Balu Alan, Mishra Divya, Marcu Jahan, Balu Ganesh
Department of Chemistry, Georgetown University, Washington, USA.
Emergency Medicine, Geisel School of Medicine, Hanover, USA.
Cureus. 2021 Dec 7;13(12):e20240. doi: 10.7759/cureus.20240. eCollection 2021 Dec.
Background Opioid medications are commonly used to treat chronic pain around the world. While these medications are quite effective at reducing pain, they can create opioid dependence and lead to further drug addiction. Long-term opioid use has significantly contributed to the "opioid epidemic" that is currently ravaging the United States, leading to opioid overdoses and unintentional deaths, particularly in Delaware. Objective To determine if medical marijuana certification helps patients in Delaware with chronic pain reduce their opiate use. Methods In this study, we examined individuals who were provided with legal; medical cannabis certifications in the state of Delaware between June 2018 and October 2019 and were concurrently being treated with opioid medications for chronic pain at a private pain management practice. Using a posthoc analysis, we conducted a retrospective cohort study on the individuals (n = 81) to determine if there was a decrease in their opioid use following medical cannabis certification. Opioid use was measured in morphine milligram equivalent (MME) through the Delaware prescription monitoring program (PMP) database. Results Overall, the average change in prescribed opioid use was found to be -12.3 morphine milligram equivalent (MME) units when including all individuals (p < 0.00001). Among the included individuals with baseline opioid use, medical cannabis certification was associated with a 31.3% average decrease in opioid use (n = 63). When examining subgroups based upon pain location, individuals with neck pain displayed a 41.5% average decrease in MME (n = 27), while individuals with low back pain were observed to have a 29.4% decrease in opioid use (n = 58). Similarly, individuals with knee pain (n = 14) reduced their opioid use by 32.6%. Conclusion The results display an association between medical cannabis certification and a decrease in opiate use among the study group individuals. This study suggests that medical cannabis use may help individuals to reduce their opiate requirements along with physician intervention. More research is needed to validate these findings with appropriate controls and verification of cannabis use.
阿片类药物在全球范围内普遍用于治疗慢性疼痛。虽然这些药物在减轻疼痛方面相当有效，但它们会导致阿片类药物依赖并引发进一步的药物成瘾。长期使用阿片类药物对当前肆虐美国的“阿片类药物流行”起到了显著的推动作用，导致阿片类药物过量使用和意外死亡，尤其是在特拉华州。
确定医用大麻认证是否有助于特拉华州患有慢性疼痛的患者减少阿片类药物的使用。
在本研究中，我们调查了2018年6月至2019年10月期间在特拉华州获得合法医用大麻认证且同时在一家私人疼痛管理诊所接受阿片类药物治疗慢性疼痛的个体。通过事后分析，我们对这些个体（n = 81）进行了回顾性队列研究，以确定医用大麻认证后他们的阿片类药物使用量是否减少。通过特拉华州处方监测计划（PMP）数据库以吗啡毫克当量（MME）来衡量阿片类药物的使用量。
总体而言，当纳入所有个体时，发现处方阿片类药物使用量的平均变化为-12.3吗啡毫克当量（MME）单位（p < 0.00001）。在纳入的有基线阿片类药物使用情况的个体中，医用大麻认证与阿片类药物使用量平均减少31.3%相关（n = 63）。在根据疼痛部位检查亚组时，颈部疼痛的个体MME平均减少41.5%（n = 27），而观察到下背部疼痛的个体阿片类药物使用量减少29.4%（n = 58）。同样，膝盖疼痛的个体（n = 14）阿片类药物使用量减少了32.6%。
结果显示医用大麻认证与研究组个体中阿片类药物使用量减少之间存在关联。本研究表明，医用大麻的使用可能有助于个体在医生干预下减少对阿片类药物的需求。需要更多研究通过适当的对照和对大麻使用的验证来证实这些发现。
