Patients’ and clinicians’ perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care

Abstract

Background: The prevalence of opioid-associated morbidity and mortality underscores the need for research on non-opioid treatments for chronic non-cancer pain (CNCP). Pain is the most common medical condition for which patients request medical cannabis. Limited research indicates that patients are interested in cannabis as a potential addition to or replacement for opioid medication. This analysis reports on CNCP patient and clinician perceptions about the co-use of cannabis and opioids for CNCP management. Methods: We interviewed 23 clinicians and 46 CNCP patients, using semi-structured interview guides, from six safety-net clinics across the San Francisco Bay Area, and 5 key stakeholders involved in CNCP management. We used a modified grounded theory approach to code and analyze transcripts. Results: CNCP patients described potential benefits of co-use of cannabis and opioids for pain management and concerns about dosing and addictive potential. Patients reported seeking cannabis when unable to obtain prescription opioids. Clinicians stated that their patients reported cannabis being helpful in managing pain symptoms. Clinicians expressed concerns about the potential exacerbation of mental health issues resulting from cannabis use. Conclusion: Clinicians are hampered by a lack of clinically relevant information about cannabis use, efficacy and side-effects. Currently no guidelines exist for clinicians to address opioid and cannabis co-use, or to discuss the risk and benefits of cannabis for CNCP management, including side effects. Cannabis and opioid co-use was commonly reported by patients in our sample, yet rarely addressed during clinical CNCP care. Further research is needed on the risks and benefits of cannabis and opioid co-use.

The Lancet Series call to action to reduce low value care for low back pain: an update

“…Studies already report concomitant use of recreational cannabis and opioids among people with chronic noncancer pain. 15 , 20 A four-year prospective observational study found cannabis users had greater pain and lower self-efficacy in managing pain, and there was no evidence it reduced pain severity or interference or exerted an opioid-sparing effect. 15 There is therefore an urgent need to address politician and public misconceptions about cannabinoids and preventive action to limit the same aggressive marketing approaches for medicinal cannabinoids that enabled the opioid epidemic; a new prescribing epidemic may be imminent.…”

Treatment Preferences for Chronic Low Back Pain: Views of Veterans and Their Providers

“…Indeed, few data, other than anecdotal reports, are available supporting the use of marijuana for cLBP, and concerns within the medical community over toxicity and abuse remain high. 25 , 26 On the other hand, currently, most states in the US have medical marijuana laws, and many states now permit recreational use. Formal study of the utility of marijuana for pain might help to address this disparity of opinions and foster more constructive conversations between patients and their medical providers.…”

A New Side-effect of Sufentanil: Increased Monocyte-endothelial Adhesion

“…Opioids have been used for many years in clinical practice, especially for cancer pain management, anaesthesia, and postoperative analgesia [20,21]. Studies on the side effects of opioids have mainly focused on nausea, vomiting, postoperative delirium, and breathing effects, and the effects of opioids on monocyte-endothelial adherence are unknown [22].…”