Marijuana Use Is Not Associated With Changes in Opioid Prescriptions or Pain Severity Among People Living With HIV and Chronic Pain

Merlin, Jessica S.; Long, Dustin; Becker, William C.; Christopolous, Katerina; Claborn, Kasey; Crane, Heidi M.; Edelman, E. Jennifer; Lovejoy, Travis I.; Mathews, W. Christopher; Morasco, Benjamin J.; Napravnik, Sonia; O'Cleirigh, Connall; Saag, Michael S.; Starrels, Joanna L.; Gross, Robert; Liebschutz, Jane M.

doi:10.1097/qai.0000000000001998

Cited by 18 publications

(16 citation statements)

References 36 publications

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“…There is preliminary but promising data to support that medical cannabis initiation can help reduce the opioid dose required to produce pain relief, or substitute the use of opioids altogether, which could help reduce the risk of fatal opioidrelated overdose (Lucas and Walsh, 2017;Reiman et al, 2017;Knerich et al, 2019), although this has not been reported in all studies (Merlin et al, 2019). A cross-sectional retrospective survey reported that medical cannabis use was associated with a 64% decrease in opioid use, improved quality of life, and fewer medication-related side-effects (Boehnke et al, 2016).…”

Section: Cannabinoids With Opioids For Cncpmentioning

confidence: 99%

Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain

et al. 2021

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Background: Chronic non-cancer pain (CNCP) is estimated to affect 20% of the adult population. Current United States and Canadian Chronic non-cancer pain guidelines recommend careful reassessment of the risk-benefit ratio for doses greater than 90 mg morphine equivalent dose (MED), due to low evidence for improved pain efficacy at higher morphine equivalent dose and a significant increase in morbidity and mortality. There are a number of human studies demonstrating cannabis opioid synergy. This preliminary evidence suggests a potential role of cannabis as an adjunctive therapy with or without opioids to optimize pain control.Methods: In 2017, the Canadian Opioid Guidelines Clinical Tool was created to encourage judicious opioid prescribing for CNCP patients and to reevaluate those who have been chronically using high MED. Mirroring this approach, we draw on our clinical experiences and available evidence to create a clinical tool to serve as a foundational clinical guideline for the initiation of medical cannabis in the management of CNCP patients using chronic opioid therapy.Findings: Following principles of harm reduction and risk minimization, we suggest cannabis be introduced in appropriately selected CNCP patients, using a stepwise approach, with the intent of pain management optimization. We use a structured approach to focus on low dose cannabis (namely, THC) initiation, slow titration, dose optimization and frequent monitoring.Conclusion: When low dose THC is introduced as an adjunctive therapy, we observe better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.

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Section: Cannabinoids With Opioids For Cncpmentioning

confidence: 99%

Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain

et al. 2021

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“…Similarly, we thought alcohol may be associated with pain as a recently published qualitative study, Cook et al concluded that PLHIV may engage in risky drinking, in order to manage physical pain [ 41 ]. A similar study by Merlin et al also noted marijuana use was not statistically associated with reductions in pain among PLHIV [ 42 ]. However, studies investigating the associations between marijuana use and pain have reported reductions in pain severity among the general population [ 43 ].…”

Section: Discussionmentioning

confidence: 91%

Factors associated with current and severe pain among people living with HIV: results from a statewide sample

et al. 2020

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Background People living with HIV (PLHIV) are more likely to suffer from pain compared to the general public. Pain often clusters with mental health symptoms and substance use. This study sought to evaluate mental health and substance use factors associated with any pain and severe pain intensities among PLHIV. Methods Data were derived from HIV+ adults (N = 733) recruited from community health centers across Florida who completed questionnaires regarding demographics, chronic pain, HIV clinical outcomes, mental health symptoms, and substance use information. Pain was assessed using the Brief Pain Inventory (BPI) short form. Multivariate logistic regression analysis was utilized to assess the relationship between selected covariates and pain. Results Approximately half (45.0%) of participants reported having any current pain while 16.1% reported severe pain. The odds of having any current pain were 2.49 (CI 95% 1.48, 4.18, p < 0.01) times greater among PLHIV reporting anxiety and 1.69 (CI 95% 1.11, 2.57, p = 0.01) times greater among PLHIV reporting PTSD compared to those without those factors. The odds of having severe pain were 2.03 (CI 95% 1.03, 4.01, p = 0.04) times greater among PLHIV reporting anxiety and 2.02 (CI 95% 1.26, 3.24, p < 0.01) times greater among female participants compared to PLHIV without those factors respectively. Factors including depression, alcohol consumption, and marijuana use were not statistically associated with any current pain nor with severe pain. Conclusion The relationship between pain and mental health is complex. Thus, future research is needed to determine if pain treatments may reduce mental health symptoms or if treatments can be targeted to address both issues simultaneously.

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“…40 Similarly, we thought alcohol may be associated with pain as a recently published qualitative study, Cook et al concluded that PLHIV may engage in risky drinking, in order to manage physical pain. 41 A similar study by Merlin et al also noted marijuana use was not statistically associated with reductions in pain among PLHIV. 42 However, studies investigating the associations between marijuana use and pain have reported reductions in pain severity among the general population.…”

Section: Substance Usementioning

confidence: 85%

Factors Associated with Current and Severe Pain Among People Living with HIV: Results From a Statewide Sample

Joseph

Jones

Canidate

et al. 2020

Preprint

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Background: People living with HIV (PLHIV) are more likely to suffer from pain compared to the general public. Pain often clusters with mental health symptoms and substance use. This study sought to evaluate mental health and substance use factors associated with any pain and severe pain intensities among PLHIV. Methods: Data were derived from HIV+ adults (N=733) recruited from community health centers across Florida who completed questionnaires regarding demographics, chronic pain, HIV clinical outcomes, mental health symptoms, and substance use information. Pain was assessed using the Brief Pain Inventory (BPI) short form. Multivariate logistic regression analysis was utilized to assess the relationship between selected covariates and pain. Results: Approximately half (45.0%) of participants reported having any current pain while 16.1% reported severe pain. The odds of having any current pain were 2.49 (CI 95% 1.48, 4.18, p<0.01) times greater among PLHIV reporting anxiety and 1.69 (CI 95% 1.11, 2.57, p=0.01) times greater among PLHIV reporting PTSD compared to those without those factors. The odds of having severe pain were 2.03 (CI 95% 1.03, 4.01, p=0.04) times greater among PLHIV reporting anxiety and 2.02 (CI 95% 1.26, 3.24, p<0.01) times greater among female participants compared to PLHIV without those factors respectively. Factors including depression, alcohol consumption, and marijuana use were not statistically associated with any current pain nor with severe pain.Conclusion: The relationship between pain and mental health is complex. Thus, future research is needed to determine if pain treatments may reduce mental health symptoms or if treatments can be targeted to address both issues simultaneously.

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Marijuana Use Is Not Associated With Changes in Opioid Prescriptions or Pain Severity Among People Living With HIV and Chronic Pain

Cited by 18 publications

References 36 publications

Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain

Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain

Factors associated with current and severe pain among people living with HIV: results from a statewide sample

Factors Associated with Current and Severe Pain Among People Living with HIV: Results From a Statewide Sample

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