Highs or Lows? Evaluating the Benefits and Consequences of Medical Marijuana Use in Older Adults with Chronic Pain and Opioid Use

高点还是低点?

基本信息

  • 批准号:
    10207583
  • 负责人:
  • 金额:
    $ 41万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2019
  • 资助国家:
    美国
  • 起止时间:
    2019-09-30 至 2023-07-31
  • 项目状态:
    已结题

项目摘要

With the “graying of America,” approximately 29% of the United States population will be 55 or older in 2019; over the next 35 years, the 50+ population will more than double. As individuals age, the prevalence of chronic pain increases; recent reports indicate that approximately 50% of older adults experience bothersome pain, and the prevalence of pain peaks during ages 50-65. Historically, opioids have been the primary therapy for chronic pain, however, they have limited efficacy for long-term treatment. Further, over the past decade, rates of opioid use disorders and opioid-related overdoses have increased at an alarming rate, resulting in a national epidemic. The development of tolerance, altered metabolism and unpredictable sensitivity also increase the risk of using these medications, especially in older adults with conditions making them prone to adverse consequences. Although the analgesic effects of marijuana (MJ) have been known for centuries, and the National Academy of Sciences recently reported there is “conclusive or substantial evidence” that cannabinoids are efficacious for the treatment of chronic pain, its Schedule I status has precluded its use in mainstream medicine. However, as the majority of states have now passed medical marijuana (MMJ) laws, many are open to MMJ use, and the proportion of older adults using MJ continues to grow. Most research thus far has focused on the impact of recreational MJ use among adolescent/young adult users, in whom cognitive decrements have been reported; however, consequences in older adults who are increasingly using MJ for medical purposes remain unknown. Recent pilot data from older MMJ patients demonstrated significant reductions in medication use, notably the use of opioids, after 3 months of MMJ treatment, aligned with studies demonstrating that states with legalized MMJ report both fewer prescriptions written and opioid-related overdoses. Additionally, we observed significant improvements in cognitive performance, clinical state, and ‘normalized’ patterns of brain activation. We propose a novel longitudinal study to quantify the impact of ‘real world’ MMJ products on multiple domains, including medication use (e.g. opioids) and pain in older adults aged 50-75. Further, we will quantify the impact of MMJ use on cognitive function and clinical state as well as neurobiologic markers using multimodal neuroimaging, which have not previously been assessed in older adults. Patients will be evaluated at baseline, prior to initiating MMJ treatment, and after 3, 6, and 12 months of treatment; analyses will be completed to determine beneficial vs detrimental cannabinoid combinations/ratios. A matched group of older adults with chronic pain not seeking MMJ treatment will serve as a control group. It is imperative to determine under which conditions MMJ may be helpful or harmful in this vulnerable population. This project fills an important gap regarding positive and negative consequences of MMJ use in opioid-maintained older adults with chronic pain, informs public health policy related to the opioid crisis and MMJ treatment outcomes, and provides a foundation for a clinical trial of MMJ in this population.
随着“美国老龄化”,2019年约有29%的美国人口将达到55岁或以上; 在未来35年,50岁以上的人口将增加一倍以上。随着个人年龄的增长, 疼痛增加;最近的报告表明,大约50%的老年人经历令人烦恼的疼痛, 疼痛的流行在50-65岁期间达到高峰。从历史上看,阿片类药物一直是慢性疾病的主要疗法。 然而,它们对于长期治疗的功效有限。此外,在过去十年中,阿片类药物的使用率 吸毒障碍和类阿片相关过量以惊人的速度增加,导致全国流行。 耐受性的发展,代谢的改变和不可预测的敏感性也增加了使用的风险 这些药物,特别是在老年人的条件,使他们容易产生不良后果。 虽然大麻(MJ)的镇痛作用已经知道了几个世纪,和国家科学院。 科学界最近报道称,有“确凿或实质性证据”表明大麻素对人体有效 由于其用于治疗慢性疼痛,其附表I状态已排除其在主流医学中的使用。但随着 大多数州现在已经通过了医用大麻(MMJ)法律,许多州对MMJ的使用开放, 使用MJ的老年人比例继续增长。到目前为止,大多数研究都集中在 青少年/年轻成人使用者中的娱乐性MJ使用,其中已报告认知减退; 然而,越来越多地使用MJ用于医疗目的的老年人的后果仍然未知。 最近来自老年MMJ患者的试点数据表明,药物使用显著减少,特别是 MMJ治疗3个月后使用阿片类药物,与研究表明, MMJ报告了更少的处方和阿片类药物相关的过量。此外,我们还观察到, 认知表现、临床状态和大脑激活的“正常化”模式的改善。我们提出 一项新的纵向研究,以量化“真实的世界”MMJ产品对多个领域的影响,包括 药物使用(例如阿片类药物)和50-75岁老年人的疼痛。此外,我们将量化MMJ的影响 用于认知功能和临床状态以及使用多模式神经成像的神经生物学标志物, 这在以前的老年人中还没有被评估过。将在开始治疗前的基线时对患者进行评价 MMJ治疗,以及治疗3、6和12个月后;将完成分析以确定是否有益 与有害的大麻素组合/比率相比。一组患有慢性疼痛的老年人 MMJ治疗将作为对照组。必须确定MMJ在哪些条件下可以 对这一弱势群体有益或有害。该项目填补了积极和消极方面的重要空白 MMJ在阿片类药物维持的慢性疼痛老年人中使用的后果,为公共卫生政策提供信息 与阿片类药物危机和MMJ治疗结果相关,并为MMJ在 这个人口。

项目成果

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{{ truncateString('STACI A GRUBER', 18)}}的其他基金

Highs or Lows? Evaluating the Benefits and Consequences of Medical Marijuana Use in Older Adults with Chronic Pain and Opioid Use
高点还是低点?
  • 批准号:
    10450065
  • 财政年份:
    2019
  • 资助金额:
    $ 41万
  • 项目类别:
Highs or Lows? Evaluating the Benefits and Consequences of Medical Marijuana Use in Older Adults with Chronic Pain and Opioid Use
高点还是低点?
  • 批准号:
    10025583
  • 财政年份:
    2019
  • 资助金额:
    $ 41万
  • 项目类别:
Highs or Lows? Evaluating the Benefits and Consequences of Medical Marijuana Use in Older Adults with Chronic Pain and Opioid Use
高点还是低点?
  • 批准号:
    9797478
  • 财政年份:
    2019
  • 资助金额:
    $ 41万
  • 项目类别:
Marijuana: Neurobiologic Correlates of Age of Onset
大麻:发病年龄的神经生物学相关性
  • 批准号:
    8644793
  • 财政年份:
    2012
  • 资助金额:
    $ 41万
  • 项目类别:
Marijuana: Neurobiologic Correlates of Age of Onset
大麻:发病年龄的神经生物学相关性
  • 批准号:
    8458055
  • 财政年份:
    2012
  • 资助金额:
    $ 41万
  • 项目类别:
Imaging Data in Emerging Adults with Addiction (IDEAA): McLean Hospital Site
初发成瘾成人的影像数据 (IDEAA):麦克莱恩医院网站
  • 批准号:
    8527905
  • 财政年份:
    2012
  • 资助金额:
    $ 41万
  • 项目类别:
Marijuana: Neurobiologic Correlates of Age of Onset
大麻:发病年龄的神经生物学相关性
  • 批准号:
    8304585
  • 财政年份:
    2012
  • 资助金额:
    $ 41万
  • 项目类别:
Marijuana and Mood: Frontal Predictors of Behavior
大麻和情绪:行为的额叶预测因子
  • 批准号:
    7491608
  • 财政年份:
    2007
  • 资助金额:
    $ 41万
  • 项目类别:
Marijuana and Mood: Frontal Predictors of Behavior
大麻和情绪:行为的额叶预测因素
  • 批准号:
    7305421
  • 财政年份:
    2007
  • 资助金额:
    $ 41万
  • 项目类别:
Frontal Neural Mechanisms and Risk for Substance Abuse
额叶神经机制和药物滥用风险
  • 批准号:
    6674640
  • 财政年份:
    2003
  • 资助金额:
    $ 41万
  • 项目类别:

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青少年大麻使用中的移动健康应用:评估睡眠、疼痛和抑制控制之间的相互作用
  • 批准号:
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  • 批准号:
    10057761
  • 财政年份:
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    $ 41万
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Development of the Cannabis Actions and Practices (CAP): A Parent-Focused Intervention to Address Adolescent Marijuana Use
大麻行动和实践 (CAP) 的发展:以家长为中心的干预措施,解决青少年大麻使用问题
  • 批准号:
    10213683
  • 财政年份:
    2020
  • 资助金额:
    $ 41万
  • 项目类别:
Characterization of Reward Processing in Adolescent Marijuana Use
青少年大麻使用奖励处理的特征
  • 批准号:
    9904607
  • 财政年份:
    2018
  • 资助金额:
    $ 41万
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Characterization of Reward Processing in Adolescent Marijuana Use
青少年大麻使用奖励处理的特征
  • 批准号:
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  • 财政年份:
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  • 资助金额:
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NEUROCOGNITIVE CONSEQUENCES OF ADOLESCENT MARIJUANA USE
青少年吸食大麻的神经认知后果
  • 批准号:
    10057378
  • 财政年份:
    2017
  • 资助金额:
    $ 41万
  • 项目类别:
NEUROCOGNITIVE CONSEQUENCES OF ADOLESCENT MARIJUANA USE
青少年吸食大麻的神经认知后果
  • 批准号:
    9239633
  • 财政年份:
    2017
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    $ 41万
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青少年吸食大麻的社会背景:系统方法
  • 批准号:
    8826722
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The Social Context of Adolescent Marijuana Use: A Systems Approach
青少年吸食大麻的社会背景:系统方法
  • 批准号:
    9037642
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    $ 41万
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