Adult Medical Cannabinoid Use and Changes in Prescription Controlled Substance Use.
Adult Medical Cannabinoid Use and Changes in Prescription Controlled Substance Use.
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成人医用大麻素的使用和处方受控物质使用的变化。
DOI：
10.1089/can.2021.0212
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发表时间：
2023
影响因子：
3.8
通讯作者：
Haney,Margaret
中科院分区：
文献类型：
--
作者：
Williams,ArthurRobin;Mauro,ChristineM;Feng,Tianshu;Waples,Josef;Martins,SilviaS;Haney,Margaret
引言：需要基于非阿片类药物的慢性非癌症疼痛管理策略来帮助减少过量死亡。虽然实验室研究和人口水平的数据表明，大麻素可以提供阿片类药物的节省效果，但在医用大麻参与者中，它们也可能通过改变其他受控物质的使用（如镇静催眠药）来影响过量风险。然而，没有研究结合了观察数据在个人层面上，以经验性地解决使用大麻素和处方控制substances.Methods之间的相互作用：电子健康记录，包括处方药监测项目数据，从一个大型多站点医用大麻计划在纽约州的所有参与者提取与非癌症疼痛和最近处方的noncannabinoid控制物质谁完成了新的摄入量访问从2018年4月15日至2019年4月14日，谁仍然积极治疗>180天。参与者被分为两个样本：最近使用阿片类药物的人和使用阿片类药物并同时使用镇静催眠药的人。患者-月水平分析评估了按药物类别列出的总平均当量毫克数（即，大麻素区分四氢大麻酚[THC]与大麻二酚[CBD]，阿片类药物和镇静催眠药）作为一个随时间变化的结果测量在每个30天的“月”期间postintake至少6 months for all participants.Results：样本1的285阿片类药物使用者的年龄为61.1岁（±13.5），57.5%的女性，并使用平均49.7（±98.5）吗啡当量每天摄入量。未经调整的分析发现，吗啡当量从第1个月的49.7（±98.5）适度下降至43.9 mg（±94.1 mg）（p=0.047），同时接受相对低剂量的THC（2.93 mg/天）和CBD（2.15 mg/天）。样本2为95例阿片类药物和镇静催眠药使用者，年龄为60.9岁（±13.1），63.2%为女性，平均每天使用86.6（±136.2）吗啡当量，平均每天使用4.3（±5.6）劳拉西泮当量。未经调整的分析没有发现吗啡当量（p=0.81）或劳拉西泮当量（p=0.980）的显着变化，患者同样接受相对低剂量的THC（2.32毫克/天）和CBD（2.24毫克/天）。结论：研究结果表明，在6个月的医用大麻使用阿片类药物或镇静催眠药的变化极小，但可能受到低保留率，外部普遍性，以及无法解释非处方物质的使用。
Introduction:Nonopioid-based strategies for managing chronic noncancer pain are needed to help reduce overdose deaths. Although lab studies and population-level data suggest that cannabinoids could provide opioid-sparing effects, among medical cannabis participants they may also impact overdose risk by modifying other controlled substance use such as sedative hypnotics. However, no study has combined observational data at the individual level to empirically address interactions between the use of cannabinoids and prescribed controlled substances.Methods:Electronic health records, including prescription drug monitoring program data, from a large multisite medical cannabis program in New York State were abstracted for all participants with noncancer pain and recently prescribed noncannabinoid controlled substances who completed a new intake visit from April 15, 2018–April 14, 2019 and who remained actively in treatment for >180 days. Participants were partitioned into two samples: those with recent opioid use and those with active opioid use and co-use of sedative hypnotics. A patient-month level analysis assessed total average equivalent milligrams by class of drug (i.e., cannabinoid distinguishing tetrahydrocannabinol [THC] vs. cannabidiol [CBD], opioids, and sedative-hypnotics) received as a time-varying outcome measure across each 30-day “month” period postintake for at least 6 months for all participants.Results:Sample 1 of 285 opioid users were 61.1 years of age (±13.5), 57.5% female, and using an average of 49.7 (±98.5) morphine equivalents daily at intake. Unadjusted analyses found a modest decline in morphine equivalents to 43.9 mg (±94.1 mg) from 49.7 (±98.5) in month 1 (p=0.047) while receiving relatively low doses of THC (2.93 mg/day) and CBD (2.15 mg/day). Sample 2 of 95 opioid and sedative-hypnotic users were 60.9 years of age (±13.1), 63.2% female, and using an average of 86.6 (±136.2) morphine equivalents daily, and an average of 4.3 (±5.6) lorazepam equivalents. Unadjusted analyses did not find significant changes in either morphine equivalents (p=0.81) or lorazepam equivalents (p=0.980), and patients similarly received relatively low doses of THC (2.32 mg/day) and CBD (2.24 mg/day).Conclusions:Findings demonstrated minimal to no change in either opioids or sedative hypnotics over the 6 months of medical cannabis use but may be limited by low retention rates, external generalizability, and an inability to account for nonprescribed substance use.