Cannabinoid-Opioid Interaction in Chronic Pain
Cannabinoid-Opioid Interaction in Chronic Pain
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DOI：
10.1038/clpt.2011.188
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发表时间：
2011-12-01
影响因子：
6.7
通讯作者：
Benowitz, N. L.
中科院分区：
文献类型：
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作者：
Abrams, D. I.;Couey, P.;Benowitz, N. L.
大麻素和阿片类药物具有多种药理特性，并可能协同作用。潜在的药代动力学和在人体内的安全性尚不清楚。因此，我们进行了一项研究来回答这些问题。21名慢性疼痛患者接受每日两次的吗啡或羟考酮缓释治疗，并接受5天的住院治疗。参与者被要求在第一天晚上吸入蒸发的大麻，在第2-4天每天吸入三次，在第5天早上吸入。第1天和第5天每隔12 h采血一次。慢性疼痛的程度也每天进行评估。药代动力学研究显示，暴露于大麻后，吗啡或羟考酮的血浆浓度-时间曲线下的面积没有显著变化。加入汽化大麻后，疼痛明显减轻（平均27%，95%置信区间（CI） 9,46）。因此，我们得出结论，汽化大麻增强阿片类药物的镇痛作用，而不会显著改变血浆阿片类药物水平。这种组合可能使阿片类药物治疗的剂量更低，副作用更少。
Cannabinoids and opioids share several pharmacologic properties and may act synergistically. The potential pharmacokinetics and the safety of the combination in humans are unknown. We therefore undertook a study to answer these questions. Twenty-one individuals with chronic pain, on a regimen of twice-daily doses of sustained-release morphine or oxycodone were enrolled in the study and admitted for a 5-day inpatient stay. Participants were asked to inhale vaporized cannabis in the evening of day 1, three times a day on days 2-4, and in the morning of day 5. Blood sampling was performed at 12-h intervals on days 1 and 5. The extent of chronic pain was also assessed daily. Pharmacokinetic investigations revealed no significant change in the area under the plasma concentration-time curves for either morphine or oxycodone after exposure to cannabis. Pain was significantly decreased (average 27%, 95% confidence interval (CI) 9, 46) after the addition of vaporized cannabis. We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.