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

项目摘要 随着美国阿片类药物的流行，迫切需要疼痛管理的替代方案。 needed.最近的生态和开放标签研究数据表明，医用大麻的引入 法律与减少阿片类药物处方和减少过量死亡有关， 大麻与处方阿片类药物停药有关。随着知识产权法律的地位的迅速变化， 大麻用于医疗和娱乐目的，更多的患者可能会寻求大麻治疗慢性疼痛 在所有年龄组中，其管理和作为止痛剂的使用正在增加。然而， 大麻用于止痛的增加情况尚不清楚，需要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。本研究的总体目标是 提高我们对处方阿片类药物后大麻使用变化程度的了解 停药，并确定与大麻用于疼痛的变化相关的临床结果。我们将招募 650名目前接受LTOT处方且上个月尿液药物检测结果呈阳性的患者 大麻和四氢大麻酚参与者将在基线和每六个月完成一组自我报告测量 两个月换两年。他们还将完成对大麻使用状况的每月网络评估， 处方阿片类药物剂量。停用处方阿片类药物的一部分受试者将完成定性研究。 访谈，以更好地了解阿片类药物停药后大麻使用的波动情况。具体 该提案的目的是描述大麻使用和大麻使用障碍症状的变化 在处方阿片类药物剂量停用后;评价阿片类药物剂量变化之间的相关性， 大麻使用，以及随着时间的推移疼痛;并定性探索患者报告的导致 处方阿片类药物停药后使用大麻。拟议的研究对以下方面具有广泛的影响： 临床护理，提供新的数据来研究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产生经验数据， 指导疼痛管理方法，优化功能增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.