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

医用大麻是否会减少艾滋病毒和艾滋病毒成人疼痛的阿片类镇痛药？

• 批准号: 10177977
• 负责人: JULIA H. ARNSTEN
• 金额: $ 73.35万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10177977
• 关键词: AIDS/HIV problem; Accidents; Address; Adherence; Adult; Adverse event; Affect; Analgesics; Animals; Anti-Retroviral Agents; Attention; Blood specimen; CD4 Lymphocyte Count; Cannabidiol; Cannabis; Certification; Cohort Studies; Data; Data Sources; Dose; Emergency department visit; Funding; Goals; HIV; High Prevalence; Hospitalization; Individual; Injury; Intervention Studies; Interview; Laws; Legal; Measures; Medical; Medical Marijuana; Natural History; Non-Malignant; Online Systems; Opiate Addiction; Opioid; Opioid Analgesics; Outcome; Outcome Measure; Overdose; Pain; Pain management; Participant; Perception; Persons; Pharmacy facility; Policies; Population; Public Health; Qualifying; Questionnaires; Records; Research; Risk Behaviors; Shapes; Structural Models; Structure; Subgroup; Tetrahydrocannabinol; Time; Urine; Variant; Viral Load result; Visit; base; c new; chronic pain; chronic pain management; clinical care; design; high risk; illicit drug use; marijuana use; marijuana use disorder; opioid epidemic; opioid overdose; opioid use disorder; overdose death; prescription monitoring program; primary outcome

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.

在过去的十年中，阿片类镇痛药的使用增加了一倍，成为管理慢性的领先策略 疼痛。同时，卵毒素的使用障碍和过量疾病大大增加了。解决这种卵 流行病，一种管理慢性疼痛的快速扩展的策略是医用大麻。截至2017年1月， 在28个州，医用大麻是合法的，27个州将疼痛作为合格状况。虽然研究 证明大麻的镇痛作用，很少有人检查医用大麻如何影响oid镇痛 使用。研究尚未检查长期医用大麻使用或将医用大麻产品与 不同的Δ9-四氢大麻醇（THC）和大麻二酚（CBD）含量。管理艾滋病毒+成人的慢性疼痛 特别具有挑战性，但很少有研究集中在这一人群上。慢性病患病率很高 HIV+成年人中的疼痛，阿片类镇痛药和大麻使用，重要的是要了解HIV+如何 成人，医用大麻的使用会影响Ooid镇痛药和HIV结局。尽管有潜在的好处 大麻有潜在的不利事件。很少有研究检查长期医学的不良事件 使用大麻，没有人检查过特定于THC/CBD含量的不良事件。我们的总体目标 是要了解医用大麻的使用如何影响Oioid镇痛随着时间的流逝，并注意 THC/CBD内容，HIV结果和不良事件。 我们将对具有（a）严重或慢性疼痛的250 HIV+和HIV-成年人进行研究，（b）电流 阿片类镇痛药的使用，（c）新近获得医用大麻的认证。在18个月的时间里，我们将收集 每3个月通过7个面对面访问的数据和39个基于Web的问卷通过手机每2周通过手机进行数据表。 数据源将包括：问卷；医疗，药房和处方监测计划（PMP） 记录；尿液和血液样本；和定性访谈。超过参与者的2周时间（单位 分析），医用大麻暴露将是医用大麻使用的天数（主要暴露） 度量），Oioid镇痛药的使用将是累积的Oioid镇痛剂量（主要结局度量）。 我们将研究医用大麻的使用如何影响：1）绿核酸镇痛药，2）艾滋病毒结局和3） 不利事件。我们假设（1）使用医用大麻将与Ooid的减少有关 镇痛药的使用，（2）医用大麻与阿片类镇痛药之间的关联将因THC/CBD而异 内容，（3）HIV结果将因医用大麻使用和THC/CBD含量而有所不同，并且（4）更多医疗 大麻使用和较高的THC（与CBD）含量将与更多不利事件相关。另外，我们 将定性地探讨个人对医用大麻使用如何影响其阿片类药物的看法 镇痛药的使用。随着医用大麻使用的继续扩展，随着阿片类药物的流行的增长， 我们的研究结果将具有重要的个人和公共卫生影响，有可能塑造 临床护理和医用大麻政策。