Medical Cannabis: Effects on Opioid and Benzodiazepine Requirements for Pain Control

O'Connell, Megan; Sandgren, Megan; Frantzen, Leah; Bower, Erika; Erickson, Brian

doi:10.1177/1060028019854221

Cited by 20 publications

(23 citation statements)

References 13 publications

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“…Previous research studies have reported a level of substantial evidence for medical cannabis’ use in the alleviation of pain [ 5 , 27 , 29 ]. Both Canadian clinicians [ 5 ] and the NASEM [ 30 ] have concurred that medical cannabis use may be effective in the management of chronic pain.…”

Section: Discussionmentioning

confidence: 99%

“…); (2) mental health conditions [12][13][14][15] (anxiety [16,17], depression [18,19]); (3) autoimmune disorders [20]; (4) sleep problems [21,22]; (5) neurological [23]; (6) gastrointestinal [24]; and (7) other health conditions [25,26] such as chemo-induced nausea/vomiting [7]. There also has been an increasing frequency of medical cannabis use as an alternative to opioids [11,18,27] for patients. With the exception of neuropathic chronic pain [10], chemotherapy-induced nausea/vomiting [28], and certain spasticity symptoms, the majority of previous studies concur that there is currently very weak evidence regarding its clinical effectiveness for its long-term use [23].…”

Section: Introductionmentioning

confidence: 99%

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Gaps in evidence for the use of medically authorized cannabis: Ontario and Alberta, Canada

et al. 2021

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Background With legal access to medical cannabis in Canada since 2001, there is a need to fully characterize its use at both the individual and population levels. We draw on data from Canada’s largest cohort study of medical cannabis to identify the primary reasons for medical cannabis authorization in Canada from 2014 to 2019 in two major provinces: Alberta (AB) and Ontario (ON), and review the extent that evidence supports each indication. Methods Self-reported baseline assessments were collected from adult patients in ON (n = 61,835) and AB (n = 3410) who were authorized medical cannabis. At baseline, sociodemographic, primary medical information, and validated clinical questionnaires were completed by patients as part of an individual assessment. Patients’ reasons for seeking medical cannabis were compared to published reviews and guidelines to assess the level of evidence supporting medical cannabis use for each condition. Results Medical cannabis use in both AB and ON was similar in both demographic and reason for authorization. The most common reasons for medical cannabis authorization were: (1) pain (AB = 77%, ON = 76%) primarily due to chronic musculoskeletal, arthritic, and neuropathic pain, (2) mental health concerns (AB = 32.9%, ON = 38.7%) due to anxiety and depression, and (3) sleep problems (AB = 28%, ON = 25%). More than 50 other conditions were identified as reasons for obtaining authorization. Conclusion In both AB and ON, the majority of reasons for medical cannabis authorization are not substantiated by clinical evidence to fully support its efficacy for long-term use. Ongoing epidemiological studies on medical cannabis on these treatments are warranted to fully outline its treatment benefits or risks.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gaps in evidence for the use of medically authorized cannabis: Ontario and Alberta, Canada

et al. 2021

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“…The positive bi-directional association between benzodiazepines and analgesics is supported by many previous studies (37)(38)(39). However, others have found a negative association between the use of cannabis and benzodiazepines (40,41), and have identified a substitutional role between them (42). These findings could explain the negative bi-directional relationship found in the present study.…”

Section: Discussionmentioning

confidence: 60%

Substance Use in Mild-COVID-19 Patients: A Retrospective Study

Ismael

Zaramella

Battagin

et al. 2021

Front. Public Health

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Background: There is a need for prospective studies investigating substance use variations in mild COVID-19 patients. These individuals represent the majority of patients affected by the disease and are routinely treated at home, facing periods of quarantine.Methods: This was a retrospective cohort study. All people who tested positive for COVID-19 and classified as mild cases (i.e., no alarm sign/symptom, no need for in-person consultation) during the treatment in the public health system of a Brazilian city with around 160,000 inhabitants were monitored by phone for all the COVID-19 symptoms listed by the Centers for Disease Control and Prevention (CDC) during the active phase of the disease (i.e., no longer experiencing symptoms, up to 14 days in mild cases). After this phase (median = 108 days after intake, IQR = 76–137), we asked these patients who were classified as experiencing mild COVID-19 (n = 993) about last-month substance use in three time-points: pre-COVID, just after COVID-19 acute phase (post-COVID acute phase) and in the period before survey (post-COVID follow-up phase).Results: The number of COVID-19 symptoms was not associated with pre- or post-infection substance use. Pre-COVID alcohol and non-medical benzodiazepine use were associated with specific COVID-19 symptoms. However, sensitivity analyses showed that such associations could be explained by previous psychiatric and medical profiles. Alcohol and tobacco use decreased and non-medical analgesics increased in the post-COVID acute phase. However, just alcohol use remained lower in the post-COVID follow-up period. Higher pre-COVID levels of tobacco and alcohol were associated with post-COVID follow-up cannabis and non-medical analgesic use, respectively. Non-medical benzodiazepine use had positive and negative bi-directional associations with cannabis and non-medical analgesic use, respectively.Conclusion: We were not able to find specific associations between substance use and COVID-19 symptomatology in the present study. Patients with mild COVID-19 should be monitored for substance use in the post-COVID-19 period, and preventive interventions for non-medical analgesic use should be implemented. Focused preventive interventions increasing the perceived risks of cannabis and non-medical benzodiazepine and analgesic use among people experiencing mild COVID-19 that reported previous substance use could be useful.

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“…opiates, anti-depressants, nonopioid pain medicine), alcohol, and illicit substances) (Lucas et al 2019). Education regarding the therapeutic benefits of cannabis and proper ways to administer cannabis may change attitudes and downstream cannabis use behavior reducing the adverse effects of cannabis (O'Connell et al 2019).…”

Section: Introductionmentioning

confidence: 99%

Attitudes about cannabis mediate the relationship between cannabis knowledge and use in active adult athletes

Zeiger¹,

Silvers

Fleegler³

et al. 2020

J Cannabis Res

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Background Little is known about how cannabis knowledge and attitudes impact cannabis use behavior. Objective To test the knowledge-attitudes-behavior paradigm in active adult athletes. Design The Athlete Pain, Exercise, and Cannabis Experience (PEACE) Survey, a cross-sectional survey study, used social media and email blasts to recruit participants and SurveyGizmo to collect data. Participants Self-defined active adult athletes ( n = 1161). Main measures Knowledge about cannabis was evaluated with four questions. Attitudes toward cannabis was evaluated with 11 questions. The attitudes questions were used in a TwoStep Cluster analysis in SPSS to assign group membership by attitudes. Chi-square was used to determine if there were differences in cluster membership by demographic factors and if knowledge about cannabis differed by cluster membership. Regression analysis was performed to determine if cannabis attitudes mediated the relationship between cannabis knowledge and cannabis use. Key results A three-cluster solution was the best fit to the data. The clusters were named Conservative ( n = 374, 32.2%), Unsure ( n = 533, 45.9%), and Liberal ( n = 254, 21.9). There was a significant difference among the clusters for all 11 attitude items (all p < 0.001). Attitude cluster membership was significantly different by age ( p < 0.001), primary sport ( p < 0.05), and knowledge about cannabis ( p < 0.001). Athletes in the liberal cluster answered the knowledge questions correctly most often. Attitudes mediated the relationship between cannabis knowledge and cannabis use [Never (32.4%), Past (41.6%), Current (26.0%)] with athletes in the liberal cluster showing more knowledge and greater likelihood to be a current cannabis user ( p < 0.001). Among current cannabis users there were differential patterns of cannabis use depending on their attitudes and knowledge; liberal athletes tended to co-use THC and CBD and used cannabis longer. ( p < 0.001). Conclusions Cannabis education needs to consider attitudes about cannabis, especially among those who might benefit from medical cannabis.

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Medical Cannabis: Effects on Opioid and Benzodiazepine Requirements for Pain Control

Cited by 20 publications

References 13 publications

Gaps in evidence for the use of medically authorized cannabis: Ontario and Alberta, Canada

Gaps in evidence for the use of medically authorized cannabis: Ontario and Alberta, Canada

Substance Use in Mild-COVID-19 Patients: A Retrospective Study

Attitudes about cannabis mediate the relationship between cannabis knowledge and use in active adult athletes

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