Does medical cannabis reduce opioid analgesics in HIV+ and HIV- adults with pain?

在过去的十年中，阿片类止痛药的使用增加了一倍，成为管理慢性疾病的主要策略 疼痛。与此同时，阿片类药物使用障碍和过量使用大幅增加。为了解决这种阿片类药物 作为一种流行病，一种迅速扩大的管理慢性疼痛的战略是医用大麻。截至2017年1月， 医用大麻在28个州是合法的，27个州将疼痛列为合格条件。虽然研究 展示大麻的止痛作用，很少有人研究医用大麻对阿片类止痛剂的影响 使用。没有研究长期使用医用大麻，也没有将医用大麻产品与 Δ、9-四氢大麻酚和大麻二酚含量不同。管理HIV+成人的慢性疼痛 尤其具有挑战性，但很少有研究关注这一群体。慢性病患病率高 在HIV+的成年人中，疼痛、阿片类止痛剂的使用和大麻的使用，重要的是了解在HIV+中 在成人中，医用大麻的使用会影响阿片类止痛剂的使用和艾滋病毒的结果。尽管它有潜在的好处， 大麻有潜在的不良反应。很少有研究考察长期服药的不良反应。 没有人检查过THC/CBD含量的特定不良事件。我们的首要目标 是了解医用大麻的使用如何随着时间的推移影响阿片类止痛剂的使用，并注意 THC/CBD含量、艾滋病毒结果和不良事件。 我们将对250名HIV+和HIV-成年人进行队列研究，这些成年人有(A)严重或慢性疼痛，(B)目前 使用阿片类止痛剂，以及(C)新获得医用大麻认证。在18个月内，我们将收取 每3个月进行7次面对面访问，每2周通过手机进行39份基于网络的问卷调查。 数据来源将包括：问卷调查；医疗、药房和处方监控计划(PMP) 记录；尿液和血液样本；以及定性访谈。在参与者的两周时间段内(单位 分析)，医用大麻暴露将是使用医用大麻的天数(主要暴露 阿片类止痛剂的使用将是阿片类止痛剂的累积剂量(主要结果衡量标准)。 我们将研究医用大麻的使用如何影响：1)阿片类止痛剂的使用，2)艾滋病毒的结果，以及3) 不良事件。我们假设(1)医用大麻的使用将与阿片类药物的减少有关 止痛剂的使用，(2)医用大麻和阿片类止痛剂的使用之间的联系将因THC/CBD而不同 内容，(3)艾滋病毒结果将因医用大麻的使用和THC/CBD含量而异，以及(4)更多的医用大麻 大麻的使用和更高的THC(与CBD相比)含量将与更多的不良事件相关。此外，我们 将定性地探索个人对医用大麻使用如何影响其阿片类药物的认知 止痛药的使用。随着医用大麻使用的不断扩大，以及阿片类药物流行的持续增长， 我们的研究结果将具有重要的个人和公共健康影响，有可能形成 临床护理和医用大麻政策。

Over the past decade, opioid analgesic use has doubled, becoming a leading strategy to manage chronic pain. Simultaneously, opioid use disorder and overdoses have dramatically increased. To address this opioid epidemic, one rapidly expanding strategy to manage chronic pain is medical cannabis. As of January 2017, medical cannabis is legal in 28 states, and 27 states include pain as a qualifying condition. Although studies demonstrate analgesic effects of cannabis, few have examined how medical cannabis affects opioid analgesic use. Studies have not examined long-term medical cannabis use or compared medical cannabis products with different Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) content. Managing chronic pain in HIV+ adults is particularly challenging, yet few studies have focused on this population. With a high prevalence of chronic pain, opioid analgesic use, and cannabis use among HIV+ adults, it is important to understand how, in HIV+ adults, medical cannabis use affects opioid analgesic use and HIV outcomes. Despite its potential benefits, cannabis has potential adverse events. Few studies have examined adverse events with long-term medical cannabis use, and none have examined adverse events specific to THC/CBD content. Our overarching goal is to understand how medical cannabis use affects opioid analgesic use over time, with attention to THC/CBD content, HIV outcomes, and adverse events. We will conduct a cohort study of 250 HIV+ and HIV- adults with (a) severe or chronic pain, (b) current opioid analgesic use, and (c) who are newly certified for medical cannabis. Over 18 months, we will collect data via 7 in-person visits every 3 months and 39 web-based questionnaires via cellphones every 2 weeks. Data sources will include: questionnaires; medical, pharmacy, and Prescription Monitoring Program (PMP) records; urine and blood samples; and qualitative interviews. Over participants’ 2-week time period (unit of analysis), medical cannabis exposure will be the number of days of medical cannabis use (primary exposure measure), and opioid analgesic use will be the cumulative opioid analgesic dose (primary outcome measure). We will examine how medical cannabis use affects: 1) opioid analgesic use, 2) HIV outcomes, and 3) adverse events. We hypothesize that (1) medical cannabis use will be associated with a reduction in opioid analgesic use, (2) the association between medical cannabis and opioid analgesic use will differ by THC/CBD content, (3) HIV outcomes will differ by medical cannabis use and THC/CBD content, and (4) more medical cannabis use and higher THC (vs. CBD) content will be associated with more adverse events. In addition, we will qualitatively explore individuals’ perceptions of how their medical cannabis use affects their opioid analgesic use. As medical cannabis use continues to expand, and as the opioid epidemic continues to grow, our study findings will have important individual and public health implications that have the potential to shape clinical care and medical cannabis policies.