. Three themes influenced experts’ perceptions of the importance of tapering: 1) benefits and harms of marijuana for the individual patient, 2) a spectrum of belief about the overall riskiness of marijuana use, and 3) variable state laws or practice policies.ConclusionsExperts disagree and are uncertain about the importance of opioid tapering for patients with marijuana use. Experts were influenced by patient factors, provider beliefs, and marijuana policy, highlighting the need for further research.
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影响因子：
9.9
作者：
Rog, DJ;Nurmikko, TJ;Young, CA
通讯作者：
Young, CA
DOI：
10.1016/j.jpain.2008.10.008
发表时间：
2009-02
期刊：
The journal of pain
影响因子：
--
作者：
Chou R;Fanciullo GJ;Fine PG;Adler JA;Ballantyne JC;Davies P;Donovan MI;Fishbain DA;Foley KM;Fudin J;Gilson AM;Kelter A;Mauskop A;O'Connor PG;Passik SD;Pasternak GW;Portenoy RK;Rich BA;Roberts RG;Todd KH;Miaskowski C;American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
通讯作者：
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
影响因子：
6
作者：
Wissel, Joerg;Haydn, Tanja;Poewe, Werner
通讯作者：
Poewe, Werner
影响因子：
24.9
作者：
Azofeifa, Alejandro;Mattson, Margaret E.;Lyerla, Rob
通讯作者：
Lyerla, Rob
影响因子：
120.7
作者：
Hill, Kevin P.
通讯作者：
Hill, Kevin P.