Abstract

Objectives

We investigated whether cannabis usage was associated with reduced opioid usage, and the rates of opioid and cannabis use disorders among chronic pain patients who had been prescribed medical cannabis.

Methods

A random sample of chronic pain patients who had license for cannabis use were interviewed by telephone about their lifetime opioid and cannabis usage. Cannabis and opioid use disorders were assessed with Portenoy’s criteria.

Results

Of the 100 participants aged 18–70 years (compliance 67% (aged >40) and 33% (aged ≤ 40y)), 76 ever used opioids. Of them, 93% decreased or stopped opioids following cannabis initiation. Ten patients (10%), 17.4% of the ≤40 y age group, met the criteria for cannabis use disorder. Compared to those who did not meet the criteria, their lifetime depression was higher (80% vs. 43.2%, respectively, P=.042), and they were less educated (12.2 ± 0.6y vs. 13.5 ± 2.1y, p = 0.05).

Conclusions

Cannabis usage was associated with reduced opioid usage. The prevalence of cannabis use disorder was high among the younger participants who also had a lower study compliance rate, suggesting the higher actual prevalence of cannabis use disorder. While medical cannabis may help reduce opioid use in chronic non-cancer pain patients, younger age, depression, and other risk factors should be carefully evaluated before cannabis is prescribed.

中文翻译：

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大麻处方治疗慢性非癌痛的风险和益处

摘要

目标

我们调查了大麻的使用是否与阿片类药物的使用减少有关，以及服用医用大麻的慢性疼痛患者的阿片类药物和大麻使用障碍的发生率。

方法

通过电话采访了随机抽样的获得大麻使用许可的慢性疼痛患者，了解他们终生使用阿片类药物和大麻的情况。使用 Portenoy 的标准评估大麻和阿片类药物使用障碍。

结果

在 100 名 18-70 岁的参与者中（67%（>40 岁）和 33%（40 岁）），76 人曾经使用过阿片类药物。其中，93% 的人在开始使用大麻后减少或停止使用阿片类药物。10 名患者（10%），17.4% 的 ≤40 岁年龄组符合大麻使用障碍的标准。与不符合标准的人相比，他们的终生抑郁程度更高（分别为 80% 和 43.2%，P = 0.042），受教育程度更低（12.2 ± 0.6 年 vs. 13.5 ± 2.1 年，p = 0.05)。

结论

大麻的使用与阿片类药物的使用减少有关。在研究依从率较低的年轻参与者中，大麻使用障碍的患病率很高，这表明大麻使用障碍的实际患病率较高。虽然医用大麻可能有助于减少慢性非癌症疼痛患者对阿片类药物的使用，但在开具大麻处方之前，应仔细评估年轻、抑郁和其他风险因素。