Association between cannabis and pain outcomes in a Tribally operated clinic

摘要 美国印第安人和阿拉斯加原住民(AIAN)受慢性疼痛的影响不成比例 疾病，包括关节炎、糖尿病神经病变和下腰痛。AIAN社区也 由于西医提供的疼痛解决方案而受到伤害，如处方阿片类药物， 导致AIAN人群中阿片类药物滥用和死亡率增加。许多AIAN人已经转向 本土医学和其他非西方的疼痛控制方法。已有34个州合法化 医用大麻，而12个州和哥伦比亚特区已将非医疗用途合法化，以及 从大麻中提取的大麻二酚(CBD)不再是受管制物质。因此，大麻产品是 适用于大多数美国成年人。66%的成年人认为大麻可以缓解疼痛，42%的成年人 医用大麻使用者报告说，使用它来缓解疼痛。虽然初步证据表明大麻 四氢大麻酚[THC]有止痛作用，这是大麻相关疼痛减轻的证据 强度和干扰(即疼痛干扰功能的程度)是有限的。有非常有限的 关于各种大麻产品如何在合法市场上获得的影响的数据(例如，不同品种， 分娩方式)和使用方式影响疼痛结局和并发症(例如，心理健康、睡眠) 与疼痛有关的东西。作为华盛顿州的一个主权国家，我们的部落伙伴发展了 Qwibil诊所，建议患者使用大麻来止痛和其他医疗 有问题。Qwibil诊所提供了一个独特的机会来调查大麻使用、 AIAN拥有和经营的诊所中的疼痛和疼痛相关因素。我们提出了一种混合方法嵌入 (Quant+Qual)评估大麻如何影响疼痛强度和干扰的研究(n=350) 在Qwibil诊所寻求慢性疼痛治疗的患者。我们将确定大麻使用的类型和模式 这与超过12个月护理的疼痛结果有关。我们还将确定是否会产生 大麻对疼痛结果的影响是通过已知的疼痛相关因素(即负面情绪、睡眠问题、 自我效能感)随时间推移。为了补充我们的定量方法，我们将使用定性访谈来探索 寻求疼痛护理的患者如何体验大麻及其对疼痛的影响，包括不同的参与者 按性别、种族(AIAN，非AIAN)和使用的大麻类型。最后，我们将为AIAN提供机会 华盛顿州立大学医学、护理、药学和预防科学专业毕业生 接受大麻培训和指导的方案和西北印度学院本科生方案 和Qwibil诊所的疼痛研究，包括定性和定量数据收集和 分析和传播研究成果。结果将提供有关以下影响的重要信息 AIAN样本中关于慢性疼痛的合法大麻产品，为患有慢性疼痛的人提供了重要信息 痛苦、提供者和部落政策制定者。

ABSTRACT American Indians and Alaska Native (AIAN) people are disproportionately affected by chronic pain conditions, including arthritis, diabetic neuropathy, and lower back pain. AIAN communities have also experienced harm as a result of pain solutions offered by Western medicine, such as prescription opioids, which have contributed to increased opioid misuse and mortality in AIAN people. Many AIAN people have turned to Native medicine and other non-Western approaches to pain management. Thirty-four states have legalized marijuana for medical use, while 12 states, and the District of Columbia, have legalized non-medical use, and cannabidiol (CBD) derived from hemp is no longer a controlled substance. Therefore, cannabis products are available to the majority of U.S. adults. 66% of adults think that cannabis provides pain relief, and 42% of medicinal marijuana users report using it to relieve pain. While initial evidence indicates that cannabis tetrahydrocannabinol [THC] has analgesic effects, the evidence for cannabis-associated reductions in pain intensity and interference (i.e., the extent to which pain interferes with functioning) is limited. There is very limited data about the effects of how a variety of cannabis products available on the legal market (e.g., different strains, methods of delivery) and patterns of use impact pain outcomes and the comorbidities (e.g., mental health, sleep) that are associated with pain. As a sovereign nation in Washington State, our Tribal partners developed the Qwibil Clinic, which advises patients on the use of cannabis for the management of pain and other medical problems. The Qwibil Clinic provides a unique opportunity to investigate the relationship between cannabis use, pain, and pain-related factors in an AIAN owned and operated clinic. We propose a mixed-methods embedded (QUANT+Qual) study to assess how cannabis impacts pain intensity and interference in a sample of n=350 patients seeking chronic pain treatment at the Qwibil Clinic. We will identify types and patterns of cannabis use that are associated with pain outcomes over 12-months of care. We will also determine whether the effect of cannabis on pain outcomes is mediated through known pain-related factors (i.e., negative affect, sleep problems, self-efficacy) over time. To supplement our quantitative methods, we will use qualitative interviews to explore how patients seeking care for pain experience cannabis and its impact on pain, including participants who differ by sex, race (AIAN, Non-AIAN), and type of cannabis used. Finally, we will provide opportunities for AIAN students enrolled in Washington State University medical, nursing, pharmacy, and prevention science graduate programs and Northwest Indian College undergraduate programs to receive training and mentorship in cannabis and pain research at the Qwibil Clinic, including training in qualitative and quantitative data collection and analysis and dissemination of research results. Results will provide important information about the impact of legal cannabis products on chronic pain in a mostly AIAN sample, providing important information to people with pain, providers, and Tribal policymakers.