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量增加了一倍，成为治疗慢性疼痛的主要策略 疼痛。与此同时，阿片类药物使用障碍和过量用药急剧增加。为了解决这个阿片类药物问题 流行病中，治疗慢性疼痛的一项迅速扩大的策略是医用大麻。截至 2017 年 1 月， 医用大麻在 28 个州是合法的，其中 27 个州将疼痛作为一项合格条件。虽然学习 证明大麻的镇痛作用，很少有人研究医用大麻如何影响阿片类镇痛剂 使用。研究尚未考察医用大麻的长期使用或将医用大麻产品与 不同的Δ9-四氢大麻酚（THC）和大麻二酚（CBD）含量。治疗艾滋病病毒感染者的慢性疼痛 特别具有挑战性，但很少有研究关注这一人群。由于慢性病患病率高 HIV+ 成年人中疼痛、阿片类镇痛剂的使用和大麻的使用，重要的是要了解 HIV+ 中如何 成人中，医用大麻的使用会影响阿片类镇痛药的使用和艾滋病毒的结果。尽管有潜在的好处， 大麻有潜在的不良事件。很少有研究检查长期医疗的不良事件 大麻的使用，并且没有人检查过 THC/CBD 含量所特有的不良事件。我们的总体目标 是了解医用大麻的使用如何随着时间的推移影响阿片类镇痛药的使用，并注意 THC/CBD 含量、HIV 结果和不良事件。 我们将对 250 名患有 (a) 严重或慢性疼痛、(b) 当前疼痛的 HIV+ 和 HIV- 成年人进行队列研究。 使用阿片类镇痛药，以及 (c) 新获得医用大麻认证的人。超过18个月，我们将收集 数据来自每 3 个月 7 次现场访问和每 2 周通过手机进行 39 次网络问卷调查。 数据来源包括：调查问卷；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。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（初次暴露 测量），阿片类镇痛药物的使用将是累积阿片类镇痛剂量（主要结果测量）。 我们将研究医用大麻的使用如何影响：1）阿片类镇痛药的使用，2）艾滋病毒结果，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 镇痛剂的使用，(2) 医用大麻和阿片类镇痛剂使用之间的关联因 THC/CBD 的不同而不同 内容，(3) HIV 结果将因医用大麻使用和 THC/CBD 含量而异，以及 (4) 更多的医疗 大麻的使用和较高的 THC（相对于 CBD）含量将与更多的不良事件相关。此外，我们 将定性探索个人对其医用大麻使用如何影响阿片类药物的看法 镇痛用途。随着医用大麻的使用持续扩大，以及阿片类药物流行病的持续增长， 我们的研究结果将对个人和公共卫生产生重要影响，有可能塑造 临床护理和医用大麻政策。