Department of Medicine at Duke University, Durham, North Carolina.
Research Department, Strainprint Technologies Ltd., Toronto, Ontario, Canada.
J Palliat Med. 2019 Oct;22(10):1180-1184. doi: 10.1089/jpm.2018.0658. Epub 2019 Aug 6.
To determine the relative contributions of tetrahydrocannabinol (THC) and cannabidiol (CBD) to patients' self-ratings of efficacy for common palliative care symptoms. This is an electronic record-based retrospective cohort study. Model development used logistic regression with bootstrapped confidence intervals (CIs), with standard errors clustered to account for multiple observations by each patient. This is a national Canadian patient portal. A total of 2,431 patients participated. Self-ratings of efficacy of cannabis, defined as a three-point reduction in neuropathic pain, anorexia, anxiety symptoms, depressive symptoms, insomnia, and post-traumatic flashbacks. We included 26,150 observations between October 1, 2017 and November 28, 2018. Of the six symptoms, response was associated with increased THC:CBD ratio for neuropathic pain (odds ratio [OR]: 3.58; 95% CI: 1.32-9.68; = 0.012), insomnia (OR: 2.93; 95% CI: 1.75-4.91; < 0.001), and depressive symptoms (OR: 1.63; 95% CI: 1.07-2.49; = 0.022). Increased THC:CBD ratio was not associated with a greater response of post-traumatic stress disorder (PTSD)-related flashbacks (OR: 1.43; 95% CI: 0.60-3.41; = 0.415) or anorexia (OR: 1.61; 95% CI: 0.70-3.73; = 0.265). The response for anxiety symptoms was not significant (OR: 1.13; 95% CI: 0.77-1.64; = 0.53), but showed an inverted U-shaped curve, with maximal benefit at a 1:1 ratio (50% THC). These preliminary results offer a unique view of real-world medical cannabis use and identify several areas for future research.
为了确定四氢大麻酚（THC）和大麻二酚（CBD）对患者常见姑息治疗症状自我评估疗效的相对贡献。这是一项基于电子记录的回顾性队列研究。模型开发使用逻辑回归和 bootstrap 置信区间（CI），采用标准误差聚类以考虑每个患者的多次观察。这是一个全国性的加拿大患者门户。共有 2431 名患者参与。自我评估大麻的疗效，定义为神经性疼痛、厌食、焦虑症状、抑郁症状、失眠和创伤后闪回减少三个等级。我们纳入了 2017 年 10 月 1 日至 2018 年 11 月 28 日之间的 26150 次观察。在这六种症状中，反应与增加的 THC:CBD 比值有关，具体为神经性疼痛（比值比 [OR]：3.58；95%CI：1.32-9.68； = 0.012）、失眠（OR：2.93；95%CI：1.75-4.91； < 0.001）和抑郁症状（OR：1.63；95%CI：1.07-2.49； = 0.022）。增加的 THC:CBD 比值与创伤后应激障碍（PTSD）相关闪回（OR：1.43；95%CI：0.60-3.41； = 0.415）或厌食（OR：1.61；95%CI：0.70-3.73； = 0.265）的更大反应无关。焦虑症状的反应不显著（OR：1.13；95%CI：0.77-1.64； = 0.53），但呈倒 U 型曲线，在 1:1 比值（50% THC）时获益最大。这些初步结果提供了对真实世界医用大麻使用的独特视角，并确定了未来研究的几个领域。
