Page 19 - Delaware Medical Journal - January/February 2021
P. 19
TREATMENT
INTRODUCTION
Medical cannabis use programs are provided in 33 states in the U.S., as well as the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands, with adult recreational use legal in 11.1 Widespread legalization of cannabis in recent years has led to increased research regarding the effects of cannabis in the context of opioid use for chronic pain, with some studies suggesting that the drug may have a critical role in the ongoing opioid epidemic. A 2018 study of cannabis use among individuals in opioid agonist treatment programs was associated with improved retention
in treatment programs.2 Cannabis use has also been found to decrease opioid use by 40-60% among patients with opioid use disorder, while simultaneously corresponding to a subjective increase in quality of life.3,4
According to state registries, 90% of medical cannabis is prescribed for the management of chronic pain,3 presenting a possible alternative to opioid use. When prescribed concurrently with opioids, cannabis use was associated with a 27% decrease in perceived pain, suggesting that cannabis may reduce the opioid dosage required for effective pain control.5 Concurrent use of inhaled cannabis and opioids for pain management did not change serum opioid levels, suggesting that inhaled cannabis did not affect opioid uptake levels.5
While recreational cannabis is not currently legal in Delaware,1 medical use of cannabis was legalized in 2011.6 Delaware has likewise been affected by the opioid crisis, with 355 opioid overdose fatalities in 2018 and a rate of opioid prescriptions almost 20% greater than the national average.7 This study explores the effect of cannabis use on the daily morphine milligram equivalent (MME) required for effective pain control by patients concurrently enrolled in medical cannabis programs in Delaware and receiving chronic pain treatment with passive opioid reduction strategies.
METHODS
authorization for medical cannabis consumption between June 2018 and October 2019 through the Delaware Medical Marijuana (aka Cannabis) Program. The providing physician had assessed
based upon their medical histories. Out of this initial group, 81 individuals had previously been followed or were being seen
According to state registries, 90% of medical cannabis is prescribed for the management of chronic pain,3 presenting a possible alternative to opioid use. When prescribed concurrently with opioids, cannabis use was associated with a 27% decrease in perceived pain, suggesting that cannabis may reduce the opioid dosage required for effective pain control.5
at a private pain management practice in Delaware for chronic pain treatment, and therefore, patients’ medical histories were observational cohort study group.
For the purposes of this cohort study, characteristics including name, date of birth, age, sex, location of chronic pain, history
of surgery for pain treatment, and date of approval for medical marijuana use were obtained from the patients’ charts and Delaware Prescription Monitoring Program (PMP) was used by the physician to securely obtain and calculate each individual’s average MME in the six months prior to approval for medical cannabis use and in the six months subsequent. Importantly, the
were taking buprenorphine during the analysis periods, ensuring a more accurate calculation of opioid use for chronic pain relief. individuals’ names and dates of birth were removed by the physician from the data set before release to the remaining authors for subsequent data analysis.
For initial analysis, a Kolmogorov–Smirnov test was applied to the six-month average MME values to examine the statistical normality of the data set against a Gaussian distribution. The non-parametric Mann-Whitney U test was used to compare independent subsets of the data, and the Wilcoxon signed-
rank test, a nonparametric measure for matched samples, was implemented to compare the paired and statistically dependent Grubbs’ test was also used to remove a single outlier value in the
Del Med J | January/February 2021 | Vol. 93 | No. 1
19
