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 这些疾病包括关节炎、糖尿病性神经病变和下背痛。AIAN社区还 由于西医提供的止痛药而受到伤害，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管理方法。34个州已经合法化 大麻用于医疗用途，而12个州和哥伦比亚特区已将非医疗用途合法化， 大麻二酚（CBD）不再是一种受管制的物质。因此，大麻产品是 为大多数美国成年人提供。66%的成年人认为大麻可以缓解疼痛，42%的人认为大麻可以缓解疼痛。 药用大麻使用者报告说，使用它来减轻疼痛。虽然初步证据表明大麻 四氢大麻酚（THC）具有镇痛作用，大麻相关疼痛减轻的证据 强度和干涉（即，疼痛干扰功能的程度）是有限的。非常有限 关于法律的市场上可获得的各种大麻产品的影响的数据（例如，不同的菌株， 递送方法）和使用模式影响疼痛结果和合并症（例如，心理健康、睡眠） 与疼痛有关的神经系统作为华盛顿州的一个主权国家，我们的部落伙伴制定了 Qwibil诊所，就使用大麻治疗疼痛和其他医疗问题向患者提供建议。 问题Qwibil诊所提供了一个独特的机会来调查大麻使用， 疼痛和疼痛相关因素在AIAN拥有和经营的诊所。我们提出了一种混合方法嵌入 （QUANT+Qual）研究，以评估大麻如何影响疼痛强度和n=350样本的干扰 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 与12个月护理的疼痛结果相关。我们还将确定 大麻对疼痛结果的影响是通过已知的疼痛相关因素介导的（即，负面情绪，睡眠问题 自我效能（self-efficacy）。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）和所用大麻种类分列。最后，我们将为AIAN提供机会 就读于华盛顿州立大学医学、护理、药学和预防科学专业的学生毕业 计划和西北印度学院本科课程，接受大麻培训和指导 Qwibil诊所的疼痛研究，包括定性和定量数据收集方面的培训， 分析和传播研究成果。研究结果将提供有关影响的重要信息， 法律的大麻产品对慢性疼痛的影响，主要是AIAN样本，为患有 疼痛，供应商和部落决策者。

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.