Impact of Prescription Opioid Dose Changes on Cannabis Use and Clinical Outcomes

项目摘要 随着阿片类药物在美国的流行，疼痛管理的替代选择迫在眉睫 需要的。最近生态和开放标签研究的数据表明，医用大麻的引入 法律与阿片类药物处方的减少和过量死亡的减少有关，而新的阿片类药物处方的启动 大麻与处方阿片类药物的停用有关。随着法律地位的迅速变化， 大麻用于医疗和娱乐目的，可能会有更多的患者寻求大麻治疗慢性疼痛 在所有年龄组中，其作为止痛剂的使用都在增加。然而，患者的临床结果 大麻用于止痛的增加尚不清楚，有人呼吁提供前瞻性的经验数据。这项建议是 在全国VA患者样本中进行前瞻性队列研究。这项研究的总体目标是 提高我们对处方阿片类药物后大麻使用变化的理解 停止使用大麻，并确定与大麻用于止痛的变化相关的临床结果。我们将招募 650名目前正在服用LTOT并在过去一个月尿药检结果呈阳性的患者 用于大麻/THC。参与者将在基线和每六个月完成一系列自我报告测量 几个月就是两年。他们还将每月完成基于网络的大麻使用状况评估，并 处方阿片类药物剂量。停用处方阿片类药物的一部分参与者将完成定性 访谈以更好地了解大麻使用在阿片类药物停用后的波动情况。具体的 这项提议的目的是描述大麻使用的变化和大麻使用障碍的症状。 在处方阿片类药物剂量停止后；评估阿片类药物剂量变化之间的关系， 随着时间的推移，大麻的使用和疼痛；定性地探索患者报告的导致 在处方阿片类药物停用后使用大麻。拟议中的研究对以下方面具有广泛的影响 临床护理，提供新的数据以检查阿片类药物剂量调整后大麻使用的变化， 以及这些变化的临床影响。这项研究的首要目标是生成经验数据，以 指导疼痛管理方法，以优化功能收益并降低不良事件的风险。

Project Summary With the ongoing opioid epidemic in the United States, alternative options for pain management are urgently needed. Data from recent ecological and open-label studies suggest that the introduction of medical cannabis laws are associated with decreased opioid prescribing and fewer overdose deaths, and that new initiations of cannabis are associated with prescription opioid discontinuations. With the rapid changes in the legal status of cannabis for medical and recreational purposes, more patients may be seeking cannabis for chronic pain management and its use as an analgesic is increasing in all age groups. However, the clinical outcomes of increased cannabis use for pain are unclear and there are calls for prospective empirical data. This proposal is for a prospective cohort study in a national sample of VA patients. The overall goal of this research is to improve our understanding of the extent to which cannabis use changes following prescription opioid discontinuation, and identify clinical outcomes associated with changes in cannabis use for pain. We will recruit 650 patients who are currently prescribed LTOT and have a past-month urine drug test result that is positive for cannabis/THC. Participants will complete a battery of self-report measures at baseline and every six months for two years. They will also complete monthly web-based assessments of cannabis use status and prescription opioid dose. A subset of participants who discontinue prescription opioids will complete qualitative interviews to better understand how cannabis use fluctuates following opioid discontinuation. The Specific Aims of this proposal are to characterize changes in cannabis use and symptoms of cannabis use disorder following prescription opioid dose discontinuation; evaluate associations between changes in opioid dose, cannabis use, and pain over time; and qualitatively explore patient-reported factors that lead to changes in cannabis use following prescription opioid discontinuation. The proposed research has broad implications for clinical care, providing novel data to examine how cannabis use changes following opioid dose modification, and the clinical impact of these changes. The overarching goal of this research is to generate empirical data to guide pain management approaches that optimize functional gains and decrease risk of adverse events.